Evidence and Value-Based Purchasing for Value Analysis. Part 1 of 4.

There’s been much conversation recently about the fate of value-based purchasing and the move from fee-for-service to outcomes-based medicine. Established by the Patient Protection and Affordable Care Act (ACA), the Hospital Value-Based Purchasing (VBP) Program is an initiative set forth by the Centers for Medicare & Medicaid Services (CMS) to provide acute-care hospitals with incentive payments based on the quality of care provided to their Medicare beneficiaries. These payments are based not only on how well the hospitals perform on each approved measure, but also on how much they improve compared with their performance that was established during a predetermined baseline period.

“There are 4 domains with metrics that must be met in order to realize these incentives. And each of them can be directly affected by the use of evidence.”

There are 4 domains with metrics that must be met in order to realize these incentives. And each of them can be directly affected by the use of evidence. In this week’s blog, we’ll look at the first of those four and examine how evidence can impact the outcomes.

The Domains

For fiscal year (FY) 2017, the four weighted domains are:

  • Patient- and Caregiver-Centered Experience of Care/Care Coordination (25%)
  • Safety (20%)
  • Clinical Care (30%)
    • Outcomes (25%)
    • Process (5%)
  • Efficiency and Cost Reduction (25%)

Let’s start with Safety.

Safety First Value Based Purchasing“Using evidence to standardize care can result in significant improvements in the patient experience of care.”

This domain includes performance based on complications and patient safety for selected indicators, as well as for rates of healthcare-associated infections (HAI). This year, central line−associated bloodstream infections (CLABSI) are one of the targeted HAIs. According to a January 2017 report from the Centers for Disease Control and Prevention (CDC), an estimated 30,100 CLABSIs occur in the intensive care units (ICUs) of acute care hospitals every year. CLABSIs significantly increase the risk of mortality and can considerably prolong hospital stays.

Evidence Impact on Safety

Evidence-based care bundles have been shown to be effective in controlling for CLABSI. They are defined as a short but cohesive evidence-based list of practices to which clinicians need to adhere for every individual patient, every time. When performed together, they result in better patient outcomes than when they are implemented individually. Using evidence to create standardized care bundles can result in significant improvements in the patient experience of care.

Winifred S. Hayes, Chief Executive Officer, Hayes

Winifred S. Hayes, founded Hayes, Inc., in 1989 and serves as its Chief Executive Officer.