Hospital Value-Based Purchasing & Reimbursement Strategy
Hospital Value-Based Purchasing & Reimbursement Strategy
The CMS value-based purchasing landscape for hospitals encompasses four major programs that collectively affect Medicare reimbursement based on clinical quality, patient safety, patient experience, and efficiency performance. Understanding each program's specific performance domains, the methodology by which performance translates into payment adjustments, and the relationship between clinical operations and measured performance is the foundation of an effective VBP strategy.
Most hospitals approach VBP reactively — receiving their payment adjustments after the performance period has ended and then trying to understand what happened. A proactive VBP strategy uses real-time performance data, a clear understanding of each program's methodology, and targeted clinical improvement efforts to shift performance before the measurement period closes.
Service Areas
Hospital Value-Based Purchasing Program (VBP)
The VBP program adjusts Medicare DRG payments based on hospital performance across four domains: clinical outcomes, person and community engagement (HCAHPS), safety, and efficiency and cost reduction. We analyze your current VBP performance domain by domain, model the payment impact of specific performance improvements, and build a targeted improvement strategy that maximizes your VBP adjustment within realistic operational constraints.
Hospital-Acquired Condition Reduction Program (HACRP)
The HACRP imposes a 1% payment reduction on hospitals in the worst-performing quartile on a composite of HAC measures. We analyze your current HACRP performance and implement the infection prevention and patient safety programs needed to move your hospital out of penalty territory.
Hospital Readmissions Reduction Program (HRRP)
The HRRP reduces payments to hospitals with excess readmissions for six specified conditions. We conduct a detailed readmission analysis — by condition, by discharge destination, by patient population, and by time period — and implement readmission reduction programs that address your specific readmission drivers.
Merit-Based Incentive Payment System (MIPS) for Hospital-Based Physicians
Hospital-based physicians who participate in Medicare Part B are subject to MIPS — a value-based payment program that adjusts their Part B payments based on quality, improvement activities, promoting interoperability, and cost performance. We help hospitals understand their hospital-based physicians' MIPS participation status and build the data reporting and clinical improvement infrastructure needed to support strong MIPS performance.
Some or all of the services described herein may not be permissible for HealthBridge US clients and their affiliates or related entities.
The information provided is general in nature and is not intended to address the specific circumstances of any individual or entity. While we strive to offer accurate and timely information, we cannot guarantee that such information remains accurate after it is received or that it will continue to be accurate over time. Anyone seeking to act on such information should first seek professional advice tailored to their specific situation. HealthBridge US does not offer legal services.
HealthBridge US is not affiliated with any department of public health agencies in any state, nor with the Centers for Medicare & Medicaid Services (CMS). We offer healthcare consulting services exclusively and are an independent consulting firm not affiliated with any regulatory organizations, including but not limited to the Accrediting Organizations, the Centers for Medicare & Medicaid Services (CMS), and state departments. HealthBridge is an anti-fraud company in full compliance with all applicable federal and state regulations for CMS, as well as other relevant business and healthcare laws.
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