Eligibility

Hospital Value-Based Purchasing

Minimum Cases and Measures

As required by the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) conducted an independent analysis and established minimum numbers of cases, measures, and surveys for hospitals to be eligible to participate in Hospital Value-Based Purchasing (VBP). Including hospitals that do not meet the minimum criteria could adversely skew results that would affect the overall program scoring.

CMS has established the following minimum reporting requirements for number of cases, measures, and surveys:

FY 2017 Minimum Reporting Requirements

  • Clinical Care – Hospitals must meet the minimum requirement in at least 1 of the 2 subdomains in order for the domain to be counted to the overall domain count for purposes of eligibility criteria.
    • Clinical Care – Process subdomain 10 cases in at least 1 of the 3 measures.
    • Clinical Care – Outcomes subdomain 25 cases in at least 2 of the 3 measures.
  • Patient- and Caregiver-Centered Experience of Care/Care Coordination: 100 completed surveys.
  • Safety: Hospitals must report the applicable case minimum for at least 3 of the 6 measures for the Safety domain.
    • AHRQ (PSI-90): 3 cases for any one of the underlying indicators.
    • CAUTI: 1 predicted infection.
    • CLABSI: 1 predicted infection.
    • CDI: 1 predicted infection.
    • MRSA: 1 predicted infection.
    • SSI: A minimum of 1 predicted infection must be calculated in at least 1 of the 2 SSI strata in order to receive a SSI measure score.
      • SSI – Colon: 1 predicted infection.
      • SSI – Abdominal Hysterectomy: 1 predicted infection.
  • Efficiency and Cost Reduction: 25 episodes of care for the Medicare Spending per Beneficiary (MSPB) measure.

FY 2018 Minimum Reporting Requirements

  • Clinical Care: 25 cases in at least 2 of the 3 measures.
  • Person and Community Engagement: 100 completed surveys.
  • Safety: Hospitals must report the applicable case minimum for at least 3 of the 7 measures for the Safety domain.
    • AHRQ (PSI-90): 3 cases for any one of the underlying indicators.
    • CAUTI: 1 predicted infection.
    • CLABSI: 1 predicted infection.
    • CDI: 1 predicted infection.
    • MRSA: 1 predicted infection.
    • SSI: A minimum of 1 predicted infection must be calculated in at least 1 of the 2 SSI strata in order to receive a SSI measure score.
      • SSI – Colon: 1 predicted infection.
      • SSI – Abdominal Hysterectomy: 1 predicted infection.
    • PC-01: 10 cases.
  • Efficiency and Cost Reduction: 25 episodes of care for the Medicare Spending per Beneficiary (MSPB) measure.

FY 2019 Minimum Reporting Requirements

  • Clinical Care: 25 cases in at least 2 of the 4 measures.
  • Person and Community Engagement: 100 completed surveys.
  • Safety: Hospitals must report the applicable case minimum for at least 3 of the 7 measures for the Safety domain.
    • AHRQ (PSI-90): 3 cases for any one of the underlying indicators.
    • CAUTI: 1 predicted infection.
    • CLABSI: 1 predicted infection.
    • CDI: 1 predicted infection.
    • MRSA: 1 predicted infection.
    • SSI: A minimum of 1 predicted infection must be calculated in at least 1 of the 2 SSI strata in order to receive a SSI measure score.
      • SSI – Colon: 1 predicted infection.
      • SSI – Abdominal Hysterectomy: 1 predicted infection.
    • PC-01: 10 cases.
  • Efficiency and Cost Reduction: 25 episodes of care for the Medicare Spending per Beneficiary (MSPB) measure.

Note: In Fiscal Year (FY) 2017, FY 2018, and FY 2019, hospitals with sufficient data in at least 3 of the 4 domains will receive a Total Performance Score (TPS). Refer to Scoring for more information.

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