Evaluating the robustness of the CMS Hospital Value-Based Purchasing measurement system

Area of Science:

• Health Services Research
• Healthcare Policy
• Hospital Management

Background:

• The Hospital Value-Based Purchasing Program (HVBP) incentivizes hospitals through Medicare payments.
• This program uses rewards and penalties to influence hospital performance.

Purpose of the Study:

• To analyze variations in Total Performance Scores (TPS) and domain scores within the HVBP program from 2014-2018.
• To assess hospital movement in TPS rankings over time.

Main Methods:

• Descriptive statistics were used to evaluate TPS and domain score distributions.
• Transitional probabilities analyzed hospital ranking changes in the top and bottom 5% of TPS.

Main Results:

• Mean TPS scores decreased from 2014 to 2018. Clinical outcome and process of care domains showed improvement.
• Hospitals in the bottom 5% demonstrated consistent upward movement in rankings.
• A majority of top-ranked hospitals maintained their high performance status.

Conclusions:

• The HVBP program's effectiveness in demonstrating sustained improvement and fair ranking requires evaluation.
• Potential redesign of the HVBP incentive structure and ranking methodology is suggested.