Hospital Value-Based Purchasing Program

The Hospital Value-Based Purchasing (VBP) Program is part of our ongoing work to structure Medicare’s payment system to reward providers for the quality of care they provide. This program adjusts payments to hospitals under the Inpatient Prospective Payment System (IPPS), based on the quality of care they deliver.

How does the Hospital VBP Program work?

Hospital performance on quality and cost measures is linked to the IPPS. The IPPS makes up the largest share of Medicare spending, affecting payment for inpatient stays in approximately 3,000 hospitals across the country.

The hospital VBP Program rewards acute care hospitals with incentive payments based on the quality of care they provide, rather than just the quantity of services they provide. The statutory requirements of the Hospital VBP Program are set forth in Section 1886(o) of the Social Security Act. The program uses selected measures that were first specified under the Hospital Inpatient Quality Reporting (IQR) Program.

Hospital VBP Program Reports

The Centers for Medicare & Medicaid Services (CMS) provides hospitals with reports reflecting the Hospital Value-Based Purchasing (VBP) program’s impact for each fiscal year (FY).

CMS provides the Baseline Measures Report and Percentage Payment Summary Report to hospitals each fiscal year. The Baseline Measures Report (Baseline Report) allows providers to access their baseline period results and the performance standards for the measures included in the Hospital VBP Program. The Percentage Payment Summary Report (Performance Report) allows providers to access their baseline period results, performance period results, performance standards, measure scores, domain scores, Total Performance Score, and the value-based incentive payment adjustment factor that will be applied each Medicare patient discharge in the fiscal year.

CMS anticipates the upcoming fiscal year Percentage Payment Summary Report to be available by August 1, prior to the start of the same fiscal year.

Reports are available on the Hospital Quality Reporting (HQR) Secure Portal- Opens in new browser tab.

CMS also provides hospitals with a Mortality and Complication Hospital-Specific Report (HSR) and a Medicare Spending per Beneficiary (MSPB) HSR for each fiscal year’s performance period. The HSRs are provided so that hospitals may review and request correction to the calculations of the performance period measure results prior to the results being used to calculate a hospital’s Total Performance Score during a 30-day review and correction period. Reports are delivered to hospitals at the start of the 30-day review and correction period through CMS’s Managed File Transfer (MFT) tool.

Hospital VBP Program value-based incentive payment adjustment factors

Hospital Value-Based Purchasing (VBP) is funded through a reduction from participating hospitals' Diagnosis-Related Group (DRG) payments for the applicable fiscal year. The money that is withheld is redistributed to hospitals based on their Total Performance Scores (TPS), as required by statute, and the actual amount earned by hospitals will depend on the actual range and distribution of all eligible/participating hospitals' TPSs. A hospital may earn back a value-based incentive payment percentage that is less than, equal to, or more than the applicable reduction for that program year.

We update the value-based incentive payment adjustment factors in Table 16B that applies to that year and which is available on CMS.gov. We publicly post Hospital VBP Program results during the January refresh update to Care Compare and the Provider Data Catalog.

You can find past Hospital VBP Program value-based incentive payment adjustment factors as posted in Table 16B:

The payment adjustment factors are listed by CMS Certification Number (CCN). If you don’t know your hospital's CCN, you can look it up.

Hospital VBP Program regulations & notices

In developing Hospital Value-Based Purchasing (VBP), the Centers for Medicare & Medicaid Services (CMS) conducted extensive research and stakeholder outreach. Information outlining Hospital VBP was published in the CMS Final Rules.

Among other topics, these final rules include details on:

  • program structure, including quality and cost measure categories ("domains")

  • quality and cost measures selected for the program

  • criteria for participating and non-participating hospitals

  • periods of performance for quality measurement

  • performance standards for all quality measures

  • scoring methodology

Baseline period means the time period during which data are collected for the purpose of calculating hospital performance on measures to establish the improvement thresholds for each measure with respect to a fiscal year.

Performance period means the time period during which data are collected for the purpose of calculating hospital performance on measures with respect to a fiscal year.

Policy and Regulation Revisions in Response to the COVID-19 Public Health Emergency Interim Final Rule with Comment Period (COVID-19 IFC)

On August 26, 2020, we issued the COVID-19 IFC, which amended the Extraordinary Circumstance Exception (ECE) announced for the Hospital VBP Program in a press release dated March 22, 2020, and a guidance memo (PDF) issued March 27, 2020.

CMS has granted exceptions and extensions for certain deadlines under its ECE policy to assist health care providers who are directing their resources toward caring for patients and ensuring the health and safety of staff. In some instances, CMS granted the exceptions and extensions because the provider’s response to COVID-19 may greatly impact collected data and that data should not be considered in a CMS quality reporting or pay-for-performance program. In other instances, the deadlines for data from clinical months and discharges prior to the COVID-19 public health emergency declaration fall during March, April, and May 2020.

 

Page Last Modified:
10/07/2022 04:25 PM