Since its launch in 2014, CMS’ Value-Based Purchasing (VBP) program has been criticized for unfairly punishing facilities that treat poorer and sicker patients, such as safety-net hospitals. VBP is primarily intended to improve care quality through financial rewards and penalties. Hospitals are scored based upon their performance in several categories compared to that of all other participating hospitals, which numbered close to 3,000 as of 2017.
VBP metrics are divided into four categories with different weighted scores: Patient Experience (25 percent), Safety (20 percent), Efficiency and Cost Reduction (25 percent), and Clinical Care (30 percent), which is subdivided into two groups. Hospitals whose final score ranks above the national median receive a percentage bonus to their Medicare reimbursements in the following year, which is paid for by penalizing hospitals with scores below the median. So far in 2018, 23 states scored higher than the national average of 38.5.
Average VBP scores varied widely by state. Florida had the lowest median score at 32.4, and Minnesota had the highest score with 49.7 out of 100. South Carolina scored closest to the overall average, with a score of 38.3. Case mix index (CMI) does not appear to strongly influence VBP performance, with all states reporting between a 1.0 and 1.5 CMI. The top 5 states with the highest VBP scores — Minnesota, Hawaii, South Dakota, Alaska, and Oregon — reported average CMIs between 1.1 and 1.4.
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