Early Performance of Hospital Value-based Purchasing Program in Medicare: A Systematic Review

Area of Science:

• Health Services Research
• Health Policy Analysis
• Quality Improvement in Healthcare

Background:

• The Affordable Care Act expanded fee-for-value programs like the Hospital Value-based Purchasing (HVBP) program.
• Existing evidence on the HVBP program's effectiveness is mixed.
• A systematic review is needed to assess the HVBP program's impact and inform improvements.

Purpose of the Study:

• To systematically review studies evaluating the HVBP program's impact on clinical processes, patient satisfaction, costs, and outcomes.
• To identify hospital characteristics associated with performance in the HVBP program.

Main Methods:

• A systematic literature search was conducted in MEDLINE/PubMed, Scopus, and ProQuest from January 2013 to July 2019.
• Studies were selected based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.
• 33 studies met the inclusion criteria for the review.

Main Results:

• Only 7 studies assessed the HVBP program's impact, reporting no significant effects on processes or patient outcomes.
• No studies evaluated the HVBP program's effect on healthcare costs.
• 28 studies examined hospital characteristics, indicating safety-net hospitals may perform worse on quality and cost measures.

Conclusions:

• The current HVBP program does not appear to yield meaningful improvements in care quality or patient outcomes.
• The program may disproportionately affect safety-net hospitals negatively.
• More robust adjustments are necessary for accurate hospital comparisons and program evaluation.