I think it's time someone checked the drinking water in Baltimore. For the second time in nearly two weeks, rule writers at the Centers for Medicare & Medicaid Services' main office issued a final rule that has — at least initially — been well received by the provider community.
A couple of weeks ago, the agency released its final regulation for Medicare's shared savings program. Provider groups and others were happy to see that the agency made significant changes from the proposed rule and there was even some optimism that providers will now be enticed to form a government-sanctioned accountable care organization.
Then, this past Tuesday, CMS released the final outpatient prospective payment rule for 2012. Tucked inside of the regulation are provisions for Medicare's value-based purchasing program, which goes into effect October 2012. Similar to shared savings, value-based purchasing represents another in the government's steps to shift Medicare away from a volume-based payer to one that rewards quality, outcomes and, you guessed it, value. The agency's proposed rule back in July drew significant criticism from the field, including the American Hospital Association, which suggested in its official comments that the rule could "undermine the intent of the (Affordable Care Act), which is to provide opportunities for hospitals to improve their performance."
Someone in Baltimore must have been listening because here is what AHA Executive Vice President Rick Pollack said in a statement about the final rule: "The key provisions in today's final rule related to value-based purchasing are good news for patients who depend on hospital care. At the AHA's urging, the Centers for Medicare & Medicaid Services revised its proposal to better reflect the intent of Congress for the inpatient VBP program under Medicare. … We commend CMS for recognizing that this process is important to protect hospitals and their patients from flawed measures that could cause unintended harm to patients or unfairly penalize hospitals."
Add to that a statement from Premier Senior Vice President of Public Affairs Blair Childs: "We appreciate CMS reversing its proposal in response to public concerns and instead adopting a measured approach in the final rule to ensure a sound and effective VBP program."
Why the high praise? Several reasons, but mainly because CMS excluded hospital-acquired condition measures, AHRQ composite measures and efficiency measures for fiscal year 2014. Those were included in the proposed regulation and were of significant concern for hospitals. In its written comments on the proposal, the AHA pointed out that the measures had not been posted to the Hospital Compare website for at least one year, which the AHA said was required by statute.
Viewing the shared savings and value-based purchasing rules under the same lens, it would appear that the agency went 2 for 2 over the past couple of weeks. The regulations seem to present an opportunity for improved care delivery. Whether they'll achieve that end is yet to be determined, but they are a break from the status quo and, from a selfish standpoint, it is nice to be writing about positive news rather than the nervousness around the so-called Super Committee and the debt reduction negotiations.
What are your thoughts about the value-based purchasing rule? Will it improve care at your hospital? Email your thoughts to firstname.lastname@example.org.