[author: Nick Manetto]

Deep within the proposed FY 2015 Inpatient Prospective Payment System (IPPS) rule released a few weeks back is an interesting proposed new measure to the Medicare hospital Value-Based Purchasing (VBP) program  – elective deliveries prior to 39 weeks gestation. When most people think of Medicare, delivering babies is probably not top of mind. But in proposing the measure for the VBP program, CMS noted that Medicare paid for about 14,000 births in 2011 and that nearly 2 million Medicare beneficiaries age 44 and under are of child-bearing age and thus potentially impacted.

CMS noted the impact of prematurity on child and maternal health as well as on long-term child development. If the measure is included within the final rule, it would be one of the process measures that, beginning in FY 17, would impact a hospital’s VBP score and, ultimately, determine if the hospital receives a bonus payment or pays a penalty. Established under the Affordable Care Act, the VBP program evaluates hospitals on measures in four domains – clinical process, clinical outcomes, efficiency and patient satisfaction. Hospitals are measured in two ways – on their overall score and their improvement against their baseline, with the higher of the two used to calculate their overall score.

Each year, CMS proposes changes to the program for out years with the current proposed rule focused on the FY 2017 evaluation period. In addition to elective delivery prior to 39 weeks, CMS is proposing two additional measures focused on MRSA and Clostridium difficile or c.diff infections. The agency is also proposing the elimination of a half-dozen measures it considers to be topped out.

Comments on the proposed rule will be accepted by through June 30th.