What does value-based purchasing have to do with accreditation? Turns out, a lot.
According to the Centers for Medicare and Medicaid Services, "Hospital Value-Based Purchasing (VBP) is part of the Centers for Medicare & Medicaid Services' (CMS') long-standing effort to link Medicare's payment system to a value-based system to improve healthcare quality, including the quality of care provided in the inpatient hospital setting. Participating hospitals are paid for inpatient acute care services based on the quality of care, not just quantity of the services they provide."
With the systemic institution of Value-Based Purchasing (VBP), healthcare organizations are finding themselves excluded from certain Medicare and Medicaid reimbursements and bonus funds based on existing Immediate Jeopardy findings, which for some organizations, can be in the multi-million dollar range.
This puts accreditation specialists directly in the spotlight... or the bull's-eye.
This VBP focus will turn quality and accreditation into an important function for CFOs. For the first time, we see accreditation directly tied to financial outcomes, good and bad, on how organizations do on quality indicators and compliance with CMS and accreditation.
This has the potential to mean accreditation—a role often banished to the basement, proverbially or literally in some organizations—could get more attention from the C-suite than ever before.
For the first time in response to a CMS event, I am, in my capacity as managing director of Compass Clinical Consulting, now speaking with CEOs and CFOs.
Accreditation has, for a long time, been a matter of "doing the right thing." And doing the right thing is important, but it is hard to put a dollar value on. We all know it's intrinsically a cost-effective thing. Poor quality is expensive, and good quality is not.
Items like 30-day readmissions and healthcare-acquired infections eat away at the bottom line, and Immediate Jeopardy incidents can cause problems in terms of public relations. But with VBP, there are now bonus dollars available for organizations who do well, and penalty dollars for hospitals who do poorly in these areas, which makes quality and compliance even more important for hospitals trying to maintain their bottom line.
This requires accreditation professionals—long the advocates for the importance of compliance and improvement—to alter their message slightly to speak to the C-suite in a convincing way.
Clever people in the quality and accreditation function will say, "Let me show you this is not just the way of the angels—it's the way of the checkbook."
VBP is not a future issue. It's a now issue. For example, the period of time for an Immediate Jeopardy finding to disqualify an organization from VBP is much longer than previously recognized. CMS is counting the very earliest date of measurement to the very latest date of measurement. You can have a qualifying event that throws you out for Fiscal Year 2017 occurring anywhere from 2013 to 2015, and the VBP rates in 2017 are even higher. It's a complex business with serious dollars attached.
How could an accreditation specialist approach VBP as a positive tool? The first thing I'd do is make sure my senior leaders are clearly aware of the relationship between our findings and the impact on hospital VBP. I'd make sure everyone understands that if you have two Immediate Jeopardy findings in that timeframe, you lose your ability to participate in the bonus program.
It doesn't matter how well the hospital performed in other areas. You may have been absolutely stellar in other areas, but you don't get to "play" if you have two Immediate Jeopardy findings.
There is quite a bit the accreditation department or specialist can act upon to help make sure this doesn't happen, however.
First and foremost: get senior leadership on board. Round up the chief executive, financial, medical, nursing officers, and more and make sure they're aware this is happening.
And next: redouble your CMS compliance focus.
That's where this is. It's not The Joint Commission. CMS are the people who pay the money and the people who can choose not to pay the money. Focus on your organization's CMS compliance.
You need to be able to measure compliance with CMS requirements to make sure your organization is in good shape. While there is an enormous amount of overlap between Joint Commission standards and CMS Conditions of Participation (CoPs), there are areas where there isn't the same degree of rigor as there is in the CoPs. And where accrediting bodies have the option to be educational and cooperative with organizations to help them improve as a result of their survey, CMS is much more black and white.
Either you complied, or you didn't. There are no shades of gray in their assessment process.
CMS has often been seen as the "tough cop" in terms of compliance, but now, with VBP, there is a financial bite that wasn't there before.
The old threat for doing poorly during a CMS survey was an Immediate Jeopardy finding, with the ultimate threat of having your participation number revoked. Now it's not just the cost of addressing whatever the deficiency is—suddenly it's the CEO's problem. The organization is going to be penalized or there are a series of rewards you won't get.
Not that the C-suite has been immune to quality indicators entirely. There has been a growing trend for leaders to be evaluated on some quality indicators, such as patient satisfaction scores, Core Measures, or other external assessments of quality.
But when you add money to it, the loss of payments or penalties, that's got their attention. That potential loss over the next three years could be the entire margin for some organizations.
This is not just a middle-management issue; this requires C-suite attention.
And, it really just boils down to this. Poor quality is expensive. Good quality isn't.
Kate Fenner has more than 35 years of experience in senior healthcare leadership roles in university, regional, state and national organizations. Throughout her career, she has worked with and presented to hospitals on a variety of regulatory topics including performance improvement, leadership standards, human resources management, root cause analysis and board involvement in quality. In addition, she has led and participated in dozens of mock surveys to help healthcare organizations meet the standards and expectations of regulatory bodies such as The Joint Commission, CMS and state departments of health.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.