Completion won’t lower your CMS penalties. Competency will.

HAC, readmissions and value-based purchasing all adjust Medicare payments on the same thing — the clinical behaviors your workforce either performs reliably or doesn’t. Size the dollars on the line against your own revenue.

1%

Medicare payments cut — HAC, worst-performing quartile

3%

of base DRG payments — the readmissions penalty cap

3%

withheld and redistributed — value-based purchasing

Size your exposure

The pattern

Three programs. The same competencies underneath.

HAC, HRRP and value-based purchasing read like three separate line items on your Medicare remittance. They aren’t. Each one adjusts your payments on the same clinical behaviors – infection prevention, medication safety, recognizing deterioration, and communication at discharge.

Training measured by completion can’t move any of them. Only reliable performance at the bedside does – the decision a clinician actually makes when it counts, not the module they finished.

The reframe

This is regulatory exposure – not a compliance cost.

The dollars HAC, HRRP and VBP take off your payments aren’t the price of the rules. They’re the price of a competency gap your own incident data already names — showing up where Medicare can see it.

Which changes the question. Not “did our staff complete the training,” but “did the decision at the bedside change” — and by how much.

Size it

Put in your own numbers.

Enter your Medicare inpatient revenue and your standing in each program. This sizes the Medicare dollars tied to clinical-competency performance — on public CMS rules, against your figures. It isn’t a claim about your scores.

Your CMS exposure

$M
▶ How the three programs stack

HAC cuts 1% of Medicare payments for the worst-performing quartile. HRRP reduces base DRG payments up to 3% for excess readmissions. VBP withholds 2% of base DRG payments and redistributes it on performance across four equal domains — this tool sizes the two clinical domains (Safety and Clinical Outcomes).

Medicare dollars tied to clinical-competency performance

$0

each year — the price of the competency gap

HAC Reduction Program · penalty$0
Readmissions (HRRP) · penalty$0
VBP safety + outcomes · in play$0
HAC and HRRP are downside-only penalties. The VBP slice is in play — budget-neutral and redistributed, so you can win it back, hold even, or forfeit it on performance. Every measure underneath is a clinical behavior your workforce performs reliably, or doesn’t.

60%

Hoag Hospital — medication errors

Hoag built OMS scenarios around the medication-error patterns its own data flagged. Errors leading to harm fell 60%, and the result repeated in year two — the safety behavior under the HAC and VBP safety measures.

See the full Hoag case →

What changes

Train the behavior.
Measure it like a study.

OMS builds scenarios around the specific decisions where these penalties originate — sepsis recognition, medication safety, infection prevention, the discharge handoff — and captures how clinicians reason and where they make errors. Run as a quality-improvement project, with a named clinical endpoint measured pre and post against your own baseline, it produces behavior-change evidence leaders can actually stand behind.

At Carle Health, that approach was associated with sepsis-bundle compliance rising from 49% to 89% – the recognition-and-response behavior under the clinical-outcomes measures.

Common questions

Answered, plainly.

No. It sizes the Medicare dollars public CMS rules place on clinical performance, using your own revenue and standing. OMS maps and trains the competencies behind each measure; whether the gap closes is then measured on your data, not assumed.

HAC and HRRP only cut payments. VBP withholds 2% of base DRG payments from every hospital and redistributes it on performance — so the slice is winnable. This tool sizes the two clinical domains, Safety and Clinical Outcomes, which together are half of the 2%.

Medication safety and adverse-drug-event prevention, healthcare-associated infections, recognition of deterioration and sepsis, and communication and coordination at discharge. Each is a bedside decision that can be practised to reliability.

By running it as a quality-improvement study with OMS – a named clinical endpoint measured pre and post against your own baseline – rather than tracking e-learning completion. The change is observed on your data, not inferred from attendance.

No. Value-based purchasing scores four equally-weighted domains; patient experience (HCAHPS) is one of them and is sized separately. The same VBP dollars never appear in two places.

Request a Working session

Map your exposure to the competencies behind it.

We’ll connect your HAC, HRRP and VBP standing to the specific clinical behaviors your workforce can train to reliability – and set up the measurement against your own baseline.