Challenges and Opportunities: The Role of Hospital Characteristics and difference in Scoring on CMS' Performance Score for Value-based Purchasing

Research Objective: With Value-based purchasing poised for 2009 CMS has been developing composite scores to score hospitals for reimbursement. The Hospital Quality Improvement Demonstration project (HQID) was based on the CMS composite score. A major shortcoming was aggregation before scoring and that only current levels of performance were rewarded. CMS has recently proposed a more complex score, the VBP performance scores due for implementation 2009 which score each measure separately and awards credit both the basis of attainment and improvement compared with a base year. This study demonstrates the potential impact of VBP performance score on hospital performance as well as financial incentives.

Study Design: With a retrospective cross-sectional study we explored the association between 6 hospital characteristics and hospital performance as measured by the VBP performance score assessing both improvement and attainment. Multiple linear regression was performed to examine the association between performance and hospital characteristics. Predicators of improvement or attainment were then determined by multiple logistic regression. Multiple comparisons of score earned for each measure were analyzed by ANOVA. The relationship between hospital characteristic and measures with same maximum scores(attainment = improvement = 10) was examined by chi square test and ttest.

Population Studied: Patient level data for 16 NHQ measures which will be part of VBP from 4 clinical areas from 450 hospitals participating in Quality Indicator Project (QIP) from 2005 to 2006 were used.

Principle findings: Most hospitals achieved their performance scores by attainment. Scores earned for the 16 measures were statistically divided into 10 different groups where groups with lowest scores were considered as groups with highest opportunity of achieving future financial incentives. Area (Northeast, South, Midwest, West) (P<0.05) and facility type (for-profit, not-for-profit, government owned) (P<0.001) were significantly associated with hospital performance after adjusting for other hospital characteristics. Small to medium size hospitals (OR=1.44 CI: 1.03-2.0, OR=1.50 CI: 1.14-1.97) and hospitals locating in mid-west (OR=1.52 CI: 1.18-1.95) were more likely to be awarded points from improvement. Hospital characteristics were significantly associated with perfect care measures or poorest care measures (both attainment and improvement score had value of 10 or 0) (all p values < 0.05).

Conclusion: Despite consideration of performance improvement, attainment still accounted for major part of VBP score. Hospitals with different characteristics achieved perfect care measures differently. Performance improvement was more important for small to medium size hospitals in mid-west.