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Facilitating Medicare to become an active purchaser of health care services
Despite slowing rates in health care expenditures in recent years, health care services delivered during a hospital admission remain the largest proportion of health care dollars spent in the US. Hospital care accounts for roughly 31 percent of all health care expenditures in the US, roughly $775 billion. The current push for hospital reimbursement policy reform is focused on the perceived value of care and on the quality of patient outcomes rather than the quantity of patients served. Under a provision of the Affordable Care Act, CMS released a rule Act that calls for reimbursement and incentive payments to be based on value, known as the Hospital Value Based Purchasing Program (HVBPP).
The Affordable Care Act of 2010 legislation mentions the word “value” close to 214 times. The definition of “value,” in relation to health care delivery, is typically described as the quality level attained at the end of prescribed care for a given cost, or quality divided by cost. Current payment reform strategists use this definition as the basis for understanding how improved patient outcomes can be achieved per dollar spent on the delivery of health care. The current goal of reimbursement reform is to reduce health care associated costs and refocus health care initiatives on quality and value. Under the HVBPP, hospitals will be incentivized with payments that are rooted in hospital outcomes based on twelve clinical processes and nine patient experience measures. This measure is expected to save Medicare $214 billion over the next 10 years.
The Hospital Value Based Purchasing Program helps to reorganize the focus of health care delivery. A backward mapping approach to this policy involves key stakeholders in the implementation discussion. This approach also involves thorough explanations of initiatives, encourages feedback on the incentive payment measures used, and allocates resources to institutions in order to improve. Focusing on a “delivery-level” method for HVBP policy such as relating the problem behavior back to the closest point of contact, the patient’s perceived value of care, could also help with implementation. This reinforces the assertion that the stakeholders, not the policymakers are the individuals that possess the competence to help solve the volume and quality driven health care issue. This policy is pivotal and deserves more attention because it has the potential to change societal views on health care delivery. A commitment to “value-based” health care can also re-energize health care providers’ focus on quality-driven initiatives that allow for improved patient outcomes.
Brandie Hollinger joined the National Coalition on Health Care as a Rogers Scholar in June 2012 with a Bachelor of Science degree in Nursing. Brandie completed her undergraduate study at the University of Central Florida. Currently, she works with children and their families at the University of California, San Francisco Medical Center Benioff Children’s Hospital as a Pediatric Intensive Care Unit nurse. In order to merge Brandie’s interest in health policy and direct patient care, Brandie is completing her Masters degree in Health Policy Nursing at UCSF. Her policy interests include hospital payment reform, chronic disease management in children, and cost containment in Medicare. She enjoys running and exercise, going to the beach, spending time with friends, and is a budding food enthusiast.