The Hospital Value Based Purchasing Program is designed to improve the quality, efficiency and safety of care that Medicare beneficiaries receive during acute care inpatient stays as well as improve their experience. A summary of the Hospital Value Based Purchasing Program for fiscal year 2021 is available here.
Wisconsin hospitals continue to see an increase in the number of hospitals qualifying for higher-level payment bonuses. Additionally, 49 eligible Wisconsin hospitals—more than 80%--received a bonus payment from this program.
Through the Hospital-Acquired Conditions (HAC) Reduction Program, CMS reduces payments to hospitals based on their performance on measures of hospital-acquired conditions. CMS evaluates overall hospital performance using total HAC scores. Hospitals with total HAC scores in the worst-performing quartile receive a 1% payment reduction on their overall Medicare fee-for-service payments for fiscal year 2021 discharges. A fact sheet related to the Hospital-Acquired Condition Reduction Program is available here.
For fiscal year 2021, 13 Wisconsin hospitals received a penalty—or 20% of those eligible—a reduction from 18 Wisconsin hospitals penalized in fiscal year 2020.
The Hospital Readmissions Reduction Program reduces payments from CMS to hospitals with excess readmissions. According to CMS, the program is designed to improve communication and coordination to better engage patients and caregivers in post-discharge planning. A fact sheet related to the Hospital Readmissions Reduction Program is available here.
Payments within this program may be reduced by up to 3%, depending on the performance outcomes for each of the six identified measures. Seventeen Wisconsin hospitals will receive no penalty this year (27% of eligible hospitals). Nationally, this remains an area of focus, and Wisconsin performs higher than the national average.