Value based purchasing for both hospitals and physician providers is a key compo

Question

Value based purchasing for both hospitals and physician providers is a key component of the Affordable Care Act (ACA) and instrumental in moving the US Healthcare System from one driven by volume to one driven by value.

Part I: Please discuss the Value Based Purchasing (VBP) initiative as it applies to hospitals. What are the performance measures hospitals are held accountable for, how much of their payment is at risk both upside and down side, and how is the program funded?

Part 2: Please discuss the value based purchasing program as it applies to physician providers (MACRA). What are the two (2) options that can be selected by the physician practice, and what basic categories of performance measures are the physicians going to be accountable for?

Explanation / Answer

Ans part 1) VBP aims at converting the healthcare system from a volume-based system to value-based system.

Performance measures for hospitals providing value based purchasing (VBP) are:

Detailed tables published by the DEPARTMENT OF HEALTH AND HUMAN SERVICES- Centers for Medicare & Medicaid Services describe exactly how these performance measurement parameters based on which Medicare provides incentives to hospitals providing Medicare. You may refer following factsheet to access the same.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf

Ans part 2)

The following fact sheet provides all the information you need.

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Cost-Measures-Field-Test-Fact-Sheet.pdf

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