How Total Performance Scores of Medicare Value-Based Purchasing Program Hospitals Change Over Time

Area of Science:

• Health Services Research
• Healthcare Policy
• Hospital Management

Background:

• The Medicare Value-Based Purchasing (VBP) program incentivizes hospitals financially based on performance.
• Understanding performance score variations across different hospital types is crucial for equitable program implementation.

Purpose of the Study:

• To investigate variations in Total Performance Scores (TPS) among different hospital types within the Medicare VBP program.
• To identify factors contributing to score differences and assess the impact of scoring system changes.

Main Methods:

• Analysis of Medicare VBP reports (2015-2017) and CMS Impact File data for 3,005 hospitals.
• Categorization of hospitals into physician-owned surgical hospitals (POSH), accountable care organizations (ACO), Kaiser, Vizient, and General hospitals.
• Longitudinal linear mixed-effects models to compare TPS and secondary outcome measures across hospital types.

Main Results:

• Total Performance Scores (TPS) declined across all hospital types.
• Physician-owned surgical hospitals (POSH) exhibited the highest TPS, followed by Kaiser, ACO, General, and Vizient hospitals.
• Significant differences in hospital characteristics (size, geography, case-mix, Medicare utilization, payment adjustments) were observed between types.

Conclusions:

• Physician-owned surgical hospitals and Kaiser hospitals demonstrated higher TPS compared to General hospitals, while Vizient hospitals had lower scores.
• Weighting reallocation and individual domain scores influenced TPS, suggesting inherent biases in the scoring system.