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Medicare’s Hospital Value-Based Purchasing (VBP) Program Shows VBP Programs Might Need Health Equity Adjustments

A Closer Look at the Impact of Medicare's Value-Based Purchasing on Racial Health Disparities

January 17, 2024  – A recent study of Medicare’s Value-Based Purchasing Program reveals a concerning trend, especially among Black adults facing acute medical conditions. The program, designed to incentivize hospitals by linking financial rewards or penalties to patient outcomes, has shown higher thirty-day mortality rates for acute myocardial infarction and pneumonia at hospitals with higher shares of Black patients.

This disparity is most apparent in the treatment of acute myocardial infarction and pneumonia. The study period spanned from 2008 to 2018 and found that while 30-day mortality rates for these conditions decreased overall, the rate of decrease was slower in hospitals with a higher concentration of Black patients. 

The findings for the Medicare Hospital Value-Based Purchasing Program are stark. Before the program’s implementation, mortality rates for acute myocardial infarction at hospitals with a high proportion of Black patients were decreasing. However, post-implementation, this decrease slowed down significantly. In contrast, other hospitals continued to see a more consistent decline in mortality rates.

The situation with heart failure was somewhat different. Both sets of hospitals – those with a high proportion of Black patients and others – showed similar trends in mortality rates, indicating no significant differential impact of the program in this area.

The most concerning data emerged in the case of pneumonia. Before the program, mortality rates were rising in hospitals with a high proportion of Black patients. After the program’s implementation, although there was a decrease, it was not enough to close the gap with other hospitals. In fact, the gap in mortality rates between the two groups of hospitals widened, highlighting a glaring issue in the program’s effectiveness in addressing health disparities.

One reason for this, could be that hospitals serving a higher proportion of Black patients are already often grappling with limited resources and the lingering effects of structural racism. They find themselves at a disadvantage from the start, which makes the implications of these findings profound. Penalizing hospitals serving a higher proportion of Black patients under the Value-Based Purchasing Program could show a failure to consider the social and economic challenges these hospitals and their patients face.

“As CMS considers ways to advance health equity, strategies beyond paying for performance may be required to improve outcomes at resource-constrained hospitals that care for racial and ethnic minority populations, particularly given our finding that mortality rates for acute myocardial infarction and pneumonia remain higher at sites caring for a high proportion of Black adults compared with other hospitals, whereas site-based inequities in outcomes for pneumonia have actually widened among Black adults,” researchers wrote.

In the face of these challenges, the pursuit of health equity becomes even more crucial. It calls for a reevaluation of the Medicare Hospital Value-Based Purchasing Program, and potentially urging the incorporation of health equity adjustments. This approach is vital to prevent the exacerbation of existing care disparities and to ensure that all individuals, regardless of their racial background, have equal access to high-quality healthcare. 

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