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The Effect of r-CABG Surgery on HCAHPS Scores and its Impact on Reimbursement for Medicare DRG’s until Financial Year 2017 (FY2017)
Sugam A. Bhatnagar, Robert S. Poston.
University of Arizona, Tucson, AZ, USA.
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Introduction:
Value based purchasing (VBP) is a strategy recently implemented by Medicare to incentivize providers to improve patient satisfaction. An important VBP metric is the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a standardized survey of patients' perspectives of hospital care that includes core clinical questions such as physician communication and pain management. The effect of innovative surgical care on VBP has not been previously investigated. Because robotic assisted, less invasive CABG (r-CABG) has been shown to improve patient satisfaction and pain control compared to the sternotomy approach, we hypothesized that r-CABG would favorably influence VBP reimbursement.
Methods:
We collected data on HCAHPS and financial charges of 190 consecutive Medicare patients undergoing r-CABG by a single surgeon over a period of 9 months to evaluate the effect of HCAHPS on the VBP reimbursement. We did a relative analysis of the revenue gained on the basis of attainment of HCAHPS scores (achievement of rating) for r-CABG. Given that 98% of cardiac surgical patients at our hospital achieved full credit for the clinical metrics of VBP, HCAHPS rankings played a determining role in VBP reimbursement.
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Results:
Direct Medicare revenue for these 190 patients was \,401,878.32 over the study period. Therefore, the incentive pool attributed to HCAHPS was \,205.63 (0.3%). Those HCAHPS questions that were most influenced by r-CABG (#2, 4-6, 8, see table) achieved >95% percentile and were therefore eligible for full reimbursement. The total amount of reimbursed money from VBP was \,238 for FY2013 and would increase to \,476 by FY2017.
Table 1: HCAHPS domain scores (ID xxxxx)
Conclusion:
The r-CABG patients’ satisfaction scores are likely to translate into significantly more revenue for the hospital. These incentives could play a much bigger role over the coming years when other private payers incorporate VBP strategies and less invasive cardiac surgery becomes commonplace.
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