By: Debasish Choudhury  Apr. 07, 2021
UNM Hospital, Albuquerque, NM, reported a CMS Value Based Purchasing (VBP) adjustment factor of 0.992 in the year 2021, which could result in an estimated penalty of $357,258. Medicare Spending Per Beneficiary (MSPB) accounts for 25% of overall VBP score and is a significant factor in driving VBP payments. MSPB costs include the costs from 3 days before hospitalization, index hospital stays, and 30 days post-discharge. The measure score of the Efficiency & Cost Reduction domain for UNM Hospital during the period was 0/10. Dexur is an approved purchaser of CMS Medicare claims data and based on our simulator, we estimate that UNM Hospital can avoid VBP penalties by reducing MSPB Cost by 9.7%.
UNM Hospital’s average MSPB cost per episode (risk adjusted and price standardized) for the period of January 2019 to December 2019 was $23,137.The average cost of post Index Stays was $12,095 with a total of 2,263 episodes.
UNM Hospital can achieve the break-even VBP adjustment factor of 1 by earning 4 points in MSPB and thereby avoid VBP penalties to achieve break even. Hospitals need to reduce post Index hospitalization costs to meet these MSPB reduction targets. Dexur’s simulator has identified four main levers and estimated reduction in each of these levers to reduce MSPB to the target levels and ultimately achieve a positive MSPB score:
Reduction in rehospitalizations: 43% shift can cause 6.2% reduction in MSPB cost and impacts 249 episodes.
Shift from SNF discharge to home: 43% shift causes 1.9% reduction in average MSPB cost and impacts 156 episodes.
Shift from SNF discharge to Home Health Agency: 43% shift causes 1.4% reduction in average MSPB cost and impacts 156 episodes.
Shift from Home Health Agency to Home: 43% shift results in 0.1% reduction in average MSPB cost and impacts 36 episodes.
In Summary, the four levers impact 597 episodes and reduce MSPB costs by 9.7% and improve the MSPB performance rate to 0.94. This increases the VBP adjustment factor to 1.0 and helps attain a perfect break even.
A higher reduction in Post Index stay costs can further improve VBP incentives. For example, a 55% reduction in post index stay costs can reduce the average MSPB cost by 12.4%, and earn a VBP Adjustment Factor of 1.0017, thereby achieving an incentive of $76k.