Back in the Black – Value Based Payment Amendments: What Health Care Facilities Need to Know

Your facility may have been approached by an MLTC plan to enter into a Value Based Payment (“VBP”) amendment to your MLTC plan participating provider contract. Should your facility consider it? And if so, what do you need to know?

What is Value Based Payment (VBP)?

Value Based Payment is a pay-for-performance initiative set forth by the New York State Department of Health (NYSDOH) where health care facilities and MLTC plans can agree, by contract amendment, to implement quality measures and performance payments for goal attainment. Health care providers and MLTC plans can receive monetary “bonuses” for meeting targets based on measurable improvements in patient care according to specific guidelines set forth by the NYSDOH.

How are Improvements in Patient Care Measured and Evaluated?

Based on present criteria, participating health care facilities are responsible for reducing the occurrences of 6 conditions which the NYSDOH has determined to cause “Potentially Avoidable Hospitalizations” (“PAH”), specifically: (1) anemia, (2) congestive heart failure, (3) electrolyte imbalance, (4) respiratory infection, (5) sepsis, and (6) urinary tract infection. Facilities that reduce these Potentially Avoidable Hospitalizations from occurring by meeting a target percentage of improvement from baseline measurement will be entitled to a bonus payment under the VBP initiative.

Should Your Facility Enter Into a VBP Contract Amendment?

The NYSDOH is requiring MLTCs to move toward the VBP model and incorporate VBP amendments into thier contracts with long-term care facilities and other health care providers in New York. 

CAUTION: All VBP contract amendments are not created equal.

Some VBP contract amendments heavily favor the MLTC plan, where the facility is responsible for improving patient care but the MLTC reaps all, or most, of the benefit.

Contact Cona Elder Law for Advice and Counsel

We have assisted our skilled nursing facility clients by reviewing and analyzing VBP contract amendments, ensuring the amendments conform to applicable laws and identifying areas of concern and issues for negotiation. 

Contact us at 631.390.5000 to request a review and analysis of your facility’s proposed VBP contract amendment.