Health Watch USA Logo Value Based Purchasing (VBP)

   
Value Based Purchasing (VBP)

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1)  Clarification of the National Quality Forum Serious Reportable Events, regarding medical devices. "2B. Patient death or serious injury associated with the use or function of a device in patient care, in which the device is used or functions other than as intended."  In response, the NQF performed the following modification in the Serious Event 2B:

"Definition of device added to glossary.  Suggested addition significantly expands the event and will be considered at next update."   View Document

The definition of the term, device, was clarified so endotracheal tubes and NG Tubes will be included.  Thus, insertion of an NG tube into the lungs and feeding the patient and the placement of an endotracheal tube into the esophagus and ventilating the patient are now clearly reportable events.  

2)  Non-Payment & Value Based Purchasing of Hospital Acquired Conditions
  

Health Watch USAsm was one of the main initiators of the national CMS policy of Medicaid adopting Medicare's policy on the non-payment of hospital acquired conditions. 

HW USA was an initiator and facilitator of this initiative on a national level with activities involving conference presentations, forming partnerships with patient advocacy organizations, and advocacy on Capital Hill. This effort started in the Spring of 2008 and was promoted in the 2008 Health Watch USA fall conference.  Ken Conner, JD,  presented on Medicare and Medicaid non-payment of never events.  Lisa McGiffert from Consumer Union also presented and after the conference joined with Health Watch USA and advanced on Capitol Hill the policy of Medicaid Adopting Medicare Regulations regarding Non-payment of Never Events.   

This provision was signed into Federal law in the 2010 Healthcare Reform Bill by President Barack Obama on Tuesday, March 23, 2010. Consumer Union played a major role in advancing and advocating for this legislation.

On July 1, 2010 Kentucky Medicaid adopted regulations for the non-payment of never events and hospital acquired conditions.

   

Non-payment policy of Hospital Acquired Conditions is not Effective in Medicare's DRG Payment System

  • Letter to the editor regarding: The effectiveness of Medicare's non-payment of hospital-acquired conditions policy   Health Policy.  August 27, 2014.  http://www.healthwatchusa.org/HWUSA-Publications/PDF-Downloads/20140829-JHP-HAC-Letter.pdf 

  • Letter to the Editor Regarding "Letter to the Editor Regarding "Nonpayment for Preventable Infections in U.S. Hospitals".    New England Journal of Medicine.  2013;  Jan. 368:191-192.  PMID: 23301747   FREE ACCESS   http://www.nejm.org/doi/full/10.1056/NEJMc1213732  

  • Medicare's Payment Policy for Hospital Acquired Conditions. The Commonwealth Fund July 5, 2011.
    Read Comment

  • New CMS Valuing Based Purchasing Initiative for HACs Proposed by CMS.   Enacted Aug 22, 2014

  • 2014, June26 - Comment on CMS Proposal to Penalize Worst Performing Hospitals in HAC Prevention.
    Read Comment
     

Other Related Publications Regarding Value Purchasing:

The Certificate of Need and Reduction of Competition

In many states, permission has to be granted to build a hospital. A certificate of need must be awarded by the State to allow a new hospital to be built or for a competitor to enter into the market. Reduced competition has not been shown to save healthcare dollars. In contradistinction, a 2010 Report by Massachusetts Attorney General Martha Coakley found “Price variations are correlated to market leverage as measured by the relative market position of the hospital or provider group compared with other hospitals or provider groups within a geographic region or within a group of academic medical centers.“ http://www.mass.gov/ago/docs/healthcare/2011-hcctd-full.pdf

2006 Study by FTC and DOJ on the Certivicate of Need
Download Study:  DOJ Site   HW USA SIte

2017  Variation In the Cost of Healthcare -  Lack of Competition Leads to Higer Costs.  View Study

The following have been areas of awareness regarding the CON which Health Watch USA has undertaken:

Presentations

1. Joseph Miller, Assistant Chief, Anti-Trust Division Office of the US Assistant Attorney General. Presents on The Certificate of Need and Anti-Trust Issues. Health Watch USA Conference Nov. 13, 2009. View YouTube Video https://youtu.be/W0kB2nyB40M   PowerPoint Slides

2. Kevin Kavanagh, MD, MS. The presentation discusses how once "need" has been determined Certificates of Need should be placed up for bid with large hospital corporations and the money raised should be used to match Federal Medicaid Funds for indigent care. Health Watch USA Conference. Nov. 20, 2008. View YouTube Video https://youtu.be/QVq_1s94TGQ
CON References   PowerPoint Slides

OpEds in State Newspapers

1. Kavanagh KT. Kentucky Should Award CONs so All Hospital Systems in The State Benefit, Not Just One Medical News - The Business of Healthcare, Louisville, KY, March. 12, 2010 http://www.healthwatchusa.org/HWUSA-Publications/Op-Eds_HWUSA_PDF/20100312-CON-MedicalNews.pdf 

2. Kavanagh KT. Poor Way to Decide Who Gets Hospitals. Lexington Herald Leader. Lexington KY. Jan. 11, 2010. http://www.healthwatchusa.org/Op-Eds_HWUSA_PDF/2010-1-CON-LHL.pdf 

3. Kavanagh KT. Kentucky's Certificate of Need Process Needs Overhauling. Courier Journal. Louisville, Ky. Jan. 5, 2009. http://www.healthwatchusa.org/Op-Eds_HWUSA_PDF/2009-1-CON.pdf

4. Kavanagh KT. The CON Steals Jessamine's Health Care Access. Jessamine Journal. Nicholasville, Ky. April 12, 2007. http://www.healthwatchusa.org/Op-Eds_HWUSA_PDF/2007-5_Jessamine_CON-L.pdf

5. Kavanagh KT. Certificate of Need Unneeded. Lexington Herald Leader. Nov. 13, 2006. http://www.healthwatchusa.org/Op-Eds_HWUSA_PDF/2006-8_CON_Unneeded-L.pdf 

6. Kavanagh KT. State Blocking Competition. Lexington Herald Leader. July 31, 2006. http://www.healthwatchusa.org/Op-Eds_HWUSA_PDF/2006-7_State_Blocking-L.pdf

7. Kavanagh KT. Certificate of Monopoly. Courier Journal. June 22, 2006. http://www.healthwatchusa.org/Op-Eds_HWUSA_PDF/2006-1_KY_Health_Plan-L.pdf