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HHS Launches New Reward Program for Hospitals That Provide Quality of Care–Algorithms To Score For Value Based Purchasing

Posted Apr 29 2011 7:19pm

Ok here’s that word again but this is what it is, mathematical formulas to grade performance based on reporting.  We are all trying to save money and so many hospitals are having trouble finding enough money today, so perhaps there might be enough in this till to help out there with proving quality care is being provided.

Every rule or law today needs an IT system and this is no different, and in 2013 the “Big Algorithm on Re-admissions” comes in.  I’m not kidding on this one though as there are some  big dollar coding carrots being hung out there by Leavitt, Heritage and company offering $3 million dollars for those algos.  So if you are a coder/programmer, here’s the link below that tells more about the “search for the magical algos”. 

From the CMS website:

“In future years, CMS will be implementing other provisions of the Affordable Care Act that are designed to improve care while reducing costs.  For example, beginning in 2013, hospitals will receive a payment reduction if they have excess 30-day readmissions for patients with heart attacks, heart failure, and pneumonia. By 2015, a portion of Medicare payments to most hospitals will also be linked to whether they meaningfully use information technology to communicate within the hospital to deliver better, safer, more coordinated care. Also beginning in 2015, hospitals with certain hospital acquired conditions will receive additional payment reductions from Medicare.”

I know I am a bit satirical here as I work with data bases, wrote my share of these things with SQL queries and so on and that’s the process so nothing new to me, but heck I wouldn’t even attempt it as there are way too many variables today and by the time you compile and get the bugs out, I would die of exhaustion at the keyboard no matter how many helpers I had.

By the way this is a long entangled process that can’t be accomplished at the day long Code-A-thons either <grin>.  I mention this as I have readers at all different levels here.  July 1, 2011 through March 31, 2012 is the first evaluation period for earning savings from CMS.  You can work on this while you get your information together on how you are going to create an ACO.  Get your calculus talents to work here and here’s a couple more paragraphs on how the payments work below and if you can’t get it there’s a lot of consultants you can hire to help you with all of this and hopefully their fees won’t be more than the hospital can collect.  If you don’t think I’m talking algorithms, keep reading….

“Finally, CMS will calculate a Total Performance Score (TPS) for each hospital by combining the greater of its achievement or improvement points on each measure image to determine a score for each domain, multiplying each domain score by the proposed domain weight and adding the weighted scores together.   In FY 2013, the clinical process of care domain will be weighted at 70 percent and the patient experience of care domain will be weighted at 30 percent.

Incentive Payment Calculations:  CMS will utilize a linear exchange function to calculate the percentage of value-based incentive payment earned by each hospital.  Those hospitals that receive higher Total Performance Scores will receive higher incentive payments than those that receive lower Total Performance Scores.   CMS will notify each hospital of the estimated amount of its value-based incentive payment for FY 2013 through its QualityNet account at least 60 days prior to Oct. 1, 2012.   CMS will notify each hospital of the exact amount of its value-based incentive payment on Nov. 1, 2012.”

I am really for anyone to be reimbursed for better care and again my only doubts here are inquiring if the carrot is attainable and easily enough understood?  I’m still waiting around for those “experts’ in all of this to share with us how they find value with using a personal health record and still silence as of today on the web.  You know when I used to write I thought I had the most “bitchen” code to really make a program rock, but when I put it out into action, guess what, it was time for the duck to eat some dog food and that happened more than once and it was a good learning experience for me and it’s why I talk the way I do today about software. 

It made me a lot more sensitive to the users after a couple experiences and I quickly learned to get over myself, and there’s a few more that might think about this wandering around out there in Health IT land.  Dog food tastes like crap. <grin> but you don’t know until you taste it. Dog food by the way means having to fess up that you screwed up in short on your perceptions and creations and admit you are willing and able to try another approach and it can make your brain hurt too but when you are working with clinicians as a true partner and both working for the same outcome, that makes a lot easier and keeps the human focus alive instead of all these folks that think algorithms will solve the problems of the world. 

When I get sick I want to see a doctor and get a prescription for a drug if that is what I need to heal, not go to Facebook and waste time with a bunch of algorithms that are going to tell me what to do, how to do it and share my questions with the world, the doctor’s office is a much better place for that.  I hope this helps some hospitals with rewards and again get you calculus folks up and ready to rock with it.  BD

The Department of Health and Human Services (HHS) today launched a new initiative that will reward hospitals for the quality of care they provide to people with Medicare and help reduce healthcare costs.  The measures to determine quality in the Hospital Value-Based Purchasing Program focus on how closely hospitals follow best clinical practices and are underpinned by the use of health information technology.

Authorized by the Affordable Care Act, the Hospital Value-Based Purchasing program marks the beginning of an historic change in how Medicare pays healthcare providers and facilities. For the first time, 3,500 hospitals across the country will be paid for inpatient acute care services based on care quality, not just the quantity of the services they provide.

Some of these measures will assess whether hospitals:

  • Ensure that patients who may have had a heart attack receive care within 90 minutes;
  • Provide care within a 24-hour window to surgery patients to prevent blood clots;
  • Communicate discharge instructions to heart failure patients; and
  • Ensure hospital facilities are clean and well maintained.

Hospital Value-Based Purchasing program in FY 2013 have been endorsed by national bodies of experts, including the National Quality Forum.  Hospitals have been reporting on quality measures through the Hospital Inpatient Quality Reporting Program since 2004, and that information is posted on the Hospital Compare website.


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