Dexur Value Based Purchasing (VBP) Program

Medicare Spending per Beneficiary (MSPB)

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MSPB is the sole metric used to calculate the Efficiency and Cost reduction domain in the VBP program. It measures the cost to Medicare for services performed by healthcare providers. The costs incurred from 3-day prior admission period to 30-day post-discharge is used to calculate the MSPB costs. In order to calculate the MSPB for each hospital, Dexur determined the time frame of the spending per beneficiary episode during which Medicare payments would be aggregated and the type of Medicare payments to be aggregated over this time frame.

Clinical Outcomes: Mortality Analytics

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The mortality rate is an important metric that has a significant weightage in different CMS programs. It weighs 22% in the CMS Star Rating program and 25% in the VBP program under the Clinical Outcomes domain. Dexur provides the mortality rates for different time periods at DRG levels to help hospitals understand their performance. Hospitals can give special attention to conditions that have a high mortality rate and come up with specific treatment plans to improve their score. Only certain conditions are taken into account in calculating the mortality score for VBP and Star Rating program.
  • AMI 30 Day Mortality Rate
  • CABG 30 Day Mortality Rate
  • COPD 30 Day Mortality Rate
  • Heart Failure 30 Day Mortality Rate
  • Pneumonia 30 Day Mortality Rate
  • Stroke 30-day Mortality Rate
  • Death rate among surgical inpatients with serious treatable complications

Hospital Acquired Conditions and Safety Measures

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Safety is another important metric that impacts multiple CMS programs. The safety measure forms an integral part of VBP program contributing 25% to it. The metric also weighs 22% in the star rating program. The metric is used to assess the safety aspect of hospitals and prevent the occurrence of infections during the inpatient stay.

Patient Experience - HCAHPS

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CMS uses the HCAHPS score to calculate the Personal and Community Engagement domain in the VBP program and Patient Experience in the star rating program. CMS developed a standardized survey of patient’s healthcare experience in collaboration with AHRQ (Agency for Healthcare Research and Quality). The survey is comprised of 27 questions that measure a patient’s experience with:
  • Communication with healthcare service providers
  • Information about medicines
  • 3-item care transition
  • Responsiveness
  • Hospital hygiene
  • Discharge information
  • Overall rating of the hospital