VBP: Don’t let ‘perfect’ be the enemy of ‘excellent’

Healthcare Consultant reviewing Value-Based Purchasing results with hospital leaders

A quick glance at the FFY 2016 Value-Based Purchasing (VBP) program results may make some organizations feel like they’re treading water. That’s why it’s important to put things in perspective. Just because you’re not perfect doesn’t mean you can’t be excellent.

Remember: You’re aiming at a moving target

Let’s get back to basics for just a second. CMS (The Centers for Medicare & Medicaid Services) built a two-year lag into the metrics it uses to measure performance. So your organization’s current VBP results reflect the work you did two years ago, and the efforts you’re making now won’t pay off until 2018. This system design enables CMS to: 1) evaluate an individual hospital’s improvement over time and assign improvement points and 2) determine performance period scoring thresholds and assign achievement points.

As your hospital improves its performance each year, CMS establishes a new, higher baseline for assessing your organization. In other words, your success pushes the bar higher and higher. And that’s why you may feel like you’re not getting credit for the progress you’ve made.

Nationwide, as more healthcare organizations have focused on improving the patient experience, their collective performance has improved, too. That means a hospital landing above the 50th percentile two years ago would have to work harder to stay there because other hospitals would have registered performance improvements as well, raising the standard for achieving the 50th percentile, where achievement points kick in. Motivating continuous improvement among hospitals is part of CMS’s longstanding effort to link Medicare’s payment system to a value-based system to improve healthcare quality.

Are hospitals topping out?

As CMS raises the bar, it’s only natural to wonder if hospitals are making the leap. The FFY 2016 VBP results suggest a decided downturn, with the average number of VBP points earned across every dimension declining for the first time. About 37% of hospitals earned zero points for Doctors Communication, for example. In fact, at least half of the hospitals participating in the VBP program earned one or zero points for Doctors Communication, Responsiveness, Pain Management, and Hospital Environment. The lone bright spot appears to be Discharge Information, where 50% of hospitals earned at least 4 points.

From FFY 2014 through FFY 2016, 300 fewer hospitals nationwide earned points for six of the eight dimensions CMS tracks in its VBP program: Nurses Communication, Doctors Communication, Responsiveness, Pain Management, Communication about Medicines, and Hospital Environment. About 10% of all hospitals fell off the points-earning bandwagon.

Whether “respondent burden” is kicking in or hospitals are beginning to think that competing for VBP points and reimbursement is a case of the juice not being worth the squeeze remains to be seen. One thing is certain, however — focusing on excellence will always point you in the right direction.

What can your organization do?

  1. For starters, if you’re a PRC client, pull out the personalized VBP report PRC sent you in mid-June, look at the numbers, and see how you stack up against your 4,000-plus colleagues in the CMS database. If you’re not a PRC client, you can still request a free, personalized report and then see how your performance compares to your peers’.
  2. Next, keep things in perspective. Looking across the hospitals in CMS’s database, we’re seeing higher highs and lower lows. It’s important to remember that the mean changes to keep up with changes in hospital performance. The bar is raised as performance improves.
    1. 62% of PRC clients earned a VBP bonus in FFY 2016.
    2. 34% of PRC clients improved their Total Performance Score from the previous year.
    3. 30% of PRC clients improved their Total HCAHPS Score from last year. Because the Achievement Threshold and Benchmark change from year to year and represent a moving target, this is a significant accomplishment.
  3. Most important, focus on excellence. If you deliver an excellent patient experience, your HCAHPS scores, VBP reimbursements, and PRC scores are likely to reflect that positive effort.

PRC clients know that working through federal requirements can be difficult. But they also know that working with PRC is easy. If you’d like to learn more about how PRC can help improve your HCAHPS and VBP performance, just let us know.


Choose excellence. Choose PRC.