Winners and Losers Under VBP

“If you don’t meet the standards, it will cost you money,” he says. “When you start looking five years out, you are going to lose up to 2% of your DRG reimbursement. That can mean millions.”

The CFO already knows this. The job now is to educate the clinical staff.

CFOs can drive home the lesson about the dollars lost and the impact that could have on operations. Granted, the finance team won’t be telling the clinical and quality partners what they need to do to improve the indicators. However, “you can certainly provide the data and financial modeling impact of the consequences of the scores where they are now, and what happens if they improve,” Nelson says.

Getting buy-in from the clinical staff hasn’t been a problem, says Thomas Newman, vice president of finance for UPMC St. Margaret, a 249-staffed-bed hospital in Pittsburgh. “Our clinical folks enjoy these challenges.” And again, it’s a matter of advancing existing quality improvement efforts. 

Hospitals need to capture, analyze, and report clinical and administrative data. A hospital may have the requisite smoking cessation program, and it may be highly successful, but if it fails to record what’s being done, then everything it accomplishes will be meaningless as far as VBP is concerned, Ladely explains. (Some hospitals still are not reporting any data, he notes.)

The accuracy of information is central to the entire process. The documentation in the medical records must reflect how the organization is performing, Bogen says.

Create dashboards that monitor the various VBP measures concurrently, he advises. Ideally, these should be developed within the EHR. Stay involved with the VBP-related issues your organization needs to confront at all levels. Process design, development, and improvement all are vital to ensuring better outcomes, Bogen says. Look for process variances as indicators of potential problems.