Value-based purchasing is a pay-for-performance program that affects a significant—and growing—percentage of Medicare reimbursement for medical providers. It ties reimbursement directly to how well a provider meets a specific set of quality and cost standards. This represents a significant shift in Medicare reimbursement: from volume to value.
Today, Medicare VBP has been expanded to include inpatient hospital services, as well as services that physicians provide Medicare patients. The Affordable Care Act (ACA) requires that VBP also be extended to nursing homes, home health care, and ambulatory surgery centers, among others. VBP is also part of a much broader trend in reimbursement among public and private payers that makes providers more financially accountable for the quality and cost of care they provide.
What are the basics of VBP? How is VBP for hospitals different than VBP for physicians? What is the private sector doing? This chapter provides answer.