Value-Based Purchasing, established by the Centers for Medicare and Medicaid (CMS) in 2012, seeks to reward hospitals by redistributing Medicare payment dollars among U.S. hospitals of the highest quality and performance.
Value-Based Purchasing Scores track hospital performance in four quality measures:
- Clinical Care (25%)
- Efficiency and Cost Reduction (25%)
- Patient and Caregiver-Centered Experience of Care/Care Coordination (25%)
- Safety (25%)
The four domain scores are weighted evenly and make up the hospital's Total Performance Score (TPS). While the weightings, domains, and measures can vary year to year, a hospital's TPS drives the Medicare Value Based Purchasing Adjustment, which either rewards or penalizes hospitals and doctors based on their quality of care. A positive adjustment indicates an increase in Medicare payments, whereas a negative number indicates a decrease. This payment is based on three factors:
- Achievement points: How well a hospital performs on each of the selected measures
- Improvement points: How much it has improved on each measure compared to the baseline period
- Consistency points: Rewards hospitals that have scores above the national 50th percentile in all eight dimensions of the HCAHPS survey
Most domains seeing higher weighted scores in 2019
From 2018 to 2019, the clinical care, patient experience, and efficiency and cost reduction domains experienced growth. Safety scores took a bit of a dive this year, but still remain higher overall than 2016.
Fig 1: Definitive Healthcare data, as of 7/2/2019
While the weightings and measures under a domain can change year to year, reviewing the weighted scores over time can still reveal where progress has been made or areas that may still need more attention. For example, the patient experience and efficiency scores have both decreased slightly since 2016 while clinical care and safety measure scores have generally increased.
U.S. hospitals with the highest weighted domain scores
|Domain score type
||Hospital(s) with highest domain scores
||Encino Hospital Medical Center, CA
|Efficiency & Cost Reduction
35-way tie, 15 of which are owned by Kaiser Permanente
||Citizens Medical Center, Columbia, LA
7-way tie between Patewood Hospital, St. Anthony Summit Medical Center, Mountain View Hospital, StoneSprings Hospital Center, Touchette Regional Hospital, Lehigh Valley Hospital - Schuylkill S. Jackson Street, and New Bridge Medical Center
Fig 2: Definitive Healthcare data, as of 7/2/2019
According to Definitive Healthcare data, the highest weighted domain score across the four domains that a hospital has reached so far in 2019 is 33.33. In clinical care and patient experience, a single facility rises to the top (so far this year). Efficiency & cost reduction and the safety domains have numerous hospitals reaching the same weighted score.
Hospitals scoring low on certain domain scores or for particular measures present as opportunities for improvement. For example, there are nearly 1,200 hospitals with an efficiency & cost reduction weighted domain score of zero. There are only a few hospitals with the lowest patient experience score of "1", including Los Angeles Community Hospital, Jackson Park Hospital, and Huntington Beach Hospital.
It can be difficult to benchmark your organization's ability to deliver value-based care. Key performance indicators like supply chain spending, wait times, and readmission rates can give your practice quantifiable achievement goals, but if you want to see where you stack up against your competitors, you should invest in a software platform that allows you to compare your hospital's scores to that of your competitors, your region, or even the national average. Software platforms like Definitive Healthcare can help you access actionable intelligence on the healthcare ecosystem to help you grow your network, retain patients, and understand where you rank compared to the competition.
Tune in: Thursday, September 26th at 11am ET
- Gary Wainer, D.O., Chief Medical Officer, Innovista Health Solutions
- Susie Valentine, MBA, VP of Population Health, Healthcare Provider Connections, Inc.
- Randall Taubman, MD, Founder & President, Inovo Health Corp & Affiliate Assistant Professor of Medicine, Charles E. Schmidt College of Medicine at Florida Atlantic University
- Tangible impacts of value-based care in both the provider and payor perspectives
- Defining success with value-based care transition
- Specific metrics when it comes to measuring value-based care performance
- Actionable steps in implementing value-based care focused changes