- A new study published in Health Affairs shows the federal government paid bonuses to 231 low-quality hospitals because they had a less expensive Medicare patient population.
- While the bonuses were small, rewarding hospitals with subpar quality is a notable departure from the Affordable Care Act’s intent to reward hospitals for providing high quality medical care.
- The Centers for Medicare & Medicaid Services said it may revise the program so hospitals rated below the national quality median in future years won’t receive a bonus, Kaiser Health News reported.
The study comes at a time when the ACA has been getting mixed reactions from consumers. This finding doesn't help improve the opinion that the ACA is wasteful legislation. That said, many have become insured under the measure.
CMS expanded its value-based purchasing program in fiscal year 2015 to reward or penalize hospitals based on both quality and spending. For the fiscal year ended September 2015, spending accounted for 20% of their score. Patients at the 231 low-quality hospitals cost Medicare on average $16,000, or $2,300 less than patients at other hospitals that earned bonuses.
In terms of quality, though, the 231 hospitals had higher mortality rates for heart attack, heart failure, and pneumonia than their higher-scoring counterparts, and were less likely to follow best practices for care.
Bonuses paid to those hospitals averaged 0.18% per Medicare patient stay. In all, 1,700 hospitals received bonuses last year, and most were above average for quality, the study noted.
The researchers said CMS should set a minimum quality threshold for bonuses in the hospital value-based purchasing program.
In addition to spending, CMS’ other determinants for awarding a bonus or exacting a penalty include death and infection rates, how closely a hospital adhered to recommended clinical guidelines and how patients rated their experience in discharge surveys.