Value incentive program 21

Several other studies that used diagnostic stewardship interventions significantly reduced unnecessary testing using a variety of approaches, such as health care professional education, decision-making algorithms, and the deployment of what are known as hard stops requiring a specialist consultation or laboratory approval prior to test ordering. This suggests there was likely a decline in the total number of C.

Regardless of the mechanism behind HO-CDI temporal decline, this change is likely to be accompanied by lower costs and less overtreatment and exposure to unnecessary antibiotics because of false-positive C. Our study has several strengths, including the use of prospectively collected data from the largest national database for CDI reporting. Additionally, the hospitals in our large sample are geographically and demographically representative of the United States.

Our study also has several potential limitations. First, we did not have information on the number of CDI tests ordered for each hospital, which limited our ability to study changes in diagnostic stewardship. Future CDI surveillance and evaluation could be enhanced by capturing data on the precise testing method used and the total number of tests performed.

Second, hospital practices change over time, including the type of testing used and use of diagnostic or antimicrobial stewardship or other interventions. To address this issue, our GEE analyses were clustered at the hospital level, and we considered changes in the type of testing used over time in the model.

Third, CO-CDI events laboratory-identified events within the first 3 days of admission used in our sensitivity analysis are captured by hospitals and may not be representative of CDI rates in the entire community. Fourth, our analysis was focused on facility-wide reported events, and we did not have data about patient characteristics that might reflect shifts in population risk of CDI over time. However, we did not observe significant shifts in the proportion of testing methods over time, suggesting that the impact of other testing methods was likely small.

Sixth, we did not have a group of control hospitals that were not subject to VBIP, nor were we able to include patient-level data for risk adjustment. The observed decline in HO-CDI rates may be due to greater opportunities for improvement in diagnostic and antimicrobial stewardship, which also align with the value these programs intend to achieve.

Given that CMS payment policies have not previously been associated with improvements in other targeted HAI rates, future research should focus on elucidating the specific processes that contributed to improvement in HO-CDI rates to better inform the design of future interventions targeted by VBIPs.

Published: October 29, Author Contributions: Dr Alrawashdeh had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Critical revision of the manuscript for important intellectual content: Alrawashdeh, Rhee, Hsu, Wang, Lee. No other disclosures were reported. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue.

Download PDF Comment. Figure 1. View Large Download. Figure 2. Figure 3. Table 1. Table 2. Antibiotic resistance threats report— Clostridioides difficile infection. Accessed February 1, National action plan to prevent health care-associated infections: road map to elimination. National HAI targets and metrics. Accessed May 15, Value-based programs. What is the rebaseline? Updated November Accessed September 28, Accessed October 13, American Hospital Association.

American Hospital Association annual survey database. Accessed November 3, January Accessed April 15, Performance of Clostridium difficile toxin enzyme immunoassay and nucleic acid amplification tests stratified by patient disease severity.

Guidelines for Clostridium difficile infection in adults. PubMed Google Scholar. April 17, Trends in U. Hospital antibiotic stewardship. Epidemiologic trends in Clostridioides difficile infections in a regional community hospital network.

Association between federal value-based incentive programs and health care-associated infection rates in safety-net and non-safety-net hospitals. Effect of nonpayment for preventable infections in U. Association between value-based incentive programs and catheter-associated urinary tract infection rates in the critical care setting. If the VECP is not accepted, the contracting officer shall provide the contractor with prompt written notification, explaining the reasons for rejection.

Except as provided in paragraph c of this subsection, the end of the sharing period is a specific calendar date that is the later of-.

This quantity is the number of units affected by the VECP that are scheduled to be delivered over a period of between 36 and 60 consecutive months set at the discretion of the contracting officer for each VECP that spans the highest planned production, based on planning and programming or production documentation at the time the VECP is accepted.

The specified quantity begins with the first future contract unit affected by the VECP and continues over consecutive deliveries until the sharing period ends at acceptance of the last of the specified quantity of units. Agencies may prescribe sharing of future contract savings on all future contract units to be delivered under contracts awarded within the sharing period for essentially the same item, even if the scheduled delivery date is outside the sharing period.

The contractor is entitled to a percentage share see paragraph a 1 of any net acquisition savings. Net acquisition savings result when the total of acquisition savings becomes greater than the total of Government costs and any negative instant contract savings.

This may occur on the instant contract or it may not occur until reductions have been negotiated on concurrent contracts or until future contract savings are calculated, either through lump-sum payment or as each future contract is awarded. This may occur once, several times, or, in rare cases, not at all. In calculating acquisition savings under incentive contracts, the contracting officer shall add any negative instant contract savings to the target cost or to the target price and ceiling price and then offset these negative instant contract savings and any Government costs against concurrent and future contract savings.

The contractor is responsible for maintaining, for 3 years after final payment on the contract under which the VECP was accepted, records adequate to identify the first delivered unit incorporating the applicable VECP. The lump-sum method may be used only if the contracting officer has established that this is the best way to proceed and the contractor agrees. For future contract savings calculated under the optional lump-sum method, the sharing base is an estimate of the number of items that the contracting officer will purchase for delivery during the sharing period.

In deciding whether or not to use the more convenient lump-sum method for an individual VECP, the contracting officer shall consider-. Sharing on construction contracts applies only to savings on the instant contract and to collateral savings. Value engineering sharing does not apply to incentive construction contracts. Contracting officers should balance the administrative costs of negotiating a settlement against the anticipated savings.

Under this method of settlement, the contractor would keep all of the savings on the instant contract, and all savings on its concurrent contracts only. The Government would keep all savings resulting from concurrent contracts placed with other sources, savings from all future contracts, and all collateral savings.

Use of this method must be by mutual agreement of both parties for individual VECPs. Contractors should be offered the fullest possible range of motivation, yet the benefits of an accepted VECP should not be rewarded both as value engineering shares and under performance, design-to-cost, or similar incentives of the contract. To that end, when performance, design-to-cost, or similar targets are set and incentivized, the targets of such incentives affected by the VECP are not to be adjusted because of the acceptance of the VECP.

Only those benefits of an accepted VECP not rewardable under other incentives are rewarded under a value engineering clause. The contracting officer shall insert a value engineering clause in solicitations and contracts when the contract amount is expected to exceed the simplified acquisition threshold, except as specified in paragraphs a 1 through 5 and in paragraph f of this section. A value engineering clause may be included in contracts of lesser value if the contracting officer sees a potential for significant savings.

Unless the chief of the contracting office authorizes its inclusion, the contracting officer shall not include a value engineering clause in solicitations and contracts-. To provide a value engineering incentive, the contracting officer shall insert the clause at The program requirement shall be shown as a separately priced line item in the contract Schedule.

AlternateII applies a value engineering program to the specified areas and a value engineering incentive to the remaining areas of the contract. If the head of the contracting activity determines for a contract or class of contracts that the cost of computing and tracking collateral savings will exceed the benefits to be derived, the contracting officer shall use the clause with its-.

The contracting officer shall insert the clause at The clause at For engineering-development solicitations and contracts, and solicitations and contracts containing low-rate-initial-production or early production units, the contracting officer must modify the clause at Every Sub-track consists of several products that fall within the VIP discount deal. An organization that wants to take part in the Value Incentive Program needs to sign in at Cisco.

It is not always necessary to possess specializations or certifications at the time you sign in. Sometimes it is only required to fulfill the expertise conditions at the end of the VIP period. Make sure you are well advised on these matters. The kind of specialization or certification depends solely on the Track s and Sub-track s that are chosen by the organization. There is always a connection between the Track, the Sub-track and the required specialization.

Cisco Gold partners who meet the requirements of the Cisco partner program will almost always meet the required specializations in the VIP program. After all, gold partners possess a broad spectrum of specializations. Cisco Premier partners however need to look closely whether already acquired specializations are sufficient for a Sub- Track in the VIP program. When a partner has obtained the Premier certification with the Express Foundation specialization the partner will not be able to take part in VIP program with a Collaboration Track without obtaining the Collaboration specializations first.

By adding expertise conditions to the VIP program Cisco shows that it wants to reward partners who offer complete Cisco solutions and provide added value to their customers.