A Snapshot of the Next VBP Cycle

On April 27, 2016, CMS published the proposed rule for the Hospital Inpatient Prospective Payment System, which identifies potential changes to the Federal Fiscal Year 2019 Value-Based Purchasing Program.

  1. One highlight is that the domain weights are remaining the same.  Safety, Clinical Care, Efficiency, and Person and Community Engagement (HCAHPS) will each continue to be weighted at 25%. This is not a change from last year.
  2. Among the HCAHPS dimensions, about half of the achievement thresholds and benchmarks are proposed to decrease slightly from the FFY 2018 values. Keep in mind, though, that these numbers are subject to change before the final rule is published.
  3. The dates for the Baseline Period and Performance Period have been updated to match the new program year. The HCAHPS Baseline will be January-December 2015, and the Performance Period will be January-December 2017.
  4. Historically, the Patient- and Caregiver-Centered Experience of Care/Care Coordination domain was encompassed by the HCAHPS survey and its composite measures. However, this year’s proposal changing the name of this domain to the “Person and Community Engagement” domain.
  5. The only new measure in the program is THA/TKA, which becomes the fourth item in the Clinical Care domain. The formal name of this measure is: “Hospital-Level Risk-Standardized Complication Rate (RSCR) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA).”

Because this is the initial proposal period, comments on the policies will be accepted by CMS until June 17, 2016. That also means that these policies are subject to change. Generally, we see the achievement thresholds and benchmarks fluctuate a little.

Also included in the rule are other guidelines for healthcare organizations that bill under the Hospital Inpatient Prospective Payment System or the Long-Term Care Hospital Prospective Payment System.