Safety net hospitals have improved patient quality and reduced care variation as a part of a hospital value-based purchasing program, according to an analysis released by the Premier healthcare alliance. Although hospitals serving a large percentage of disproportionate share patients performed below others at the outset of the Centers for Medicare & Medicaid Services (CMS), Premier Hospital Quality Incentive Demonstration (HQID) value-based purchasing project, differences in quality lessened after three years.
The HQID project is the basis for CMS’ proposal to Congress for a national value-based purchasing or pay-for-performance program. However, concerns have been expressed that the program would reward certain classes of hospitals over others. Premier’s research found that hospitals, regardless of size or location, can succeed in value-based purchasing. However, there are differences based on the patient-payer mix. In its report, Premier recommends that value-based purchasing policies should do the following to address these differences:
- Phase in the payment policy gradually to give hospitals time to adjust
- Provide incentives for both attainment and improvement
- Give hospitals that fall below the quality benchmarks technical assistance and resources to improve, giving priority to hospitals that provide care to the underserved, have limited resources and/or have disparities in care among patient populations
- Appropriately risk-adjust outcomes measures (such as mortality and readmissions) to account for socio-economic, environmental and existing patient conditions that are beyond the hospitals’ control
