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Limited Change With Hospital Value-Based Purchasing Program

WEDNESDAY, June 14, 2017 -- The Hospital Value-Based Purchasing (HVBP) program, started in 2013, has not improved clinical-process and patient-experience measures, according to a study published in the June 15 issue of the New England Journal of Medicine.

Andrew M. Ryan, Ph.D., from the University of Michigan School of Public Health in Ann Arbor, and colleagues examined whether quality improved more in acute care hospitals exposed to HVBP than in control hospitals. Measures of quality included composite measures of clinical process and patient experience (measured in units of standard deviation [SD]), and 30-day risk-standardized mortality among patients admitted for acute myocardial infarction, heart failure, and pneumonia.

The researchers found that the improvements in clinical-process and patient-experience measures were not significantly greater for HVBP-exposed hospitals versus control hospitals (difference-in-differences estimates, 0.079 SD [95 percent confidence interval, −0.140 to 0.299] and −0.092 SD [95 percent confidence interval, −0.307 to 0.122], respectively). For patients admitted for acute myocardial infarction or heart failure, HVBP was not associated with a significant reduction in mortality (difference-in-differences estimate, −0.282 percentage points [95 percent confidence interval, −1.715 to 1.152] and −0.212 percentage points [95 percent confidence interval, −0.532 to 0.108]); patients admitted for pneumonia had a significant reduction in mortality (−0.431 percentage points [95 percent confidence interval, −0.714 to −0.148]).

"HVBP was not associated with improvements in measures of clinical process or patient experience and was not associated with significant reductions in two of three mortality measures," the authors write.

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Posted: June 2017

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