VALUE-BASED PURCHASING

To support value-based purchasing reimbursement models when they are appropriately structured to improve healthcare quality, patient satisfaction, and clinical outcomes, and encourage medication error reporting and quality improvement; further,

To affirm the role of pharmacists in actively leading the design and interdisciplinary implementation of medication-related value-based purchasing initiatives; further,

To support pharmacy workforce efforts to ensure safe and appropriate medication use by using data and technology for continuous quality improvement in pharmacy-designed, medication-related value-based purchasing initiatives; further,

To advocate that the Centers for Medicare & Medicaid Services and others guide the development of a common portfolio of measures for potential alignment across regulated programs, federal programs and agencies, and the private sector. 

Rationale

Value-based purchasing is one aspect of a portfolio of healthcare reform incentives based on pay-for-performance principles. The Hospital VBP Program adjusts payments to hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of care they deliver. In April 2021, the Centers for Medicare & Medicaid Services (CMS) announced efforts to (1) readdress 2020 policies during the duration of COVID-19 public health emergency (PHE) and (2) close healthcare equity gaps and provide greater accessibility to care, requesting comments regarding the modernization of the quality measurement enterprise to digital quality measurement. In response to the pandemic, CMS established the New COVID-19 Treatments Add-on Payment (NCTAP) for eligible discharges during the PHE. To enhance the medical workforce in rural and underserved communities, CMS is proposing to distribute 1,000 additional physician residency slots to qualifying hospitals, phasing in 200 slots per year over five years. To address the future of digital quality measurement, CMS is currently reviewing proposals and holding discussions through 2022.

     CMS was seeking comment on plans to modernize its quality measurement enterprise by:

• clarifying the definition of digital quality measures;
• using the Fast Healthcare Interoperability Resources (FHIR) Standard for electronic clinical quality measures that are currently in the various quality programs;
• standardizing data required for quality measures for collection via FHIR-based application programming interfaces;
• leveraging technological opportunities to facilitate digital quality measurement;
• better supporting data aggregation; and
• developing a common portfolio of measures for potential alignment across CMS regulated programs, federal programs and agencies, and the private sector.

ASHP recognizes the pharmacist’s leadership role while explicitly acknowledging the interdisciplinary nature of initiatives designed to achieve value-based purchasing measures. Often, however, active membership on the design team does not include pharmacy. Because there needs to be thoughtful consideration of what pharmacy can reasonably control within an organization in terms of achievable tactics to improve a specific goal, pharmacy leaders need to engage their entire departments in these efforts to ensure that there is a concerted approach toward improving patient care. Finally, as value-based purchasing program proliferate, CMS and other stakeholder organizations need to guide the development of a common portfolio of measures for potential alignment across regulated programs, federal programs and agencies, and the private sector.