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Are Safety Net Hospitals Reimbursed Fairly Under Hospital Value-Based Purchasing-Prioritizing Satisfaction Over

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    Adjusting the Hospital Value-Based Purchasing Program (HVBP) weights can improve reimbursement for safety net hospitals (SNH). Prioritizing clinical outcomes and safety benefits SNH financially.

    Keywords:
    HCAHPSHVBPhospital consumer assessment of healthcare providers and systemshospital value-based purchasingpatient satisfactionsafety net hospitals

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    Area of Science:

    • Health Services Research
    • Healthcare Policy
    • Hospital Administration

    Background:

    • The Centers for Medicare and Medicaid Services (CMS) uses the Hospital Value-Based Purchasing Program (HVBP) for hospital reimbursement.
    • Current HVBP weighting equally distributes value across clinical outcomes, safety, efficiency, and patient satisfaction.
    • Safety net hospitals (SNH) may face reimbursement inequities under the current HVBP structure.

    Purpose of the Study:

    • To investigate if modifying HVBP weights can address reimbursement disparities for SNH.
    • To analyze the impact of adjusted HVBP scoring on SNH financial performance.

    Main Methods:

    • Analysis of 2,731 non-federal hospitals using CMS payment data from 2020.
    • Categorization of hospitals into SNH and non-SNH based on Disproportionate Share Hospital (DSH) status.
    • Comparison of HVBP scores between SNH and non-SNH, accounting for COVID-19 impacts.

    Main Results:

    • SNH demonstrated lower scores in patient and community engagement domains compared to non-SNH (p<0.001).
    • This resulted in significantly lower HVBP Total Performance Scores (TPS) and adjustment factors for SNH (p<0.001).
    • Reallocating TPS weights to prioritize clinical outcomes and safety (35%) improved SNH performance.

    Conclusions:

    • Shifting HVBP weight towards clinical outcomes and safety can alleviate financial burdens on SNH.
    • Policy adjustments in value-based purchasing can promote equitable reimbursement for vulnerable hospital populations.