Accounting for Social Risk Factors in Medicare Payment (2017) / Chapter Skim
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AA: Overview of Medicare Value-Based Payment Programs
AA: Overview of Medicare Value-Based Payment Programs
Pages 207-216
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From page 207... ...
The algorithm used to calculate excess readmissions captures an individual hospital's performance compared to that of hospitals nationally over a 3-year performance period. The excess readmission measure is then risk adjusted using a methodology endorsed by the National Quality Forum (NQF)
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National Healthcare Safety Network (NHSN) measures include Central Line- associated Bloodstream Infection (CLABSI)
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. The GAO analysis also found that payment adjustments varied significantly by hospital characteristics, with safety-net hospitals receiving smaller bonuses and larger penalties compared to hospitals overall, while small urban hospitals received larger bonuses and smaller penalties compared to hospitals overall (GAO, 2015)
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. Although the precise value modifier calculation methodology will change slightly between 2015 and 2016, for physicians in category 1, quality is assessed using a composite score covering six domains (effective clinical care, person- and caregiver-centered experience and outcomes, community/population health, patient safety, communication and care coordination, and efficiency and cost reduction)
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. End-Stage Renal Disease Quality Incentive Program To calculate facility performance, the Medicare Improvements for Patients and Providers Act requires CMS to use quality measures assessing anemia management, dialysis adequacy, and other measures specified by the Secretary of the Department of Health and Human Services regarding iron management, bone mineral metabolism, vascular access, and patient satisfaction (CMS, 2015c)
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MEDICARE VALUE-BASED PAYMENT PROGRAMS FOR HEALTH PLANS Medicare Advantage (MA) /Part C To determine payments to county-level MA plans, plans first submit a bid to offer coverage, which reflects administrative costs and profit.
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. Risk corridor adjustments limit plans' potential losses or gains by financing costs that are higher than expected or recouping profits deemed excessive (MedPAC, 2015a)
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2015c. End-Stage Renal Disease Quality Incentive Program frequently asked ques tions.
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2014. Medicare program; hospital Inpatient Prospective Payment Systems for acute care hospitals and the long-term care hospital Prospective Payment System and fiscal year 2015 rates; quality reporting require ments for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR)
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