A reimbursement strategy implemented by the Centers for Medicare & Medicaid Services (CMS) to incentivize hospitals to improve the quality of care provided to Medicare beneficiaries. Hospitals are financially rewarded or penalized based on their performance in various quality measures.
Specific indicators used to assess the quality of care provided by hospitals. These measures encompass clinical outcomes, patient experiences, and adherence to best practices.
A numerical rating assigned to hospitals based on their performance on quality measures. This score determines the amount of financial incentives or penalties a hospital receives under the VBP Program.
A reimbursement model where healthcare providers receive financial incentives or penalties based on their performance on quality and efficiency measures. It aims to align payment with the value of care delivered.
Monetary rewards provided to hospitals that demonstrate high performance on quality measures. These incentives encourage hospitals to prioritize quality improvement efforts.
Quality measures that assess the results of healthcare interventions or services, such as patient mortality rates, readmission rates, and infection rates. Outcome measures indicate the effectiveness of hospital care.
Quality measures that evaluate the processes or procedures involved in delivering healthcare services, such as timely administration of medications, adherence to clinical guidelines, and patient education practices.
The perception of patients regarding the care they receive from hospitals, including aspects such as communication with healthcare providers, responsiveness to patient needs, and overall satisfaction with the healthcare encounter.
A statistical method used to account for differences in patient characteristics and health statuses among hospitals when comparing performance on quality measures. Risk adjustment ensures fair evaluation and avoids penalizing hospitals that serve sicker or more complex patient populations.
A multiplier applied to hospitals’ base operating Medicare Severity Diagnosis-Related Group (MS-DRG) payments to fund the VBP Program. The adjustment factor redistributes a portion of Medicare payments to reward high-performing hospitals and penalize low performers based on their performance scores.