Research confirms that hospitals using evidence-based practice support for nurses at the point of care deliver better outcomes – a requirement in an era of value-based care, and a key measure for reimbursement under Medicare’s Hospital Value-Based Purchasing Program.
The juggling act between cost and outcomes is best illustrated in the context of Medicare’s Hospital Value-Based Purchasing (VBP) program, which rewards higher-performing hospitals with incentive payments and penalizes lower-performing hospitals. It’s a potential loss few hospitals can afford, creating a make-or-break situation for long-term financial sustainability.
The Hospital VBP program, established by the Affordable Care Act, implements a pay-for-performance approach to the payment system that accounts for the largest share of Medicare spending – affecting payment for inpatient stays in approximately 3,000 hospitals across the country.
And the financial pressures will only intensify as the Department of Health & Human Services (HHS) expects 50% of traditional fee-for-service Medicare payments to make the transition to value-based payment models by 2018.
Under the VBP program, hospitals are assessed based on:
- How well they perform on each measure; or
- How much they improve performance on each measure compared to performance during a baseline period.
VBP measures are grouped into specific quality domains that tend to vary year-to-year; in 2017, those categories included: (1) clinical process of care, (2) patient experience, (3) patient outcomes, (4) efficiency, and (5) patient safety through the use of an achievement threshold and benchmark to measure clinical effectiveness.
In terms of overall performance, multiple studies have confirmed what most in the industry have observed in practice: that access to evidence-based care information at the bedside improves both hospital performance and patient outcomes, which translates into overall better scores or ratings.
A recent wide-scale study conducted by the Rockburn Institute found that hospitals that provide nurses with the latest evidence-based nursing procedures at the point of care, combined with real-time step-by-step guides for skills, had a significantly higher Total Performance Score than the national average when VBP and financial data from The Centers for Medicare and Medicaid Services (CMS) were compared.
For fiscal year 2017, high performing healthcare organizations have an average percent rank for VBP Total Performance Score that is 24.5% better than those that don’t use evidence at bedside. The findings support that the best available evidence helps inform clinical decision making at the point of care, which not only improves patient outcomes, but in turn, drives Medicare reimbursement by CMS.