Hospital Executive leadership are dedicated to the mission that patients expect and deserve the excellent care from that health care providers. The Centers for Medicare & Medicaid Services (CMS) is the driving force behind the delivery of quality care, and ensuring that healthcare insurance remains accessible and affordable to the public. in order for leadership to advance CMS's mission; they may need to look outside the organization for real solutions in reducing their hospital-acquired conditions and improve quality scores.

THE AFFORDABLE CARE ACT

Section 3008 of the Patient Protection and Affordable Care Act (ACA) established three programs that have dramatically altered the Hospital Inpatient Prospective System (IPPS). The Hospital-Acquired Condition (HAC) Reduction Program provides an incentive for hospitals to reduce HACs. The effective fiscal year 2015 that targeted discharges beginning 2014. The HAC reduction program requires an adjustment to payments to hospitals of 1% that rank in the worst performing quarter. In 2017 HAC Reduction program , hospitals with a total HAC score greater than 6.577 are subject to a payment reduction. ('CMS', 2016, para.2)

THE VALUE BASED PURCHASING PROGRAM

The ACA also established the Value Based Purchasing Program that offers incentives to hospitals based on:

  • How well they perform on each measure

  • How much they improve their performance on each measure compared to their performance during baseline period

The measures include:​

  • Clinical Process of Care

  • Patient Experience of Care Outcomes

  • (2017) Efficiency & Cost Reduction ('CMS,' 2016, pg. 11)

CMS makes rate adjustment reduction when the facility falls below benchmark, the reduction started in 2013 at 1% to 2017 at 2%. The organizations that exceed benchmarks will realize a bonus up to 2% in 2017 that is funded by those organizations who were penalized.

THE HOSPITAL READMISSIONS REDUCTION PROGRAM

It is important to focus on the institution's HACs and how those conditions effect effect quality scores that impact the bottom line. CMS publishes hospitals and provider scores for competitors and consumers to review. Would a potential patient choose a provider that has a score of 6.577 or greater for Surgical Site Infections to perform their hip replacement? HQM Consulting can provide solutions for your organizations that address quality outcomes through a very targeted process.

HQM Consulting will provide benchmarks and develop cost effective strategies to facilitate change; as simple as workflow re-design. HQM has proven strategies that can improve quality outcomes and increase reimbursements that help ensure the success of the organization.

References:

Home.(n.d.).Retrieved December 27,2016, from http://www.cms.gov

NQF:Home. (n.d.).Retrieved December 27,2016, from http://www.qualityforum.org/Home.aspx

Overview.(n.d.). Retrieved December 27,2016, from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-instruments/hospital-value-based-purchasing/index.html

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