November 12, 2020
Medicare value-based payment reforms have had mixed effects on the quality of, and spending for, cardiovascular care, according to a review article published in the Methodist DeBakey Cardiovascular Journal.
“Most people would philosophically agree that we should be paying for quality rather than quantity in health care,” wrote researchers from the University of Michigan Medical School. “However, while the concept of incentivizing high-quality care is simple, the design and implementation of policies to achieve that goal is not.”
The review paper highlighted nationwide Medicare value-based payment programs affecting cardiovascular care, such as the Hospital Readmissions Reduction Program, in which hospitals with higher-than-expected readmission rates for select conditions receive reduced reimbursement; Hospital Value-Based Purchasing, in which payments are tied to performance on quality metrics; and Bundled Payment for Care Improvement, in which hospitals receive a fixed amount for care delivered after a specific medical event.
The Hospital Readmissions Reduction Program resulted in significant reductions in readmissions and spending, according to the review. For heart failure, risk-adjusted readmission rates dropped from 24.8% to 20.1% between 2008 and 2016. During the same period, risk-adjusted readmission rates for acute myocardial infarction decreased from 20% to 15.5%. Such improvements in readmissions have saved Medicare billions of dollars, researchers reported.
Bundled Payment for Care Improvement, however, has failed to result in significant improvements in cardiovascular care and spending, studies have suggested. Researchers pointed out that cardiovascular bundled payment models are currently voluntary, making evaluations of the models challenging.
“As value-based payment reforms continue to evolve and expand,” they wrote, “we expect changes to how clinical and social risks are considered and modifications to policy designs to ensure that high-value care is appropriately incentivized.”
Sukul D, Eagle KA. Value-Based Payment Reforms in Cardiovascular Care: Progress to Date and Next Steps. Methodist Debakey Cardiovasc J. 2020;16(3):232-240. doi:10.14797/mdcj-16-3-232