Hospitals Medicare Quality

ACOs and VBP

Accountable Care Organizations aim to link providers through the supply chain (i.e., hospitals, physicians, post-acute care facilities) to incentivize providers to improve quality and reduce costs.  In addition to its ACO program (the Medicare Shared Savings Program), the Centers for Medicare and Medicaid Services (CMS) have implemented a number of value-based payment programs, including the Hospital Value-Based Purchasing Program (HVBP), the Hospital Readmissions Reductions Program (HRRP), and the Hospital-Acquired Conditions (HAC) Reduction Program.  Whereas joining an ACOis optional, all hospitals that accept Medicare payments are required to participate in Medicare’s HVBP, HRRP and HAC programs.  Payment adjustments for HVBP can be as high as 1.75%, for HRRP 3%, and HAC 1%.

Are hospitals in ACOs more likely to perform well on the Medicare VBP programs?  Muhlestein et al. (2016) attempts to answer that question.  Using data from FY2013-FY2016, they find:

For FY2016, ACO-participating hospitals performed better than non-ACO hospitals for the HRRP, but not on the HVBP and the HAC Reduction Program. Longitudinal analysis, however, reveals that results are more varied, with evidence that hospitals joining ACOs did increasingly better than their peers for the HRRP, but had inconsistent results year-over-year with the HVBP.

Part of the reason for the lack of correlation, however, is that the scoring methodologies change frequently.  Nevertheless, based on this study, hospitals in ACOs do not universally provide better care than those outside an ACO network.

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