MHA's Executive Briefing

Some providers can't find insurers to partner with on risk-based payment

More medical practices are willing to take on financial risk under an alternative pay models, but they say they can't find insurance companies to partner up with. Nearly 60% of American Medical Group Association members say they are ready to embrace alternatives to fee-for-service payments within two years. More than 450 multispecialty medical groups and integrated delivery systems and 177,000 physicians are members of the group.

But while Medicare is eager to participate in new payment models, few other payers are, even though the Medicare Access and CHIP Reauthorization Act (MACRA) offers incentives for those signing up to receive performance bonuses. Read more from Modern Healthcare here.

AHA urges Congress to improve hospital quality, pay-for-performance programs

The American Hospital Association on Sept. 7 shared with the House Ways and Means Health Subcommittee suggestions for enhancing existing hospital quality reporting and pay-for-performance programs to more effectively drive improvement in outcomes and health. In a statement submitted for a hearing on the issue, AHA recommended streamlining Medicare quality reporting and payment program measures to focus on the highest priority quality issues; incorporating socioeconomic adjustment into the Hospital Readmissions Reduction Program; and reforming the Hospital-Acquired Conditions Reduction Program “to provide a fairer, more effective incentive to improve performance.”

AHA also recommended changes to pay-for-performance legislation for post-acute care providers (H.R. 3298) to achieve an appropriate balance between lower cost and better care. “Without a more balanced, budget-neutral approach that includes an assessment of quality, the PAC [value-based purchasing] program appears to function as a mechanism to cut provider payments in perpetuity, rather than primarily as a way to promote value,” AHA said.

Witnesses at the hearing included Elisabeth Wynn, senior vice president of health economics and finance for the Greater New York Hospital Association.

Value-Based Payment Is Spreading, But Models Need Refinement

Value-based payments by private health plans increased markedly over the past year, according to Catalyst for Payment Reform's 2014 national scorecard. Some 40 percent of payments by private plans to health care providers are now tied to “value,” meaning they are linked to better or less costly care, rather than the volume of services provided. In 2013, just 11 percent of such payments aimed to improve quality and efficiency.

Read more here.

When Pay for Performance Hits Hospital Employee Paychecks

A main tenet of the accountable care movement is tying physician and hospital reimbursement to their performance. For instance, in an accountable care organization, providers are often rewarded for meeting certain quality improvement and cost saving goals. Additionally, hospitals can be penalized for poor performance in the form of Medicare reimbursement cuts.

These changes are all to encourage healthcare providers to offer higher quality, more patient-centered care. This challenge often falls squarely on the shoulders of direct patient care workers, like physicians and nurses. However, the entire employee base at a hospital or health system can positively or negatively impact the level of patient care provided at the organization.

For those reasons, Jersey City (N.J) Medical Center started the unique practice of tying employee bonuses to the hospital's performance. 

Understanding the Drivers of the Patient Experience

A 2012 industry survey asked top hospital leaders (CEOs, COOs, and others) what was necessary to improve the patient experience. The top six recommendations included: new facilities, private rooms, food on demand, bedside-interactive computers, unrestricted visiting hours, and more quiet time so patients could rest.

There was one problem with them: They were not based on a systematic examination of what most patients really wanted. In other words, hospital executives wanted to focus on what they felt were important drivers of the patient experience but didn’t know for sure.

Read more from Harvard Business Review here.

Investing in Nurse Communication Pays Dividends in HCAHPS Scores

A recent report by Press Ganey identified communication with nurses as a "rising tide" patient experience measure — one that influences a host of other HCAHPS measures, including responsiveness of hospital staff, communication about medication and overall patient experience scores. Hospitals could potentially affect 15 percent of their Value-Based Purchasing incentive payments by focusing their improvement efforts on the nurse communication metric, according to Press Ganey's research findings.

Learn more here.

HCA going undercover to spot service flaws

The chief executive officer of an HCA-owned (HCA) hospital recently went undercover, wearing a two-day- old beard and a baseball cap to pose as a patient entering his hospital. His goal: spot service flaws and get them fixed.

Read more from Bloomberg here.

From Volume to Value, by 2020?

Suzanne Delbanco, executive director of Catalyst for Payment Reform, sits down with H&HN contributing editor Bob Kehoe to discuss the organization's vision for spreading value-based payment, and moving away from fee-for-service reimbursement, over the next decade.

Watch the video here.

Study: Payment penalties aren’t responsible for declining hospital infections

Hospital infection rates continue to fall, but Medicare payment penalties have not contributed to the result, according to a study in the Oct. 11 New England Journal of Medicine. “In this national evaluation of the effect of the 2008 [Centers for Medicare & Medicaid Services] policy to reduce additional payments for preventable hospital complications, we did not find any effect on rates of targeted healthcare-associated infections as measured with the use of clinical data,” the authors report.

The study found a strong downward trend for targeted infections well before the implementation or announcement of the CMS policy, with no measurable additional benefit of the policy. “As CMS continues to expand this policy to cover Medicaid through the Affordable Care Act, require public reporting of [National Healthcare Safety Network] data through the Hospital Compare website, and impose greater financial penalties on hospitals that perform poorly on those measures, careful evaluation is needed to determine when these programs work, when they have unintended consequences, and what might be done to improve patient outcomes,” the study concludes.

[ via AHA News Now ]

Board's Eye View: Preparing for Value-Based Purchasing

The Medicare value-based purchasing (VBP) program is an initiative described in the Affordable Care Act whose purpose is to provide a practical means to reduce costs to the nation’s healthcare system while improving quality of care. Hospitals that achieve the highest total performance scores (TPSs) under this program’s scoring methodology can earn incentive payments for performance excellence.

Read more from HFMA here.