The Affordable Care Act (ACA) created a national quality strategy for the triple aim of better care, healthy people and communities, and affordable care.1 It also initiated a significant transition from fee-for-service to value-based care.
The ACA established 3 important INITIATIVES to improve care:
- Value-Based Purchasing Program (VBP)
- Readmissions Reduction Program
- Hospital-Acquired Conditions (HAC) Reduction Program
These initiatives require the Centers for Medicare and Medicaid Services (CMS) to reward and/or penalize hospitals financially for performance, readmissions and safety issues as outlined below.
VALUE-BASED PURCHASING PROGRAM2 (VBP)is a performance-based payment strategy that links financial incentives to a provider’s performance on a defined set of measure domains (categories) including:
NOTE: In fiscal year (FY) 2019, the CAUTI and CLABSI measures in the safety domain will expand beyond the ICU to “select wards” (ie, Medical/Surgical Units, etc.)
READMISSIONS REDUCTION PROGRAM3 is a three-year rolling process of reporting all-cause readmissions within 30 days of discharge for (FY 2017):
HOSPITAL-ACQUIRED CONDITIONS (HAC) REDUCTION PROGRAM4 allows CMS to reduce payments for specific safety issues and hospital-acquired infections:
NONCOMPLIANCE RESULTS IN FINANCIAL PENALTIES TO YOUR HOSPITAL
In fact, some measures are penalized in multiple programs2,4:
In FY 2017:
- VALUE-BASED PURCHASING PROGRAM (VBP): 1343 hospitals were penalized and over 1600 hospitals received bonuses from a bonus pool of about $1.8 BILLION6
- READMISSIONS REDUCTION PROGRAM:2597 hospitals were expected to be fined $528 MILLION7
- HOSPITAL-ACQUIRED CONDITIONS (HAC) REDUCTION PROGRAM: CMS estimated that overall payments to 769 hospitalswould drop by roughly $430 MILLION8
With nearly $3 BILLION at stake, it is imperative for both healthcare providers and healthcare companies to consider methods of reducing HACs and readmissions.
Because Eloquest Healthcare cares about the care you deliver, we are dedicated to providing products that make it easier to improve patient health and that are backed by evidence that proves they will lead to improved outcomes.
Our subsequent postings will review and explore many of the World Health Organization and Centers for Disease Control recommendations that can help you minimize risk at your hospital as well as your hospital’s risk of penalty in accordance with the Affordable Care Act.
Come back for our next installment, “The ACA’s Value-Based Purchasing Program (VBP) and You!”
Minimizing infection risk is an essential part of optimizing “The Triple Aim” of the Affordable Care Act. Eloquest Healthcare is committed to providing solutions that can help you reduce risk of conditions like a CAUTI, CLABSI, or SSI.
- Berwick, DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Affairs 27, no.3(2008):759-769. Doi: 10.1377/hlthaff.27.3.759.
- Hospital Value-Based Purchasing. Department of Health and Human Services, Centers for Medicare & Medicaid Services. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf. Published April 18, 2016. Accessed January 16, 2017.
- Understanding the Hospital Readmissions Reduction Program. The Lake Superior Quality Innovation Network, Centers for Medicare & Medicaid Services Quality Improvement Organization Program. https://www.stratishealth.org/documents/Readmissions_Reduction_Fact_Sheet.pdf. Published November 2014. Accessed January 16, 2017.
- FY 2017 HACRP Key Dates Matrix. Hospital-Acquired Condition Reduction Program (HACRP). Centers for Medicare & Medicaid Services. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/HAC-Reduction-Program.html. Accessed January 16, 2017.
- Hospital-Acquried Condition (HAC) Reduction Program. CMS.gov. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HAC/Hospital-Acquired-Conditions.html. Accessed April 11, 2017.
- Whitman E. Fewer Hospitals Earn Medicare Bonuses Under Value-Based Purchasing. Modern Healthcare. http://www.modernhealthcare.com/article/20161101/NEWS/161109986. Published November 1, 2016. Accessed January 16, 2017.
- Rau J. Medicare’s Readmission Penalties Hit New High. http://khn.org/news/more-than-half-of-hospitals-to-be-penalized-for-excess-readmissions/. Published August 2, 2016. Accessed January 16, 2017.
- Haefner M. 769 hospitals see medicare payments cut over high HAC rates: 7 things to know. http://www.beckershospitalreview.com/quality/769-hospitals-see-medicare-payments-cut-over-high-hac-rates-7-things-to-know.html. Published December 22, 2016. Accessed January 16, 2017.