**Post need response and one question to the writer.
Should we continue the Hospital Value-Based Purchasing program?
The Hospital Value-Based Purchasing (VBP) program is one of the federally mandated
regulations that is a part of the Affordable Care Act (ACA) (Lee et al., 2019). The United
States, (U.S.) among other developed nations globally, ranks number one for health
care spending, but ranks the lowest of developed countries in health care performance
and outcomes. The purpose of this program is to encourage hospitals and
administrators to improve in four categories: clinical approach, patient outcomes, patient
experiences and efficiency (Lee et al., 2019).
Before, the U.S. health care system relied on fee-based services, regardless of patient
outcomes or quality of care. With the launch of the program, there was some skepticism
that VBP would be effective, but also bias, that well-off hospital systems would be
unfairly rewarded due to financial advantages (Chee et al., 2016). The purpose of the
VBP is to assess and analyze opportunities through strengths and weaknesses,
reducing health disparities, establishing measurement outcomes and improving quality
(Chee et al., 2016). The question at hand and being proposed is are hospitals really
thriving and sustaining financially under the VBP?
According to the authors Chee et al. (2016), the VBP is meant to play a significant role
in the future of healthcare delivery systems, and provide a basic infrastructure for valueoriented care. In 2019 alone, Medicare paid out $1.9 billion dollars in incentives to
qualifying hospital systems (LaPointe, 2019). According to the author LaPointe (2019),
55% of hospitals participating in the VBP will see Medicare reimbursements due to a
quality of inpatient care provided. The remaining 45% will either not see a change in
Medicare payment or fall within the threshold of the affected 4% with penalties.
In contrast, VBP has been reported by many physicians to be complex, and providers
report that measures are overly complex and contradictory (Chee et al., 2016). Under
the ACA, up to 4% of Medicare payments were affected and dependent upon negative
patient experiences, and up to 9% of payments by 2022 are in play (Chee et al., 2016).
Some skeptics state that hospitals in poverty-stricken regions, are likely to face higher
health disparities (Chee et al., 2016). These areas are reported to have lower financial
means and higher illiteracy rates. When discussing the patients’ ability to report
satisfaction, these socioeconomic outliers could affect VBP programs.
In 2010, when the first findings of the program were published, physicians in the lowest
quartile of performing hospitals, had the greatest improvement than those of the highest
quartile, meaning a marginal improvement in patient experience and clinical quality
(Chee et al., 2016). In 2016, Medicaid programs showed that VBP programs improved
the overall quality of care (LaPointe, 2019). Authors Chee et al. (2016), stated that VBP
is on the right track, but does need to adjust incentives, increase feedback and have
more focused clinician feedback. What this essentially means, is as a hospital system
performs well, larger incentives need to be incorporated to continue to uphold the
quality. Also more detailed and continous feedback is needed for areas of improvement,
and individual physician assessments are needed instead of whole departments.
References
Chee, T. T., Ryan, A. M., Wasfy, J. H., & Borden, W. B. (2016). Current State of ValueBased Purchasing Programs. Circulation, 133(22), 2197-2205.
doi:10.1161/circulationaha.115.010268
Lee, S. J., Venkataraman, S., Heim, G. R., Roth, A. V., & Chilingerian, J. (2019). Impact
of the value‐based purchasing program on hospital operations outcomes: An
econometric analysis. Journal of Operations Management, 66(1-2), 151-175.
doi:10.1002/joom.1057
LaPointe, J. (2018, December 03). 55% of Hospitals Earn Incentive in Value-Based
Purchasing Program. Retrieved June 01, 2020,
from https://revcycleintelligence.com/news/55-ofhospitals-earn-incentive-in-valuebased-purchasing-program
Purchase answer to see full
attachment