What you can expect from the final inpatient VBP rule for FFY 2019

Healthcare consultant speaking to a group of doctors and other healthcare professionals

If you’ve been holding your breath waiting for the proposed rule regarding the Hospital Inpatient Prospective Payment System, which identified potential changes to the Federal Fiscal Year (FFY) 2019 Hospital Value-Based Purchasing (VBP) program and was published in the Federal Register dated April 27, 2016, to become final … you can exhale. The suspense is over. The rule was finalized August 22, 2016.

So is there really any news here?

You bet. Granted, just about everything that was previewed in April is part of the final rule. For example, domain weights will remain the same, with Safety, Clinical Care, Efficiency, and Person and Community Engagement (the domain formerly known as “Patient- and Caregiver-Centered Experience of Care/Care Coordination,” representing HCAHPS) each checking in at 25%. And dates for the Baseline and Performance periods have been updated to match the new program year. But there are a few nuggets of information that deserve a deeper look, and continued attention.

  1. A painless decision? Earlier this summer, the media played up reports that The Centers for Medicare & Medicaid Services (CMS) were on the verge of eliminating the Pain Management dimension across the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Speculation was that the move would be made in response to concerns raised by physicians and researchers that the desire to achieve higher HCAHPS scores could be driving docs to over-prescribe opiates and other painkillers, exacerbating a national addiction problem. Publication of the inpatient final rule left Pain Management in place with an asterisk, advising healthcare organizations to wait for publication of the outpatient final rule in November for the final word on whether the dimension is in or out for VBP calculations. (The questions will remain in the survey until CMS can identify suitable replacements that do not emphasize medication as a pain management tool.) Cliffhangers keep TV viewers coming back. Now you’ll have to stay tuned this fall, too.
  2. Lowering the bar. In April, the prevailing thought was that CMS would decrease about half of the achievement thresholds and benchmarks for FFY 2019 from the FFY 2018 values. As it turns out, five of the nine Achievement Thresholds dropped, while only two of the nine Benchmarks declined. Just as important, all of the floors (the lowest scores earned by program participants during the baseline period) fell significantly, which indicates that these low performers will have a harder time earning Consistency Points.
  3. The hip bone’s connected to … the Hospital-Level Risk-Standardized Complication Rate (RSCR) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKS), which is the only new measure in the FFY 2019 VBP program. As PRC has previously mentioned, someone on your Quality team has probably been tracking these rates already. But now the RSCR for THA and TKS is official for VBP, so be sure to get on top of it ASAP.

If you’d like to learn more about the final VBP rule for FFY 2019 and what it could mean for your team, check out our Value-Based Purchasing Summary for FFY 2019 or contact us. We’d love to help.