Irving Jorge, Miriam Weismann, Justin Brady, Chi Zhang, Kayla Li Haydon, David Etzioni, Yu-Hui Chang, Zhi Ven Fong, Nabil Wasif
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Are Safety Net Hospitals Reimbursed Fairly Under Hospital Value-Based Purchasing-Prioritizing Satisfaction Over Outcomes?
Background: The Centers for Medicare and Medicaid Services (CMS) reimburse hospitals through the Hospital Value-Based Purchasing Program (HVBP) based on clinical outcomes, safety, efficiency, and patient satisfaction, currently weighted equally. The aim is to explore whether adjusting these weights could address reimbursement inequities for safety net hospitals (SNH).
Methods: We assessed 2,731 non-federal hospitals using CMS payment files. They were divided into SNH and non-SNH based on their DSH (Disproportionate Share Hospital) status in 2020. We compared both groups' 2020 HVBP scores to ensure data accuracy and account for COVID-19 impacts.
Results: SNHs had lower person and community engagement domain scores (6.9) compared to non-SNHs (8.87, p<0.001), resulting in lower HVBP total performance scores (TPS) (p<0.001) and lower 2020 HVBP adjustment factors (p<0.001). Changing the TPS weights to 35% for clinical outcomes and safety, 25% for efficiency, and 5% for patient and community engagement improved TPS for SNH.
Conclusions: Prioritizing clinical outcomes and safety measures can ease financial pressure on SNH.
期刊介绍：
The Journal for Healthcare Quality (JHQ), a peer-reviewed journal, is an official publication of the National Association for Healthcare Quality. JHQ is a professional forum that continuously advances healthcare quality practice in diverse and changing environments, and is the first choice for creative and scientific solutions in the pursuit of healthcare quality. It has been selected for coverage in Thomson Reuter’s Science Citation Index Expanded, Social Sciences Citation Index®, and Current Contents®.
The Journal publishes scholarly articles that are targeted to leaders of all healthcare settings, leveraging applied research and producing practical, timely and impactful evidence in healthcare system transformation. The journal covers topics such as:
Quality Improvement • Patient Safety • Performance Measurement • Best Practices in Clinical and Operational Processes • Innovation • Leadership • Information Technology • Spreading Improvement • Sustaining Improvement • Cost Reduction • Payment Reform
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