How are Hospital CMS Star Rating & VBP Programs Co-related?


Get Personalized Hospital Specific Presentation on Unified AI Quality, Safety, Risk & Incident Software


This article is part of the Dexur Insight, which is focused on Hospital Quality and Safety topics and is read by CEOs, CMOs, CNOs, CQOs, Quality, Safety, Compliance, Analytics & Performance teams. Please email dexurqualitysights@dexur5.com to join this newsletter and receive updates (not more than once per week).

Introduction

The Centers for Medicare & Medicaid Services (CMS) Star Rating and the Value-Based Purchasing (VBP) Program are pivotal in shaping healthcare quality and reimbursement. Both programs aim to improve patient care by incentivizing hospitals based on performance metrics. This article delves into the potential correlation between a facility's CMS Star Rating and its financial impact under the VBP Program, hypothesizing that there may be a tangible link between the two.

Background

CMS evaluates hospitals on a 1 to 5-star scale based on several quality measures, including mortality, safety, and patient satisfaction. The VBP Program adjusts payments under the Inpatient Prospective Payment System based on performance in clinical outcomes, safety, efficiency, and patient experience. The interplay between these two programs is crucial, as they influence hospital reimbursement based on shared quality metrics.

Shared Quality Metrics between VBP and CMS Programs

Many of the measures highlighted by VBP programs align with those in the CMS's quality assessment initiatives, including the CMS Star Rating. Some of the shared measures include:

Dexur Analysis

Dexur’s analysis validates that CMS Star Rating and VBP program performance have a high correlation. Specifically, hospitals with higher Star Ratings (CMS 4 and 5 stars) are likely to receive positive VBP adjustments, while those with lower ratings (CMS 1 and 2 stars) may face penalties.

A detailed examination of CMS Star Ratings and corresponding VBP payouts for the year 2023 confirms that hospitals with higher star ratings tend to secure better financial returns under the VBP Program.

The table analysis indicates that hospitals with a 5-Star rating often benefit from VBP incentives, with 65% experiencing a positive impact. Conversely, 90% of hospitals rated at 1-star incur VBP penalties, clearly highlighting the correlation between star ratings and financial outcomes. This pattern supports the hypothesis of a beneficial correlation between higher CMS ratings and VBP outcomes, highlighting that hospitals with higher star ratings tend to secure better financial returns under the VBP Program. The significant overlap in the metrics used by both programs, including factors like mortality, safety, and patient experience, further substantiates the observed correlation. These metrics suggest that high CMS Star Ratings could be reliable predictors of positive VBP financial outcomes. Validating this correlation could offer crucial strategic insights for healthcare facilities aiming to enhance care quality and financial performance.

CMS Star Rating 2023 All Hospitals -2 to -1.5 Impact -1.5 to -1 Impact -1 to -0.5 Impact -0.5 to 0 Impact 0 to 0.5 Impact 0.5 to 1 Impact 1 to 1.5 Impact 1.5 to 2 Impact
1 Star 8.26% (224) 5% (11) 44% (98) 29% (65) 13% (29) 7% (15) 1% (2) 2% (4) 0% (0)
2 Star 22.71% (616) 2% (12) 26% (160) 39% (243) 17% (107) 10% (61) 4% (22) 1% (4) 1% (7)
3 Star 29.01% (787) 0% (3) 15% (120) 35% (279) 24% (187) 15% (116) 4% (30) 3% (25) 3% (27)
4 Star 25.21% (684) 0% (1) 4% (24) 23% (160) 34% (232) 23% (155) 8% (53) 4% (25) 5% (34)
5 Star 14.82% (402) 0% 0% (1) 7% (30) 27% (110) 27% (109) 18% (72) 7% (27) 13% (53)
All Hospitals 2,713 27 403 777 665 456 179 85 121

Correlation between CMS Star Rating and VBP Payout


Cross-Program Integration Capabilities of Dexur:

Dexur implements advanced AI-driven simulations to provide a detailed cross-program analysis, enhancing the understanding of how metrics from different quality programs such as CMS Star Ratings, Value-Based Purchasing (VBP), and Leapfrog are interconnected. This capability allows hospitals to simultaneously identify strategic improvements that positively influence multiple quality metrics.

Dexur’s AI-driven platform examines how the Safety measure, for example, Catheter-associated urinary tract infection (HAI-2- CAUTI), affects performance across the CMS Star Rating, VBP, and Leapfrog programs. This granular insight helps hospitals pinpoint specific areas for improvement that yield benefits across various quality assessments, optimizing overall performance.

By leveraging Dexur’s comprehensive report, healthcare providers can enhance their performance metrics in all major quality programs, leading to better patient outcomes and increased healthcare efficiency. This holistic approach identifies vital overlaps within individual programs. Also, it highlights how improvements in one area can elevate scores across multiple metrics, creating a broader impact on quality and operational excellence.