​In U.S. hospitals, patient experience improved "steadily but modestly" from 2008 through 2014, but researchers found no evidence that the Centers for Medicare and Medicaid Services' (CMS) Value-Based Purchasing (VBP) program "led to meaningful gains in patient experience," states a study in the January 2017 issue of Health Affairs. In 2011, the VBP began tying Medicare payment to measures based on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a survey given to a random sample of patients after discharge. Over the study period, one global HCAHPS measure, the percentage of patients reporting a positive overall experience (a score of 9 or 10 on patients' overall assessment of the hospital in the HCAHPS survey), increased from 64% to 70%. Hospitals with the lowest overall patient experience scores as of 2008 experienced the most improvement over the study period (12 percentage points), while those with the highest baseline scores improved the least (1 percentage point). The researchers found no evidence to support the idea that implementation of the VBP program "accelerated" the trend in improvement; in fact, overall patient experience scores improved fastest before the VBP program was implemented. The researchers found similar trends even when comparing hospitals that participated in the VBP program with those excluded from VBP participation. "As value-based payment continues to be promoted, it is critical to ensure that payments are structured in ways that lead to better patient experience," the authors concluded.

HRC Recommends: Over many years now, the healthcare system, including both government and private payers, has been shifting from fee-for-service to value-based purchasing. Risk managers can aid quality assurance managers, clinical leaders, and others in ensuring the appropriate capture, transmission, and analysis of quality measures and implementing improvement activities. More broadly, healthcare organizations should stay abreast of changes in healthcare delivery and payment models and plan accordingly.