245365 Value-Based Purchasing (VBP): Identifying improvement opportunities by studying the scoring pattern and variation among individual measures

Tuesday, November 1, 2011: 5:30 PM

Jenhao (Jacob) Cheng, PhD, MS , Research & Development, Press Ganey Associates, Inc., Elkridge, MD
Alice Li, MS , Quality Indicator Project, Press Ganey Associates, Inc., Elkridge, MD
Carlos Alzola, MS , Data Insights, Vienna, VA
Robert Wolosin, PhD , Research, Press Ganey Associates, South Bend, IN
Nikolas Matthes, MD, PhD, MPH , Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
Background: CMS just released the proposed methodology for VBP for fiscal year 2013. Hospitals will be scored on improvement and achievement on 17 clinical and 8 satisfaction measures.

Data: Measure-level scores were calculated for 3211 hospitals from most recent public data from 2Q09 to 1Q10 for the assessment period and prior year for the baseline period.

Methods: Coefficient of variation (CV) was used for measure-level scores to identify measures with low mean scores and high variance for improvement opportunities. Each measure was categorized into one of the following four groups: scored by achievement, scored by improvement, tied and zero scores. Distribution of 4 score groups and rank correlation were performed to explain scoring patterns.

Results: Antibiotic selection in pneumonia and beta blocker in surgeries are the two measures with highest CV (72 and 68) presenting the greatest opportunity for improvement. All 8 satisfaction measures have higher CV and present opportunities with physician communication and staff responsiveness having the highest CV (>95). Low-performing measures were those with a high ratio of zero group to achievement group. The achievement is always the dominant over the improvement group (about 50% or more) and explaining a high correlation (>0.93) with the individual measure score. Satisfaction measures have a higher proportion in zero group (25%-31%) explaining lower satisfaction performance.

Conclusion: Hospitals are found to be lagging on two clinical measures and all satisfaction measures. Efforts to improve performance in these areas may lead to significant national improvement on both clinical process and patient satisfaction.

Learning Areas:
Administration, management, leadership

Learning Objectives:
Understand how clinical scores for Value-based Purchasing for hospitals are calculated Understand how hospitals scored on improvement and achievement Understand which measures provide the greatest opportunities for improvement nationally

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Published in the area of performance measurement, value-based purchasing, and statistics.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.