Valuing improvement in value-based purchasing.

Area of Science:

• Health Services Research
• Health Economics
• Healthcare Policy

Background:

• Medicare's Value-Based Purchasing (VBP) program rewards hospitals for achievement and improvement.
• Current VBP improvement metrics disadvantage hospitals with lower initial performance, often located in socioeconomically disadvantaged areas.
• This disparity risks financial penalties for vulnerable institutions under the proposed VBP system.

Purpose of the Study:

• To develop and evaluate an alternative VBP improvement scoring system.
• To assess the impact of the proposed VBP scoring on hospitals across various socioeconomic dimensions.
• To promote a more equitable distribution of VBP scores.

Main Methods:

• Developed an alternative improvement scale for hospital VBP scoring.
• Applied both Medicare's proposed and the alternative scale to national hospital performance data (2005-2008).
• Analyzed Medicare process measures for acute myocardial infarction (AMI) and heart failure (HF), comparing scores across socioeconomic disadvantage metrics.

Main Results:

• Medicare's proposed VBP scoring favored more socioeconomically advantaged hospitals for AMI and HF.
• The alternative VBP formula significantly reduced score disparities between advantaged and disadvantaged hospitals.
• Under the alternative, advantaged hospitals still scored higher, but the gap narrowed considerably.

Conclusions:

• An alternative VBP formula based on "equal credit for equal improvement" promotes score equity.
• This revised approach could enable both socioeconomically advantaged and disadvantaged hospitals to achieve success in VBP.
• Equitable VBP scoring is crucial for fair reimbursement and hospital viability.