Transparency Two-Way Street for Value-Based Purchasing




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Transparency is the name of the game for health care’s future outcomes-based business model. No program demonstrates that better than the Centers for Medicare and Medicaid Services (CMS) Value-Based Purchasing (VBP) program.

What once was only a reporting of hospital performance has evolved into the basis for Medicare reimbursement. In order for the VBP program to work, there must be transparency in financial and operational results. The need for transparency applies to CMS, as well as acute care hospitals.

Measuring Up

Starting in Fiscal Year 2013, a reduction of a hospital’s Diagnosis Related Group (DRG) Medicare payments funds future VBP payments. The amount of reimbursement for a hospital depends on how well it performs on VBP’s quality measures.

In a recently released letter, the American Hospital Association (AHA) asks for the same transparency from CMS. The letter “urges CMS to make available a database including all of the data used to calculate the hospital VBP measures.”

The AHA argues that without data “in a format that is consistent with the time periods used for the baseline and performance data,” hospitals are not receiving the right of appeal as specified in healthcare reform’s Affordable Care Act.

Certainly, the AHA’s recommendation for validation by an external agency makes sense. An independent analysis would assist CMS in deciphering the data and enable a uniform platform for review by hospitals on an ongoing basis.

Click here to review the full, 14-page AHA letter to CMS.

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