Health Information Management

GAO finds HVBP Program has minor effect on Medicare payments, quality trends

HIM-HIPAA Insider, October 19, 2015

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In the first three years after implementation, incentives and penalties tied to the Hospital Value-Based Purchasing (HVBP) Program had a minimal effect on Medicare, while also doing little to improve quality trends, according to a recent Government Accountability Office (GAO) report.

The program, instituted as a result of the Affordable Care Act, was created to evaluate individual hospital performance on a designated set of quality measures related to inpatient hospital services. Payment adjustments based on performance began in fiscal year 2013, and the study looked at data through 2015.

The GAO found that incentives and penalties amounted to less than 0.5% of applicable Medicare payments at the approximately 3,000 eligible hospitals. However, the percentages having been rising since the program began. In 2013, only 3% of payments resulted in penalties of greater than 0.5%. By 2015, that number rose to 8%. Bonuses have also risen, starting at 4% in 2013 and rising to 18% in 2015.

The study also found no shift in existing trends in hospital performance on the quality measures included in the HVBP program. GAO concluded shifts could emerge in future years as new quality measures are added and the weight placed on clinical process measures, on which hospitals had little room for improvement, will be substantially reduced.

Hospital officials the GAO interviewed said the new program reinforced ongoing quality efforts, but did not lead to major changes in focus.

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