A new partnership of public and private entities, Partnership for Patients, has a mission to improve the quality of health care and lower the cost. That mission became the rallying cry of healthcare reform with the signing of the Affordable Care Act.
An initiative from the Act, the Hospital Value-Based Purchasing program, changes the way Medicare pays health care providers to one of performance-based payments. Recently, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for the program.
Provisions of the Program
The program starts in Fiscal Year 2013 and the first reporting period will be July 1, 2011 through March 31, 2012 for FY2013 payments. The amount of the payments depends on how well hospitals perform on certain quality measures.
The final rule specifies 17 quality measures for the clinical process of care related to heart attacks, heart failure, pneumonia, healthcare-associated infections, and surgeries. It also includes eight measures of the patient experience of care, obtained from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Five of these 25 reportable measures are anesthesia-related. These measures are:
- Pre-Surgical Antibiotic Prophylaxis
- Cardiac Glycemic Control
- Beta Blockade
- Venous Thromboembolism Prophylaxis
- Pain Management
Anesthesiologists and CRNAs also have an indirect – but no less significant – impact on many more quality indicators because anesthesia is a part of patient care in nearly every department of the typical hospital.
CMS says the basis for scoring is the hospital's performance on each measure, relative to other hospitals, and the level of improvement on each measure over time. Plans include adding measures that focus on improved patient outcomes and the prevention of hospital-acquired conditions.
CMS will continue to issue payments based on the Medicare Inpatient Prospective Payment System to hospitals delivering care to Medicare patients. However, a reduction of one percent of those payments starts in fiscal year 2013 to create the funding for the new value-based payments. CMS estimates the amount of funding at $850 million.