February 8, 2019

Carol Wolfenbarger: What Value-Based Purchasing in Healthcare Means to You, the Consumer

Carol WolfenbargerBy Carol Wolfenbarger
President, Mission Hospital McDowell

There are far too many technical terms and phrases that are unique to the healthcare industry that may seem technical, insignificant or confusing; but one phrase that is essential for you to understand is value-based purchasing (VBP). This care and reimbursement model for hospitals and other providers moves away from the traditional system of paying only for healthcare services provided and instead bases payment instead on whether expected targets for quality, patient experience and efficiency were actually achieved. In short, it’s a new, quality rather than quantity model that incentivizes excellent care. There are three components of VBP:

  • Care quality
  • Patient experience
  • Cost of care

These are the benchmarks that the Centers for Medicare and Medicaid Services (CMS), the federal government’s healthcare reimbursement agency, examines to determine if the services – from checkups to surgery – were provided according to evidence-based, industry standards. Whether it is the timeliness of our emergency department’s service to you, the prevention of infections, the delivery of evidence-based wellness care and screenings, preventing readmission to the hospital within 30 days, or patients’ perception of their care, all of these translate into whether a monetary bonus will be earned or a penalty applied for every hospital, including Mission Hospital McDowell (MHM).

Our goal is to exceed every benchmark because it is the right thing to do for our community and we want to be the best. Our efforts have resulted in recognition by CMS with a 5-star rating in December 2017. CMS will again update those rankings in February 2019 with a new scoring methodology. Several of the quality metrics defined by CMS for value-based purchasing are “yes or no” regarding performance – something either did happen or didn’t happen. When it comes to the perception of our care, however, performance ratings hinge upon the actual feedback provided by our patients through telephone or written surveys after they have received care. The survey feedback is then reported to CMS and it is used to calculate our score compared to our goal, benchmarked against other hospitals with a requirement for ongoing improvement.

The financial impact of the care we deliver has also been transformed by VBP which withholds a fixed percentage of our reimbursement each year; we only receive this withhold back if we achieve our targets. Even without such incentives, we are intensely focused on preventing harm, preventing unnecessary hospitalizations by focusing on your wellness, reducing the cost of care by refraining from ordering unnecessary or prescriptions, and by helping patients avoid costly sites of care like emergency departments.

How does this model affect MHM? I believe that, even before VBP was established, our providers and team members strived continuously to provide excellent care. In our case, VBP has only supported our motivation to work even harder to deliver successful and meaningful outcomes to our community. Our journey at MHM – both prior to and in the era of VBP – is focused on excellence, and we want you to feel that as a patient. Every MHM team member who interacts with a patient influences our patent experience scores, but it’s equally true and more important that they care about – not just for – our patients.

Carol Wolfenbarger, MSN, RN, FACHE, is President of Mission Hospital McDowell. She holds both Bachelors and Masters of Science degrees in nursing administration from the University of Tennessee, is board certified in Healthcare Management and is a Fellow of the American College of Healthcare Executives (ACHE). Carol, who has served hospitals and health systems for more than three decades, has worked to add full-time cardiology services, led growth in outpatient services including imaging and surgery, and the expansion of primary care offering in Burke County since assuming her role as President at McDowell Hospital in 2015. She is an active member in Rotary and serves as a Board member for the Rutherford/Polk/McDowell Health District Board of Directors, the Corpening YMCA Board of Directors, and the McDowell County Chamber of Commerce Board of Directors.

Mission Hospital McDowell