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
Authors: Rishi K. Wadhera, Muthiah Vaduganathan, Ginger Y. Jiang, Yang Song, Jiaman Xu, Changyu Shen, Deepak L. Bhatt, Robert W. Yeh, Gregg C. Fonarow
Journal: JAMA Cardiology (2020)

<h3>Importance</h3> The US Centers for Medicare &amp; 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<i>award hospitals</i>) have performed under value-based programs. <h3>Objective</h3> 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. <h3>Design, Setting, and Participants</h3> 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. <h3>Exposures</h3> 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. <h3>Main Outcomes and Measures</h3> 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. <h3>Results</h3> 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%];<i>P</i> &lt; .001), although payment reductions were similar (median, 0.39% [interquartile range (IQR), 0.08%-0.84%] vs 0.33% [IQR, 0.03%-0.89%];<i>P</i> = .17). Under the VBP, a higher proportion of award hospitals received penalties compared with other hospitals (250 [51.7%] vs 950 [41.4%];<i>P</i> &lt; .001), and fewer award hospitals received financial rewards (234 [48.4%] vs 1347 [58.6%];<i>P</i> &lt; .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%];<i>P</i> &lt; .001), and median payment increases were lower (0.0% [IQR, 0.00%-0.34%] vs 0.13% [IQR, 0.00%-0.60%];<i>P</i> &lt; .001). Thirty-day mortality at award hospitals was similar (acute myocardial infarction, 13.2% vs 13.2%;<i>P</i> = .76) or slightly lower (heart failure, 11.3% vs 11.7%;<i>P</i> = .001) compared with other hospitals. <h3>Conclusions and Relevance</h3> 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.