​Although hospitals have been subject to the Hospital Value-Based Purchasing (HVBP) program for Medicare reimbursement since 2013, the quality of care they provide has not improved at a significantly different rate from hospitals not subject to value-based purchasing, according to a study in the June 15, 2017, New England Journal of Medicine. The authors used Hospital Compare data to compare HVBP-participating hospitals with critical access hospitals, which do not participate in HVBP. They examined data for these hospitals related to patient experience, clinical processes, and 30-day mortality from acute myocardial infarction, heart failure, and pneumonia. For almost all measures, hospitals in both groups improved at similar rates. The only measure that yielded worse results was 30-day mortality among heart failure patients; this measure saw a similar change for both groups of hospitals. HVBP-participating hospitals outperformed their counterparts only in the reduction in 30-day mortality for pneumonia patients, with HVBP-participating hospitals improving their mortality by a statistically significant 0.43 percentage points more than nonparticipating hospitals. Arguing that HVBP has thus produced "little tangible benefit over its first four years," the authors propose development of alternative incentive programs, including those that offer larger financial incentives.

HRC Recommends: The study's results are similar to those reported in 2015 by the U.S. Government Accountability Office (GAO), which found little improvement in quality in participating hospitals but a more significant financial impact on safety net hospitals than others (see HRC Alerts, October 7, 2015: No Increase in Quality from Value-Based Purchasing). Unlike GAO's analysis, however, the current study found increases in overall quality, but that the improvements were not dependent on participation in HVBP. As the authors suggest, efforts to tie reimbursement to outcomes are only expected to continue to be introduced. Risk managers, quality assurance managers, clinical leaders, and others involved in quality measurement and reporting must not only understand the measures they are required to report but must also ensure that data to fulfill those requirements is being captured and transmitted appropriately.