Since 2004, the Centers for Medicare and Medicaid Services (CMS) have offered a reimbursement premium to hospitals that submit quality data. The 2010 Affordable Care Act brought both a carrot and a stick to hospital quality reporting in the form of Value-Based Purchasing (VBP), a mandatory “pay or play” program that pays hospitals based on the quality, rather than quantity, of their care. On a national level, VBP is budget-neutral, meaning that the amount of reimbursement premiums given must match up with the amount of penalties levied.

In 2013, CMS will establish one overall VBP quality score for each participating hospital based on data collected under Medicare’s Hospital Inpatient Quality Reporting (IQR) program. IQR measures inpatient quality using two factors: the hospital’s process of care and the patient’s experience of care.

Patient experience, which accounts for 30% of the VBP score, requires that:

• Nurses always communicated well
• Doctors communicated well
• Patients always received help quickly from hospital staff
• Staff always explained medicines before giving them to patients
• Patients given definitive information about what to do during their recovery at home

Thus, quality engagement with patients is now critical to receiving reimbursement premiums from Medicare. Further, as with the CMS Readmission Reduction program, many commercial health plans intend to follow in Medicare’s footsteps and introduce value-based purchasing arrangements in their hospital contracts. Therefore, hospitals that are actively implementing patient engagement initiatives will be well positioned to profit from VBP.

Axial helps hospitals improve the patient experience by:

• enabling doctors and nurses to communicate the right information to the right patient every time
• zeroing in on patient concerns in real time
• allowing patients to learn at their own pace
• educating patients on the purpose of their medication
• giving patients a head start on managing their recovery and aftercare