The U.S. Government and Accountability Office (GAO) issued an October 2015 report (available here) to congressional committees concluding that the initial results of the Hospital Value-Based Purchasing (HVBP) program show “no apparent shift” in hospitals’ performance trends on the quality measures included in the HVBP. GAO analyzed the first three years of the HVBP program, 2013 – 2015, and found that the bonuses and penalties received by the nearly 3,000 eligible hospitals for the program totaled less than 0.5 percent of applicable Medicare payments each year.
Enacted in 2010 as part of the Affordable Care Act, the HVBP program adjusts payments to hospitals under the inpatient prospective payment system (IPPS) based on the quality of care they provide to patients, as defined by reference to certain consensus-based measures, and enacts performance standards that are linked to value-based incentive payments and penalties.
GAO analyzed data on bonuses and penalties given to hospitals in fiscal years 2013 – 2015 and data on hospital quality measures collected by CMS from 2005 through 2014 to evaluate the initial effects of the HVBP program on the following three areas: (1) Medicare payments to hospitals; (2) quality of care provided by hospitals; and (3) certain hospitals’ quality improvement efforts. GAO also interviewed officials in eight hospitals that participated in the HVBP program. These officials shared certain of the factors that impacted their hospital’s quality improvement overall, including electronic health records and IT systems, however these factors were not specifically linked to implementation of the HVBP program.
GAO explained that although the initial results of the HVBP program show no apparent shift in hospitals’ quality practices, “shifts in quality trends could emerge in the future as the HVBP program continues to evolve,” and especially as new quality measures are added with an increased emphasis on clinical process measures.