24 Feb Hospitals That Received Awards for Quality Care More Likely to Be Penalized by CMS
MedicalResearch.com Interview with:
Rishi K. Wadhera, MD
Beth Israel Deaconess Medical Center
Harvard Medical Faculty Physicians
MedicalResearch.com: What is the background for this study?
Response: In recent years, the Centers for Medicare and Medicaid Services has implemented nationally mandated value-based programs to incentivize hospitals to deliver higher quality care. The Hospital Readmissions Reduction Program (HRRP), for example, has financially penalized hospitals over $2.5 billion to date for high 30-day readmission rates.
In addition, the Value-Based Purchasing Program (VBP) rewards or penalizes hospitals based on their performance on multiple domains of care. Both programs have focused on cardiovascular care. The evidence to date, however, suggests that these programs have not improved health outcomes, and there is growing concern that they may disproportionately penalize hospitals that care for sick and poor patients, rather than for poor quality care.
MedicalResearch.com: What are the main findings?
Response: In this study, we examined how hospitals that received awards from the American Heart Association (AHA) and American College of Cardiology (ACC) for providing the highest quality cardiovascular care (for a heart attack or heart failure) performed in CMS value-based programs in fiscal year 2018. Overall, we found that AHA/ACC award hospitals were more likely to be financially penalized by both the Hospital Readmissions Reduction and Value-Based Purchasing Programs, and less likely to be financially rewarded by the Value-Based Purchasing Program, compared with all other hospitals participating in these CMS programs. Although AHA/ACC award hospitals fared worse under CMS value-based programs, their death rates for heart failure or a heart attack were similar or lower than other hospitals.
MedicalResearch.com: What should readers take away from your report?
Response: These findings suggest that hospitals that receive awards from national cardiovascular societies for providing high quality care for heart failure and heart attacks are more likely to be financially penalized by CMS value-based programs compared with other hospitals, and highlight how challenging it can be for health policymakers to fairly evaluate hospital quality.
In the U.S., the quality of care provided by healthcare systems are increasingly being appraised by multiple bodies, including the federal government (CMS), national societies, and news and media organizations. Our findings highlight that efforts are needed to promote fair, equitable, and standardized measurement of cardiovascular care quality.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: There is growing concern that CMS value-based programs may be regressive and disproportionally penalize hospitals that care for medically and socially complex patients. Further research is needed to determine how well these CMS programs distinguish hospital quality and understand whether other approaches – beyond blunt financial incentives – can be used to encourage healthcare systems to improve care delivery and health outcomes.
Wadhera RK, Vaduganathan M, Jiang GY, et al. Performance in Federal Value-Based Programs of Hospitals Recognized by the American Heart Association and American College of Cardiology for High-Quality Heart Failure and Acute Myocardial Infarction Care. JAMA Cardiol. Published online February 19, 2020. doi:10.1001/jamacardio.2020.0001
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