SHM Joins D.C. Session on Value-Based Purchasing
SHM had a seat at the table at a high-level roundtable meeting March 6 in Washington, D.C., to discuss Medicare’s value-based purchasing of hospital care.
SHM President Russell Holman, MD, chief operating officer for Cogent Healthcare, Nashville, participated in the roundtable convened by Senate Finance Committee Chairman Max Baucus, D-Mont., and ranking member Chuck Grassley, R-Iowa. The roundtable included representatives from 22 public and private healthcare organizations, including SHM, the American Hospital Association, and National Quality Forum.
“SHM was one of only two physician organizations participating,” points out Laura Allendorf, SHM’s senior adviser for advocacy and government affairs. “That is very significant. I think [our inclusion] is a testament to our growing presence, our advocacy efforts and our willingness to help representatives with healthcare issues like value-based purchasing.”
The Proposed Plan
At the roundtable, representatives from the Centers for Medicare and Medicaid Services (CMS), the Medicare Payment Advisory Commission (MedPAC), and the Government Accountability Office (GAO) presented an overview of the report that CMS submitted to Congress in November, which outlines a hospital value-based purchasing program. The plan is designed to meet CMS’ objective of “transforming Medicare from a passive payer of claims to an active purchaser of care.” It builds on the existing framework of the current pay-for-reporting program, Reporting Hospital Quality Data for Annual Payment Update, but more closely links hospital Medicare payments to performance.
Dr. Holman is well versed in the plan; he and members of SHM’s Public Policy Committee, who were in Washington for annual visits to Capitol Hill, had just met with CMS’s Chief Medical Officer Tom Valuck, MD.
“That same morning, Tom Valuck had spent an hour and a half briefing Public Policy Committee members on Medicare’s value-based purchasing plan,” says Allendorf. “I’d lined up that meeting before the roundtable was set up.”
A transition to CMS’s proposed value-based purchasing plan, or VBP, would probably occur over three years. Under the plan, a percentage of the hospital’s diagnosis related group (DRG) payment would rely on the hospital’s performance on a specific set of measures. Although the report is comprehensive, details on implementation, incentives, and more must be made final.
Public reporting of quality measures remains a key part of the plan; quality of care information would be available to patients through the CMS Hospital Compare site at www.medicare.gov. A PDF of the CMS report to Congress is available at www.cms.hhs.gov/center/hospital.asp.
Support For Harmonization
After the formal presentation on the VBP plan, roundtable moderator John Inglehart, founding editor of Health Affairs, asked a series of questions directed at specific segments of the group, targeting issues surrounding the plan’s quality measures, performance standards, incentives, and plan implementation.
Dr. Holman was asked to comment on how CMS could ensure that hospital measures and physician measures become more aligned.
“The measures that each party are asked to report in terms of Part B of Medicare are somewhat different and can lead to confusion and people working at cross purposes,” Dr. Holman explains. “This adds complexity to a system that’s already too complex. In my statement, I said that what we call harmonization [of reporting measures] is a very important step for CMS to take, so that physicians and hospitals are required to measure and report the same thing. The more we can move toward outcome measures, as well as efficiency and patient experience measures, the more harmonization we’ll have. Focusing on outcomes creates a common goal.”
Dr. Holman continued his comments to the roundtable by using an example of harmonization at the heart of hospital medicine: transitions of care. “I let the group know that SHM is working on a number of initiatives regarding care transitions,” he says. “Transitions of care require the whole system to come together; it’s a great way to help galvanize all the stakeholders toward that shared goal.”
