Overlapping value-based purchasing programs: The case of nurse-sensitive hospital-acquired conditions in Florida

Objective: In 2011, the Centers for Medicare and Medicaid Services (CMS) announced the first of two value-based purchasing (VBP) programs for hospital-acquired conditions. This represents one of few studies assessing the impact of both programs, the Hospital Value-Based Purchasing (HVBP) program and the Hospital-Acquired Condition Reduction Program (HACRP), while also uniquely exploring nursing-based investments as mechanisms for improvement.
Methods: 2007-2019 inpatient discharge and financial data from Florida’s Agency for Health Care Administration are combined with Agency for Healthcare Research and Quality patient safety indicators (PSIs). Modified interrupted time series analyzes timing of the announcement of each program to PSI trends and the association of these outcomes (PSI rates) with nursing-based investments, for a select set of nurse-sensitive, inpatient PSIs. Study compares two PSIs targeted by the VBP programs to a non-targeted PSI, using a panel of statewide acute care general hospitals (137 hospitals, N = 1,781), controlling for hospital fixed effects and other unobservable factors (omitted variables).
Results: Annual reduction (improvement) in trends of 16% and 2% for targeted, and insignificance for non-targeted, outcomes (PSI rates), following announcement of the HVBP program (2011). No further reduction following announcement of the HACRP (2014). Investments in nurse education and staffing are associated with reductions in targeted outcomes of 7% and 4.5%, respectively, following announcement of the HVBP.
Conclusions: HVBP (only) was associated with improvement in hospital safety, and with a positive association of investment with safety. CMS should consider consolidating its two overlapping programs while incorporating incentives for quality investment.