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Changes in Hospital Quality Associated with Hospital Value-Based Purchasing.

Andrew M Ryan1, Sam Krinsky1, Kristin A Maurer1

  • 1From the Department of Health Management and Policy, University of Michigan School of Public Health (A.M.R., S.K., K.A.M.), and the Department of Surgery, University of Michigan Medical School (J.B.D.) - both in Ann Arbor.

The New England Journal of Medicine
|June 15, 2017
PubMed
Summary

The Hospital Value-Based Purchasing (HVBP) program did not significantly improve clinical processes or patient experience in hospitals. While it did not reduce mortality for heart attack or heart failure patients, HVBP was linked to a reduction in pneumonia patient mortality.

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Area of Science:

  • Health Services Research
  • Healthcare Quality Improvement
  • Health Economics

Background:

  • The Hospital Value-Based Purchasing (HVBP) program, initiated in fiscal year 2013, adjusts Medicare reimbursements for acute care hospitals based on quality performance.
  • This program aimed to incentivize improvements in healthcare quality by linking financial incentives to performance metrics.

Purpose of the Study:

  • To evaluate the impact of the HVBP program on healthcare quality in acute care hospitals compared to control hospitals (Critical Access Hospitals).
  • To assess changes in clinical process measures, patient experience, and 30-day risk-standardized mortality rates following HVBP implementation.

Main Methods:

  • A quasi-experimental design comparing acute care hospitals exposed to HVBP with non-exposed Critical Access Hospitals.
  • Quality was measured using composite scores for clinical process and patient experience, and 30-day risk-standardized mortality for acute myocardial infarction, heart failure, and pneumonia.
  • Statistical analysis involved difference-in-differences estimation on matched samples over the first four years of the HVBP program.

Main Results:

  • No significant improvements were observed in clinical process or patient experience measures between HVBP-exposed and control hospitals.
  • The HVBP program was not associated with significant reductions in mortality for acute myocardial infarction or heart failure.
  • A significant reduction in 30-day risk-standardized mortality was observed for pneumonia patients in HVBP-exposed hospitals.

Conclusions:

  • The HVBP program did not demonstrate significant improvements in overall hospital quality measures, including clinical processes and patient experience.
  • While not impacting mortality for all conditions studied, HVBP showed a positive effect on reducing pneumonia-related mortality.
  • Further research may be needed to understand the nuances of value-based purchasing and its heterogeneous effects on different quality outcomes and patient populations.