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Hospital Value-Based Purchasing Fails to Improve Outcomes

July 14, 2017

Over the first 4 years of the program, Hospital Value-Based Purchasing (HVBP) did not cause any meaningful improvements in clinical process or patient experience at participating acute care hospitals compared with control hospitals. Mortality rates for 2 out of 3 conditions were not significantly affected, either, with researchers attributing statistical “improvements” for the third condition to a mortality increase at control hospitals.

Researchers published their findings in The New England Journal of Medicine (N Eng J Med. 2017;376(24):2358-2366).

“Our evaluation suggests that HVBP, which introduced small quality performance-based adjustments in Medicare payments, has resulted in little tangible benefit over its first 4 years,” wrote researchers from the University of Michigan.

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The study compared quality performance at acute care hospitals exposed to HVBP with matched critical access hospitals not exposed to the program.

“Our estimates of the effect of HVBP on clinical process, patient experience, and mortality were small, not consistent with one another in the direction of the association, and generally nonsignificant,” researchers reported.

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While the study found no meaningful reductions in mortality for patients admitted for acute myocardial infarction and heart failure, it did identify a significant reduction in mortality among patients admitted for pneumonia. However, researchers explained the drop actually reflected an increase in pneumonia mortality at matched critical access hospitals. Clinical process indicators related to pneumonia at acute care hospitals did not improve, they added, making it “unlikely that HVBP would have reduced mortality among the patients who were admitted for pneumonia, since such reductions are harder to achieve than improvements in clinical process.”

The results of the study are consistent with previous studies that found HVBP did not improve clinical process or patient experience measures during the first 9 months and the first 30 months of the program. Yet the findings do contrast with those concerning the Medicare Hospital Readmissions Reduction Program (HRRP), which appears to have improved readmission rates. The researchers speculated that the complex, wide-ranging, and evolving set-up of HVBP may be less effective than the simpler, more narrowly targeted, and penalty-focused HRRP.

“It is possible that alternative incentive designs — including those with simpler criteria for performance and larger financial incentives — might have led to greater improvement among hospitals,” researchers concluded. “It may be useful for the Centers for Medicare and Medicaid Services to continue to experiment with other value-based payment models, including the HRRP, accountable care organization programs, and bundled payment programs, in an effort to improve the value of hospital spending.”

Jolynn Tumolo

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