Value-Based Purchasing Program Failed to Increase Medicare Patient Satisfaction

In a recent paper published in Health Affairs, researchers examined trends in multiple measures of patient satisfaction over 6 years to determine the impact of the Center for Medicare and Medicaid Service’s (CMS) most recent strategy—tying payments to performance under the value-based purchasing (VBP) program—but found no evidence that the program has a beneficial effect (Health Aff [Millwood]. 2017;36[1]:133-140).

Hospitals that are in the VBP program are rewarded for a high rank or for improving on patient experience metrics. Often times patient experiences with health care has been given top priority, and evidence has shown that high patient satisfaction leads to higher quality of care.

To determine patient satisfaction, the researchers used the national Hospital Consumer Assessment of Healthcare Providers and Systems scores from 2008 to 2014.

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“Has patient experience improved over time and, if so, by how much?” Irene Papanicolas, PhD, assistant professor of health economics in the department of social policy at the London School of Economics, and colleagues asked in their study. “Did implementation of the VBP program have a measurable effect on patient experience? And finally, did certain types of hospitals (for example, poor performers at baseline or major teaching hospitals) see greater improvements than other types of institutions under the program?”

The researchers found that hospital characteristics were correlated to how well patient’s perceived their care. They determined that:

• small hospitals had a greater improvement after the intervention compared with larger ones;
• hospitals in the Northeast improved more than other regions; and,
• rural hospitals improved more than urban settings.

However, following the intervention, a decrease in improvement across all characteristics, with the exception of public hospitals, was recorded.

According to the results of the study, the overall experience ratings during the time of the study increased by 6.1 percentage points for all participating hospitals. Notably, the overall patient experience improved at a faster rate prior to the VBP patient experience measurement period began. Additionally, researchers found that hospitals with the lowest baseline performance improved the most, while hospitals with the highest baseline performance improved the least.

According to the authors their findings, “narrowed the gap between high and low performances from 25 percent to 15 percent.”

The researchers concluded that Medicare’s VBP program did not improve overall patient experience any faster than the improvements that were already occurring in the industry.

“Our study suggests that as value-based payment continues to be promoted, it is critical to ensure that payments are structured in ways that lead to better patient experience,” the authors concluded. “Alternative approaches—such as using stronger incentives or more narrowly focused metrics—are needed to clarify how to improve the experience of patients in US hospitals.”

—Julie Gould