An Assessment of Medicare’s Hospital Quality Initiatives: Value-Base Purchasing, HAC Reduction Program, and HRRP

KNG Health was commissioned to critically assess aspects of Medicare’s Hospital Value Based Purchasing (VBP), Hospital-Acquired Condition Reduction Program (HAC-RP), and Hospital Readmissions Reduction Program (HRRP).  The study was completed through qualitative and quantitative analyses, including: (1) literature review on each of the quality programs to identify issues raised by quality experts and policy analysts as well as existing empirical research on the effects of the programs; (2) descriptive analyses to examine how quality as measured in each and across all the initiative varies by hospital characteristics.  Based on this initial work, we investigated possible bias in the HAC-RP by simulating hospitals’ likelihood of being in the worst-performing quartile for 8 patient safety measures, assuming identical expected complication rates across hospitals. Simulated likelihood of being a poor performer varied with hospital size. This relationship depended on the measure’s complication rate.   We concluded that the Centers for Medicare & Medicaid Services could address potential bias in the HAC-RP by stratifying by hospital size or using a broader “all-harm” measure.  The study findings were published in the American Journal of Medical Quality.

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Services : Payment Policy & Delivery System Innovation, Quality & Performance Measurement Expertise: , ,