Is Quality of CV Care Associated With Hospital Performance in Value-Based Care Programs?

Hospitals that receive awards for high-quality cardiovascular care from the ACC or American Heart Association (AHA) quality improvement initiatives may be less likely to receive financial incentives under federal value-based care programs, according to a study published Feb. 19 in JAMA Cardiology.

Rishi K. Wadhera, MD, MPP, MPhil, et al., looked at whether hospitals that received awards for high-quality care from the ACC or AHA were less likely to be penalized under the Hospital Readmissions Reduction Program (HRRP) or Hospital Value-Based Purchasing Program (VBP). The researchers identified hospitals participating in HRRP and VBP in 2018 using publicly available data from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. The researchers then identified hospitals in HRRP and VBP that had been recognized for providing high-quality cardiovascular care by ACC's Chest Pain – MI Registry and AHA's Get With the Guidelines-Heart Failure quality improvement programs. In addition, the researchers collected 30-day risk-standardized mortality and readmission rates for heart failure (HF) and acute myocardial infarction (AMI) for hospitals that received awards vs. other hospitals from the CMS data.

According to the results, 490 award hospitals and 2,685 other hospitals participated in HRRP in 2018, while 484 award hospitals and 2,297 other hospitals participated in VBP. Among facilities participating in HRRP, a higher proportion of award hospitals received penalties vs. other hospitals (85.5% vs. 78.7%). Under VBP, 51.7% of award hospitals received financial penalties vs. 41.4% of other hospitals, and 48.4% of award hospitals received financial incentives vs. 58.6% of other hospitals. Median payment reductions were similar among all hospitals, but median payment incentives were lower for award hospitals vs. other hospitals.

In terms of clinical outcomes, HF 30-day risk-standardized mortality rates were lower at award hospitals vs. other hospitals, while 30-day risk-standardized readmission rates did not differ significantly. For AMI, 30-day risk-standardized mortality rates were similar among all hospitals, but readmission rates were lower at award hospitals.

"Overall, these findings suggest a need to understand differences in assessments of hospital quality between AHA/ACC quality improvement initiatives and federal value-based programs and potentially standardize quality measurement for cardiovascular care across hospitals," the researchers write. They note that award hospitals may be "disproportionately penalized" under HRRP and VBP for the "patient populations and communities they serve rather than for poor quality of care." They also suggest that HRRP and VBP models do not account for clinical factors like frailty, disability, and cognitive and functional status or for social risk factors like poverty or neighborhood disadvantage.

"The study raises important questions," says ACC’s Chief Science Officer John S. Rumsfeld, MD, PhD, FACC, "but it also has significant limitations such as the cross-sectional design and differing time period used for awards reporting between the programs." The researchers also noted that the awards programs focus on a broader inpatient population than VBP and HRRP programs, which look at post-discharge and Medicare-only patients. “The findings also suggest the need to further explore the limitations of claims data when it comes to clinical and social determinants of care and outcomes," he says.

"Participation in these two performance improvement programs was associated with an improvement in outcomes," says Michael C. Kontos, MD, FACC, chair of the registry steering committee, noting that HF mortality and AMI readmission rates were lower at award hospitals. "The value of the awards programs is not reflected in overall value-based purchasing programs, which assess additional metrics not included in the award metrics ."

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Patient Readmission, Value-Based Purchasing, Medicare, Patient Discharge, Centers for Medicare and Medicaid Services (U.S.), Quality Improvement, Inpatients, Medicaid, Risk Factors, Social Determinants of Health, Heart Failure, Registries, National Cardiovascular Data Registries, Chest Pain, Chest Pain MI Registry, Myocardial Infarction


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