title: An advanced look at surgical performance under Medicare's hospital-inpatient value-based purchasing program: who is winning and who is losing?
abstract: BACKGROUND
  The Centers for Medicare and Medicaid Services (CMS) is beginning to shift from paying providers based on volume to more explicitly rewarding quality of care. The hospital value-based purchasing (VBP) program is the first in a series of mandatory programs to financially reward and penalize US hospitals based on quality measure performance. Our objective was to identify the characteristics of hospitals that perform well (and those that perform poorly) on the surgical measures in CMS' hospital VBP program.
  
  
  METHODS
  Using 2008 to 2010 performance data from CMS' Hospital Compare website and the 2009 American Hospital Association annual survey, we examined surgical measure performance for all acute care general hospitals in the US. Outcomes were determined by a composite surgical performance score indicating the percentage of eligible surgical performance points that a hospital received.
  
  
  RESULTS
  There were 3,030 hospitals included in our study. Composite surgical performance scores were 15.6% lower at public hospitals than at for-profit hospitals (p < 0.01). Additionally, there were significant differences in the routes by which hospitals achieved points, with smaller hospitals, for-profit hospitals, Magnet hospitals, and NSQIP hospitals all more likely to obtain points via the achievement route.
  
  
  CONCLUSIONS
  The results of our study indicate that public hospitals perform worse on the surgical measures in the hospital VBP program. This study raises important questions about the impact that this new, mandatory program will have on public hospitals, which serve an important safety-net role and appear to be disadvantaged in the hospital VBP program. This issue should continue to be investigated as these mandatory quality programs are updated in future years.
authors.affiliation: Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL. Electronic address: jim.dupree@gmail.com.
authors.forename: James M
authors.initials: JM
authors.lastname: Dupree
authors.affiliation: Center for Healthcare Studies, Northwestern University, Feinberg School of Medicine, Chicago, IL.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Neimeyer
authors.affiliation: Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Healthcare Studies, Northwestern University, Feinberg School of Medicine, Chicago, IL.
authors.forename: Megan
authors.initials: M
authors.lastname: McHugh
mesh_terms: D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D016304:Hospitals, Private / Q000592:standards / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D006278:Medicare / Q000458:organization & administration*; D015999:Multivariate Analysis; D015397:Program Evaluation; D058996:Quality Improvement / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000592:standards*; D014481:United States; D062505:Value-Based Purchasing / Q000458:organization & administration*