Fist full of dollarsShow Me the Money: A Closer Look at Dollars at Risk

Come October 2016, we’ll feel the brunt of Medicaid and Medicare “pay for performance” changes. By then, as much as 6 percent of all payments will be initially withheld – and only earned back if hospitals score well on a number of quality, safety and value measures. The chart below shows what’s at stake for Strong Memorial.

Buzzword

In a Nutshell…

Date ‘Full Risk’ Phased In

Percentage of Gov’t Revenue at Risk

Dollars at Risk

Value-Based Purchasing

Rewards/penalizes hospitals that score well on core quality, safety and efficiency measures.

 Oct. 2016

-2% to +2% (Best performers will be repaid up to twice their initial withholding; worst hospitals lose it entirely.)

$4.8M (At best, we stand to gain $2.4M in incremental revenue; at worst, we could lose that much.)

Readmissions

Penalizes hospitals with high rates of re-hospitalized patients (persons readmitted FOR ANY REASON within 30 days after discharge).

Oct. 2014

-3% to 0%

$3.6M

Hospital-Acquired Conditions

Penalizes hospitals (lowest-performing quartile) who do the worst job warding off avoidable complications (e.g.,surgical-site infections, pressure ulcers).

Oct. 2014

-1% to 0%

$1.2 M

TOTAL (by Oct. 2016)

$9.6M at stake annually

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