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An advanced look at surgical performance under Medicare's hospital-inpatient value-based purchasing program: who is winning and who is losing?
J Am Coll Surg. 2014 Jan; 218(1):1-7.JA

Abstract

BACKGROUND

The Centers for Medicare and Medicaid Services (CMS) is beginning to shift from paying providers based on volume to more explicitly rewarding quality of care. The hospital value-based purchasing (VBP) program is the first in a series of mandatory programs to financially reward and penalize US hospitals based on quality measure performance. Our objective was to identify the characteristics of hospitals that perform well (and those that perform poorly) on the surgical measures in CMS' hospital VBP program.

STUDY DESIGN

Using 2008 to 2010 performance data from CMS' Hospital Compare website and the 2009 American Hospital Association annual survey, we examined surgical measure performance for all acute care general hospitals in the US. Outcomes were determined by a composite surgical performance score indicating the percentage of eligible surgical performance points that a hospital received.

RESULTS

There were 3,030 hospitals included in our study. Composite surgical performance scores were 15.6% lower at public hospitals than at for-profit hospitals (p < 0.01). Additionally, there were significant differences in the routes by which hospitals achieved points, with smaller hospitals, for-profit hospitals, Magnet hospitals, and NSQIP hospitals all more likely to obtain points via the achievement route.

CONCLUSIONS

The results of our study indicate that public hospitals perform worse on the surgical measures in the hospital VBP program. This study raises important questions about the impact that this new, mandatory program will have on public hospitals, which serve an important safety-net role and appear to be disadvantaged in the hospital VBP program. This issue should continue to be investigated as these mandatory quality programs are updated in future years.

Authors+Show Affiliations

Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL. Electronic address: jim.dupree@gmail.com.Center for Healthcare Studies, Northwestern University, Feinberg School of Medicine, Chicago, IL.Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Healthcare Studies, Northwestern University, Feinberg School of Medicine, Chicago, IL.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

24280448

Citation

Dupree, James M., et al. "An Advanced Look at Surgical Performance Under Medicare's Hospital-inpatient Value-based Purchasing Program: Who Is Winning and Who Is Losing?" Journal of the American College of Surgeons, vol. 218, no. 1, 2014, pp. 1-7.
Dupree JM, Neimeyer J, McHugh M. An advanced look at surgical performance under Medicare's hospital-inpatient value-based purchasing program: who is winning and who is losing? J Am Coll Surg. 2014;218(1):1-7.
Dupree, J. M., Neimeyer, J., & McHugh, M. (2014). An advanced look at surgical performance under Medicare's hospital-inpatient value-based purchasing program: who is winning and who is losing? Journal of the American College of Surgeons, 218(1), 1-7. https://doi.org/10.1016/j.jamcollsurg.2013.09.017
Dupree JM, Neimeyer J, McHugh M. An Advanced Look at Surgical Performance Under Medicare's Hospital-inpatient Value-based Purchasing Program: Who Is Winning and Who Is Losing. J Am Coll Surg. 2014;218(1):1-7. PubMed PMID: 24280448.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An advanced look at surgical performance under Medicare's hospital-inpatient value-based purchasing program: who is winning and who is losing? AU - Dupree,James M, AU - Neimeyer,Jennifer, AU - McHugh,Megan, Y1 - 2013/10/01/ PY - 2013/07/22/received PY - 2013/09/05/revised PY - 2013/09/05/accepted PY - 2013/11/28/entrez PY - 2013/11/28/pubmed PY - 2014/2/22/medline SP - 1 EP - 7 JF - Journal of the American College of Surgeons JO - J. Am. Coll. Surg. VL - 218 IS - 1 N2 - BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) is beginning to shift from paying providers based on volume to more explicitly rewarding quality of care. The hospital value-based purchasing (VBP) program is the first in a series of mandatory programs to financially reward and penalize US hospitals based on quality measure performance. Our objective was to identify the characteristics of hospitals that perform well (and those that perform poorly) on the surgical measures in CMS' hospital VBP program. STUDY DESIGN: Using 2008 to 2010 performance data from CMS' Hospital Compare website and the 2009 American Hospital Association annual survey, we examined surgical measure performance for all acute care general hospitals in the US. Outcomes were determined by a composite surgical performance score indicating the percentage of eligible surgical performance points that a hospital received. RESULTS: There were 3,030 hospitals included in our study. Composite surgical performance scores were 15.6% lower at public hospitals than at for-profit hospitals (p < 0.01). Additionally, there were significant differences in the routes by which hospitals achieved points, with smaller hospitals, for-profit hospitals, Magnet hospitals, and NSQIP hospitals all more likely to obtain points via the achievement route. CONCLUSIONS: The results of our study indicate that public hospitals perform worse on the surgical measures in the hospital VBP program. This study raises important questions about the impact that this new, mandatory program will have on public hospitals, which serve an important safety-net role and appear to be disadvantaged in the hospital VBP program. This issue should continue to be investigated as these mandatory quality programs are updated in future years. SN - 1879-1190 UR - https://www.unboundmedicine.com/medline/citation/24280448/An_advanced_look_at_surgical_performance_under_Medicare's_hospital_inpatient_value_based_purchasing_program:_who_is_winning_and_who_is_losing L2 - https://linkinghub.elsevier.com/retrieve/pii/S1072-7515(13)01110-1 DB - PRIME DP - Unbound Medicine ER -