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Original Investigation
February 19, 2020

Performance in Federal Value-Based Programs of Hospitals Recognized by the American Heart Association and American College of Cardiology for High-Quality Heart Failure and Acute Myocardial Infarction Care

Author Affiliations
  • 1Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Division of Cardiology, Harvard Medical School, Boston, Massachusetts
  • 2Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
  • 3Baim Institute for Clinical Research, Boston, Massachusetts
  • 4David Geffen School of Medicine, Division of Cardiology, University of California, Los Angeles Medical Center, Los Angeles
  • 5Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology
JAMA Cardiol. 2020;5(5):515-521. doi:10.1001/jamacardio.2020.0001
Key Points

Question  How have hospitals awarded for high-quality cardiovascular care by the American Heart Association and American College of Cardiology performed under federal value-based programs?

Findings  In this cross-sectional study, a higher proportion of award hospitals were financially penalized under the Hospital Readmissions Reduction Program and the Hospital Value-Based Purchasing Program compared with other hospitals. Award hospitals had either similar or slightly lower 30-day mortality rates than other hospitals.

Meaning  In this analysis, hospitals awarded for high-quality cardiovascular care were more likely to receive financial penalties under federal value-based programs; these findings highlight the potential need to standardize quality measurement for cardiovascular care.

Abstract

Importance  The US Centers for Medicare & Medicaid Services have implemented national value-based programs that incentivize hospitals to deliver better cardiovascular care. However, it is unclear how hospitals recognized for high-quality cardiovascular care by American Heart Association (AHA) and American College of Cardiology (ACC) national quality improvement initiatives (termed award hospitals) have performed under value-based programs.

Objective  To determine if hospitals that received awards for high-quality cardiovascular care from the AHA/ACC were less likely to be penalized under the Hospital Readmissions Reduction Program (HRRP) and the Hospital Value-Based Purchasing Program (VBP) compared with other hospitals.

Design, Setting, and Participants  This national cross-sectional study included data from short-term acute care hospitals in the United States that were participating in the HRRP or VBP in fiscal year 2018.

Exposures  Recognition awards for high-quality care from the AHA’s Get With The Guidelines–Heart Failure and ACC’s Chest Pain–MI (myocardial infarction) Registry national quality improvement initiatives.

Main Outcomes and Measures  Proportion of hospitals that received a financial penalty or financial reward under the HRRP or VBP, median payment adjustments, and hospital-level 30-day mortality rates.

Results  This study included 3175 hospitals participating in the HRRP and 2781 hospitals participating in the VBP in fiscal year 2018. Under the HRRP, a higher proportion of award hospitals received financial penalties compared with other hospitals (419 [85.5%] vs 2112 [78.7%]; P < .001), although payment reductions were similar (median, 0.39% [interquartile range (IQR), 0.08%-0.84%] vs 0.33% [IQR, 0.03%-0.89%]; P = .17). Under the VBP, a higher proportion of award hospitals received penalties compared with other hospitals (250 [51.7%] vs 950 [41.4%]; P < .001), and fewer award hospitals received financial rewards (234 [48.4%] vs 1347 [58.6%]; P < .001). Median payment reductions were higher for award hospitals than other hospitals (0.01% [IQR, 0.00%-0.38%] vs 0.0% [IQR, 0.00%-0.28%]; P < .001), and median payment increases were lower (0.0% [IQR, 0.00%-0.34%] vs 0.13% [IQR, 0.00%-0.60%]; P < .001). Thirty-day mortality at award hospitals was similar (acute myocardial infarction, 13.2% vs 13.2%; P = .76) or slightly lower (heart failure, 11.3% vs 11.7%; P = .001) compared with other hospitals.

Conclusions and Relevance  Hospitals that received awards for high-quality cardiovascular care from the AHA/ACC were more likely to be penalized and less likely to be financially rewarded by federal value-based programs. These findings highlight the potential need to standardize measurement of cardiovascular care quality.

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