In Part 1 of our four-part series on the value-based purchasing (VBP) program, we looked at the history that led to the program and followed that with an examination of the final rule issued by the Centers for Medicare and Medicaid Services (CMS).
Part 3 reviews the impact anesthesia services has on the VBP program.
Anesthesia Plays Key Role
With VBP focusing on clinical Process of Care measures and the patient’s experience, the operating room (OR) takes center stage.
The anesthesia provider is the one constant in the OR environment and plays a key role in the assessment and management of the patient’s care. Therefore, the impact of anesthesia services is significant to a hospital’s compliance with the VBP program.
Anesthesia Quality Measures
As noted in Part 2 of our series, the 12 Process of Care measures of the VBP program carry a 70 percent weight factor, while the HCAHPS survey used for measuring the patient’s experience has a 30 percent weight.
Anesthesia services has a direct impact on four of the twelve Process of Care measures:
- Prophylactic antibiotics
- Cardiac surgery post-operative glycemic control
- Beta blockade during perioperative period
- Venous thromboembolism (VTE) prophylaxis within perioperative period
Anesthesia services has a direct or indirect relation with all eight areas of the HCAHPS survey, which includes:
- Communication with nurses
- Communication with doctors
- Responsiveness of hospital staff (OB response time)
- Pain management
- Communication about medicines
- Cleanliness and quietness of hospital environment
- Discharge information
- Overall rating of hospital
Scoring System
The VBP program for Fiscal Year 2013 set performance targets at the top 10 percent with 100 percent compliance with the measures.
The program established threshold (or median) measurements and a benchmark for each measure. It sets a high bar for anesthesia services.
- Prophylactic antibiotics – Threshold: 97 percent/Benchmark: 99.98 percent
- Cardiac surgery post-operative glycemic control – Threshold: 94 percent/Benchmark: 99.63 percent
- Beta blockade during perioperative period – Threshold: 93 percent/Benchmark: 99.85 percent
- VTE prophylaxis within perioperative period – Threshold: 94 percent/Benchmark: 100 percent
- HCAHPS Survey – Threshold: 68.75 percent/Benchmark: 77.90 percent
To receive points, hospitals must exceed the threshold.
Complying with VBP Program
Clearly, the hospital’s quality improvement program must have the infrastructure and controls in place as business models shift to an outcomes-based measurement. The quality measures will have an increasing impact on reimbursement so hospitals that prepare and adapt to the changing healthcare environment will ultimately succeed.
In the final installment of our four-part series, we review how anesthesia services can assist a hospital with its compliance efforts in preparing for the VBP program.