Value-based Metrics Penalize Top-Performing Hospitals

Hospitals recognized for high-quality cardiac care are more likely to be penalized under value-based programs than other hospitals.

No good work goes unpunished.

Hospitals that are recognized for high-quality cardiac care are also more likely to be penalized under value-based payment models, according to a new study in JAMA Cardiology.

Researchers at Beth Israel Deaconess Medical Center in Boston found that hospitals awarded by the American Heart Association and American College of Cardiology for their high-quality care for acute myocardial infarction and heart failure were more likely to be financially penalized under value-based programs than other hospitals.

 "Our findings highlight that evaluations of hospital quality for acute myocardial infarction and heart failure care differ between AHA/ACC national quality improvement initiatives and federal value-based programs," said study lead author Rishi Wadhera, MD, an investigator at BIDMC's Smith Center for Outcomes Research.

"Hospitals recognized by the AHA/ACC for high quality care were more likely to be financially penalized by federal value-based programs than other hospitals, despite achieving similar and/or better outcomes," Wadhera said.

The findings show that federal incentives are not aligned with prevailing medical consensus on what constitutes appropriate cardiovascular care.

The Hospital Readmissions Reduction Program slaps financial penalties on hospitals with high 30-day readmission rates, while the Hospital Value-Based Purchasing Program rewards or penalizes hospitals based on their performance on multiple domains of care, including 30-day mortality.

Both programs have focused on heart failure and AMI because their clinical and financial burden.

The BIDMC researchers looked at some award-winning hospitals and found they were also more to be penalized by the HRRP and VBP compared with other hospitals. The award hospitals were also less likely to see reimbursement increases by the VBP and saw higher median payment reductions and lower payment increases under the VBP than other hospitals.

The researchers suggested that the award hospitals are being penalized by the value-based programs for factors unrelated to the quality of care. The award hospitals were larger, urban, teaching hospitals with a poorer, sicker, more complex patient mix.

That fragile patient mix not taken into consideration by risk-adjustment models used for value-based programs, which means that award hospitals could be getting penalized for the populations they serve rather than for the quality of the care delivered.   

 "As the shift to value-based care continues in the United States and as multiple bodies simultaneously assess hospital systems, we need to prioritize efforts to promote fair, equitable and standardized measurement of cardiovascular care quality," Wadhera said.