Hospital Performance in the First 6 Years of Medicare's Value-Based Purchasing Program.

Area of Science:

• Health Services Research
• Healthcare Policy
• Hospital Management

Background:

• The Medicare value-based purchasing (VBP) program, established in 2013, aims to enhance hospital quality through financial incentives.
• Prior studies focused on characteristics of penalized hospitals, leaving a gap in understanding hospitals that improve or consistently excel in VBP performance.

Purpose of the Study:

• To identify distinct performance trajectories within the Medicare VBP program.
• To examine organizational and community factors associated with improved VBP performance.
• To explore potential drivers of performance changes in the VBP program.

Main Methods:

• Analysis of hospital performance data across multiple years of the Medicare VBP program.
• Categorization of hospitals into performance trajectories: improvement, decline, consistent good/poor, and mixed.
• Statistical examination of organizational, community, and participation characteristics linked to performance trajectories.

Main Results:

• Five distinct hospital performance trajectories were identified.
• 24% of hospitals demonstrated improvement in VBP performance, while 14% consistently earned bonuses.
• Organizational and community characteristics in 2013 were linked to higher odds of improvement; few manager-controlled variables showed association, though ACO participation was noted.

Conclusions:

• Hospital performance in the Medicare VBP program exhibits diverse trajectories.
• Organizational and community factors, rather than solely manager-controlled variables, appear influential in VBP performance improvement.
• Modifications to VBP program metrics may have positively impacted some hospitals' scores.