The Centers for Medicare & Medicaid Services (CMS) released updates and changes to its Hospital Value-Based Purchasing (VBP) Program.
Due to the ongoing COVID-19 public health emergency (PHE), “hospitals could provide care to their patients that meets underlying clinical standards but results in worse measured performance, prompting lower incentive payments in the Hospital VBP Program,” CMS stated. “It is not our intention to penalize hospitals based on measure scores that we believe are distorted by the COVID-19 PHE and not reflective of the quality of care that the measures in the Hospital VBP Program were designed to assess.”
In response, the CMS has chosen to suppress certain measures for 2022, including:
- Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey;
- Medicare Spending Per Beneficiary (MSPB) measure;
- Five Healthcare-Associated Infection (HAI) measures.
CMS will calculate measure rates for all measures, but they will only evaluate achievement and improvement scores for those measures not suppressed. CMS will quantify domain scores for Clinical Outcomes, but Total Performance Scores (TPS) for hospitals will not be enumerated.
According to CMS, “Each hospital’s base-operating Diagnosis Related Group (DRG) payment amount will be reduced by 2%, as required under the Social Security Act. Since no hospital will receive a TPS for FY 2022, each hospital will be assigned a value-based incentive payment percentage that results in a value-based incentive payment amount that matches the 2% reduction to the base operating DRG payment amount. The net result of these payment adjustments will be neutral for all hospitals. That is, a hospital’s base operating DRG payment amount would remain unchanged for FY 2022.”
Because of the ongoing PHE, CMS believes hospital performance data are distorted and therefore “not reflective of the quality of care that the measures in the Hospital VBP Program were designed to assess.” Just as certain measures are suppressed, so are three of the four domains for 2022: Person and Community Engagement; Safety; and Efficiency and Cost Reduction. According to the updates:
- The Clinical Outcomes Domain is comprised of five mortality measures and one surgical complication measure that are weighted together for 25% of the TPS.
- The Person and Community Engagement Domain is comprised of eight dimensions of the HCAHPS and will be suppressed for FY 2022.
- The Safety Domain is comprised of five HAI measures and will be suppressed for FY 2022.
- The Efficiency and Cost Reduction Domain is comprised of one Medicare spending measure and will be suppressed for FY 2022.
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