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CMS Plan Would Tie Efficiency Scores to Hospital Payments

Cheryl Clark, for HealthLeaders Media, May 2, 2012

Other hospitals on the highest end of cost include Harmon Medical and Rehabilitation Hospital, Las Vegas, NV, 1.59; and Cancer Treatment Centers of America at Southwestern Regional Medical Center in Tulsa, OK, 1.54.

The database includes Medicare claims for care provided between May 15, 2010 and Feb. 14, 2011.

Linking efficiency scores to incentive payments
Under value-based purchasing rules, hospitals will have withheld from their payments 1.5% of their Medicare DRG total by 2015. That money will enter a pool to be redistributed as incentive payments to top performing hospitals.

Patient experience as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems stays at 30%, outcome measures including 30-day mortality are weighted at 30%, and clinical process of care measures weighted at 20%.

So the efficiency score, weighted at the remaining 20%, could mean as much as $200,000 for every $1 million of incentive payments in the pool.

For small hospitals, that could be a lot of cash.

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