Medicare's VBP Has Led to Little Meaningful Gains in Patient Experience

Patient experience with healthcare has been given greater priority over the last decade and evidence has shown that high patient satisfaction is associated with high quality of care. CMS has tried to improve patient experience by tying payments to performance as part of the Value-Based Purchasing (VBP) program; however, a paper published in Health Affairs found no evidence that the program has had a beneficial effect.

Through the VBP, hospitals are rewarded for a high rank or for improving on patient experience metrics.

“Has patient experience improved over time and, if so, by how much?” asked the authors. “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 used the national Hospital Consumer Assessment of Healthcare Providers and Systems scores for 2008 to 2014. Throughout this study period, overall experience ratings increased by 6.1 percentage points for all hospitals. Overall, patient experience improved at a faster rate before the VBP patient experience measurement period began.

Hospital characteristics played a role. For instance, 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 ones. But after the intervention, there was a decrease in improvement across all characteristics, with the exception of public hospitals, the authors found.

They also determined that hospitals with the lowest baseline performance improved the most over the study time period, while hospitals with the highest baseline performance improved the least.

“This narrowed the gap between high and low performances from 25 percent to 15 percent,” the authors wrote.

Ultimately, the researchers determined that Medicare’s VBP program did not accelerate the improvement of patient experience more than the improvements that were already occurring in the industry. They were unsure why the VBP program has not sped up the improvement efforts and why the rate of improvement has slowed.

“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.”