CMS Releases Latest Value-Based Purchasing Program Scorecard

By Dr. Patrick Conway, CMS Chief Medical Officer and Director of the Centers for Clinical Standards and Quality

On November 14, for the second year in a row, the Centers for Medicare & Medicaid Services (CMS) posted Hospital Value-Based Purchasing payment incentive adjustment factors for fiscal year 2014. We think this second anniversary deserves recognition—it’s a sign that value-based purchasing in Medicare is becoming routine.

The Affordable Care Act gave CMS many new tools to convert Medicare from a program that paid for decades on automatic pilot into one that deliberately pays to promote better health. Now, thanks to one of these tools, the Hospital Value-Based Purchasing program, Medicare is no longer a program that just pays the bills. Acute-care hospitals across the country not only are paid more for higher quality care, they also have skin in the game.

In FY 2014, 1.25 percent of a hospital’s Medicare base-operating DRG payments go into a value-based purchasing pool. Depending on how well hospitals measured up to their peers on important health-care quality indicators during a prior performance period, they will either break even, get a bonus, or—if their performance is lower than average—get back less than what they contributed to the FY 2014 pool.

FY 2014 payments began October 1. About half of the hospitals participating in the program —over 1300 hospitals—will essentially break even over the course of the year, that is, their payment change is between -0.2 percent and +0.2 percent. Across the country, 630 hospitals—just under a quarter—will receive a bonus, that is, an increase in Medicare payment above +0.2 percent. Just over a quarter of hospitals (778) will receive an overall decrease in Medicare payment, which means that it is less than -0.2 percent.

But even though we’d like to see every hospital across the country offer the highest quality care possible, we’re pleased with this round of results. Hospital Value-Based Purchasing provides a useful snapshot of how hospitals are performing on important indicators for patient safety, care, quality, and well-being. The Hospital Value-Based Purchasing program refines the measures it uses to evaluate performance annually.
In FY 2014, there were fewer higher performers—that is, their incentive payment is greater than the amount they contributed—than lower performers—their incentive payment is lower than the amount they contributed, that higher performers’ bonuses on average will be larger than the lower performers’ losses over the course of the year.

Finally, a little over two-thirds of the higher performers were higher performers last year, and about three-quarters of the lower performers also had an incentive adjustment factor of less than one in FY 2013. That’s good news too. The fact that not every higher performing hospital last year made the grade this year, and not every lower performing hospital last year will see payment decline this year,, means that hospitals are adjusting to the new world of value-based payment. It also may mean that the important addition of 30-day mortality measures for heart attack, heart failure and pneumonia had an impact on hospitals’ scores.

As the Hospital Value-Based Purchasing program continues to evolve with a richer set of measures including an efficiency measure in FY 2015, we may see the mix of value-based payment adjustment factors change again. Meanwhile, value-based purchasing in Medicare continues to move ahead, improving the way that health care is delivered to people with Medicare now and helping create a health care system that will ensure quality care for generations to come.

To see the November 14, 2013 value-based incentive payment adjustment factors, please go to: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/

Virtual Research Data Center Offers Secure Timely Access to Data at Lower Cost

By Niall Brennan, Acting Director, Offices of Enterprise Management

One of the Obama administration’s top priorities is to make healthcare affordable through better quality and more efficient delivery.  But a thoughtful approach to health system transformation requires the country’s best minds working on it, using the most comprehensive, up-to-date evidence available.

On November 12, the Obama administration took an important step forward on this path.  At the White House’s Data to Knowledge to Action event, Building New Partnerships, the Centers for Medicare & Medicaid Services (CMS) announced the new Virtual Research Data Center (VRDC), which can provide the nation’s researchers with access to the most comprehensive, up-to-date data sets available through CMS.

CMS covers 100 million Americans through Medicare, Medicaid, the Children’s Health Insurance Program, and soon through the Health Insurance Marketplace. The Medicare program is the nation’s largest health insurer, handling more than 1 billion claims per year.  We have made our data sets available to researchers for many years.  Studies that help us better understand the healthcare ecosystem are published almost weekly in major medical journals based on CMS data.

Demand for CMS data has grown exponentially in recent years.  Historically, the scale of CMS data and a lack of technological alternatives meant most researchers were physically shipped data, with yearly updates as permitted. Medicare data for 2012 is only just now being physically shipped to researchers. Through the VRDC, we are changing that. The VRDC will help investigators access data in a much timelier manner and will provide them with a variety of tools to analyze the data.  It will also help approved researchers doing approved surveillance and other studies that require current data, which needs to be refreshed on a regular basis, something that has traditionally been unavailable.

We also want CMS data to be affordable, and the VRDC helps with this, too. The lowest price of a complete set of Medicare Parts A, B, and D data was more than $100,000 for a single year, and many researchers need multiple years of data.  Now, with the VRDC, a single researcher conducting one project over the course of the year can have access to as much data as his or her research requires for $40,000.  User fees reflect the cost of making the data available and are used to fund CMS data dissemination to researchers.  Additional users can be added to a project for $15,000. We believe this helps lower any price-based barriers to obtaining Medicare data.

Finally, the VRDC will make data sharing more secure.  In the VRDC, sensitive, individually-identifiable information about beneficiaries never leaves the CMS data environment.  This can help prevent breaches or unauthorized data use.  In addition, since researchers will be accessing CMS data through a secure virtual desktop, they no longer need to maintain expensive data infrastructures of their own or prove to CMS through data security assessments that their data infrastructure meets the security requirements in the CMS Data Use Agreement.   However, I also want to assure established CMS data users who have invested significant sums in an existing data storage infrastructure:  you can still get your data physically as you always have. CMS data has the potential to help create a more efficient, higher-quality healthcare system. Our goal is to break down barriers to information and encourage innovation in health care delivery.  Even under the old system, CMS data has provided the basis for breakthroughs in healthcare reform.  We look forward to using the VRDC to stimulate innovations that are equally groundbreaking in years to come.

For more information or to submit a VRDC research request, visit the ResDAC VRDC webpage: http://www.resdac.org/cms-data/request/cms-virtual-research-data-center.

Fighting Medicaid Fraud, Waste, and Abuse Through Education

By Ted Doolittle, CMS Deputy Director, Center for Program Integrity

The Centers for Medicare & Medicaid Services (CMS) wants everyone to join in the fight against fraud, waste, and abuse as part of our comprehensive strategy to protect federal health care programs and taxpayer dollars.  We are now making it easier than ever before for health care providers, managed care plans, and individuals and families with Medicaid benefits to use the education and training materials on the new Medicaid Program Integrity website.

Resources available on the website include videos, fact sheets, and checklists, made specifically for providers and beneficiaries.  These tools are national in scope, but some information can be personalized by your State of residence (or where you live) upon request.  One of the key resources is a brochure on how people with Medicaid can protect themselves and the Medicaid program from fraud. You can also email MedicaidProviderEducation@cms.hhs.gov for the state contact number for reporting fraud.

State program integrity professionals and counselors will also find valuable education and training materials on the site – all available at no cost.  We have developed toolkits to address hot issues and frequently asked questions about Medicaid program integrity, including beneficiary protections and compliance resources for dental professionals and managed care organizations.  Take a moment to learn more about the CMS Medicaid Program Integrity education and training materials available by clicking on this link, that will take you to the CMS.gov website.

Click here to join our listserv to receive timely notices of new material as it becomes available. Listserv members are also notified when new training, education, or speaking events are scheduled.

We value your feedback, recommendations, questions, and requests and encourage you to e-mail the Education Medicaid Integrity Contractor at medicaidprovidereducation@cms.hhs.gov for further information.

Thank you for being a partner in Medicaid program integrity!

And for more information on CMS’s efforts to protect consumers in the Health Insurance Marketplace, please visit: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-Sheets/2013-Fact-Sheets-Items/2013-09-18.html