Using patient experience scores to determine payment works within value-based purchasing

Using patient experience scores from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is working as intended within CMS’s Value-Based Purchasing (VBP) program, according to a study published in the journal Health Affairs.

The study, led by RAND Corporation’s senior principal researcher in health, Marc N. Elliot, examined how reimbursement for more than 3,100 hospitals was affected by the three components of the patient experience score: achievement, improvement and consistency. FY2015 data was used by the HCAHPS survey to determine 30 percent of a hospital's VBP payment. The study also examined how the scores impacted hospitals that served a higher percentage of non-white patients.

The achievement component, intended to be the most influential of the three within HCAHPS, had the biggest effect on payments, with Elliot and his coauthors writing it “accounted for 96 percent of the differences among hospitals in total HCAHPS."

For hospitals serving more minority patients, the consistency points were most beneficial, as all high-minority hospitals had lower overall HCAHPS scores than predominantly white hospitals.

“Although HCAHPS scores are adjusted for a variety of patient characteristics, including socioeconomic status, racial/ethnic minorities are still more likely to receive care from lower-performing hospitals,” Elliot and his coauthors wrote. “This results in a negative association between a hospital’s proportion of minority patients treated and its HCAHPS scores, including achievement points. Our analyses indicate that improvement points, and to a lesser extent consistency points, are merit-based means of lessening this negative association.”

While the study concluded HCAHPS scores with VBP are largely having their desired effect, Elliot and his coauthors did caution CMS about “unintended consequences” in having multiple Medicare incentive programs where payments are reallocated across providers, saying  “by 2017, 6 percent of hospitals’ payments will be based on the three pay-for-performance programs” of VBP, the Hospital Readmissions Reduction Program and the Hospital-Acquired Condition Reduction Program.