10 Ways CMS's Value-Based Purchasing Proposal is Flawed

Cheryl Clark, March 10, 2011

"Everything You Know Is Wrong!" the title of an album by the comic troupe Firesign Theatre, came to mind this week as I reviewed the state of chaos that stymies progress in healthcare quality.

The Senate may not confirm Don Berwick as administrator for the Centers for Medicare and Medicaid Services. Anticipated CMS regulations governing accountable care organizations are held up, reportedly because the Federal Trade Commission sees a lethal anti-trust flaw. And the entire Affordable Care Act has been declared unconstitutional by a Florida court, although the Obama administration is asking for a speedy decision to its appeal.

If all these obstructions aren't enough to befuddle providers, I wandered into the comments section of CMS' regulations.gov yesterday to find nearly 300 postings on the agency's proposed regulations governing Hospital Inpatient Value Based Purchasing (VBP) penalties (the deadline for filing comments was 11:59 p.m. Tuesday).  

I took a sample of 32 comments and found vehement objections to various aspects of the formula that directs how hospitals will soon be paid. I wondered, how did the process get this far along with so many major players still finding so much to oppose?

Perhaps the most detailed dissection of the regulations' perceived unfairness came from American Hospital Association executive vice president Rick Pollack, who wrote a nearly 10,000-word letter with strong protests on nearly every one of its 20 pages.

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