He added that what seems clear from their data is that these hospitalized patients have longer lengths of stay. "They're more expensive to take care of because they have fewer social support systems at home."
Under value-based purchasing, all hospitals automatically will receive 1% less in reimbursement for discharges starting Jan. 1, 2013. They will have a chance to earn that back based on scores they receive during a performance period that began on July 1, 2011 and ends March 31, 2012. That period will be compared with a baseline period that began July 1, 2009, and ran through March 31, 2010.
Hospitals will be scored the first year based on a formula that includes patient experience as measured by HCAHPS scores (Hospital Consumer Assessment of Healthcare Providers and Systems survey) , and 12 clinical process of care measures, such as whether a heart attack patient received a percutaneous coronary intervention within 90 minutes arrival, or whether surgical patients received an appropriate prophylactic antibiotic.
In the following years, value-based purchasing rules will deduct from federal Medicare payments another quarter percent for each of four years until the decrease reaches a maximum of 2% in 2017.
Under the Affordable Care Act, the VBP formula is expected to add, in later years, a component that measures efficiency, or how much it costs to take care of a patient. "We suspect that it will become a key part of future payment changes," Jha said, which will further punish the poorest hospitals that have high costs and poor quality.