Rayford Scott Jones
University of Virginia, USA
Keynote: Primary Health Care
Background: The Hospital Value-Based Purchasing Program measures value of care provided by participating Medicare hospitals while creating financial incentives for quality improvement and fostering increased transparency. Limited information is available comparing hospital performance across healthcare business models. Study Design: 2015 hospital Value-Based Purchasing Program results were used to examine hospital performance by business model. General linear modeling assessed differences in mean total performance score, hospital case mix index, and differences after adjustment for differences in hospital case mix index. Results: Of 3089 hospitals with Total Performance Scores (TPS), categories of representative healthcare business models included 104 Physician-owned Surgical Hospitals (POSH), 111 University HealthSystem Consortium (UHC), 14 US News & World Report Honor Roll (USNWR) Hospitals, 33 Kaiser Permanente, and 124 Pioneer Accountable Care Organization affiliated hospitals. Estimated mean TPS for POSH (64.4, 95% CI 61.83, 66.38) and Kaiser (60.79, 95% CI 56.56, 65.03) were significantly higher compared to all remaining hospitals while UHC members (36.8, 95% CI 34.51, 39.17) performed below the mean (p < 0.0001). Significant differences in mean hospital case mix index included POSH (mean 2.32, p<0.0001), USNWR honorees (mean 2.24, p 0.0140) and UHC members (mean =1.99, p<0.0001) while Kaiser Permanente hospitals had lower case mix value (mean =1.54, p<0.0001). Re-estimation of TPS did not change the original results after adjustment for differences in hospital case mix index Conclusions: The Hospital Value-Based Purchasing Program revealed superior hospital performance associated with business model. Closer inspection of high-value hospitals may guide value improvement and policy-making decisions for all Medicare Value-Based Purchasing Program Hospitals.
Jones served as the Stephen H. Watts Professor and Chairman of the Department of Surgery at the University of Virginia from 1982 till 2001. He is now the Professor and Chairman Emeritus of the Department of Surgery. His clinical practice focused on gastrointestinal surgery and particularly on hepatobiliary and pancreatic problems. He engages in outcomes research, surgical safety, and quality improvement using the American College of Surgeons National Surgical Quality Improvement Program (ACSNSQIP). He and his associates have explored methods to measure the value of surgical services and of individual surgeons. Recently they examined how U.S. Medicare measures value using the Medicare Value-Based Purchasing Program.
E-mail: rsj@virginia.edu
