Winners (and Losers) in the Quality Race for Cash

Cheryl Clark, October 28, 2010

For a good part of Tuesday, health providers across the country lined up in a federal phone cue. 

They'd been invited to a special forum to express their deep concerns about a major piece of health reform rules yet to be written; the ones that will take a huge chunk of their money.

Starting in just 24 months, hospitals falling under the Inpatient Prospective Payment System will automatically see their reimbursements drop by 1% for FY 2013, 1.25% for FY 2014, 1.5% for FY 2015, 1.75% for FY 2016 and 2% for FY 2017 and beyond—it says so quite plainly in section 3001 of the Affordable Care Act, Hospital Value-Based Purchasing Program or VBPP.

Some hospitals will be winners and earn some or all that money back, but that’s only if their scores on selected outcome measures — initially acute myocardial infarction, heart failure, pneumonia, surgeries, healthcare associated infections and patient satisfaction—are better than their peers. 

Other hospitals which can't move as fast will see their reimbursements shrink for the year.  By decree, this must be a zero sum game, for there are no extra dollars in the award.

During the call, hospital representatives sounded like they are nervously measuring their strides as they wait for the starting bell to go off in just 24 months. Will the rules, which have yet to be made public, be fair?

Centers for Medicare and Medicaid Services' chief medical officer, Barry Straube, MD, launched the phone conference forum by asking for help in writing the regulations. The intended goal: to accomplish what his new boss, Don Berwick, describes as the "Triple Aim: Better care for individuals, better health for populations, and lower costs in healthcare through improvement."  That's so CMS can be transformed "from a passive payer of claims to an active purchaser of care." 


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