​According to initial results, the Centers for Medicare and Medicaid Services (CMS) value-based purchasing program had no measurable effect on the quality of hospital care and affected safety net hospitals more than other hospitals, according to a report from the U.S. Government Accountability Office (GAO). Although it acknowledged that future changes to the program (e.g., changes to quality measures, reduced weight on clinical process measures) could affect its impact on the quality of care, GAO found that trends in quality measures were unchanged from 2005 to 2014 among the 3,000 hospitals participating in the value-based purchasing program. The only exception was rates of readmissions, a quality measure that was not actually included in the value-based purchasing program during the study period. GAO also found that safety net hospitals received smaller bonuses and larger penalties than all hospitals overall as part of the program, but that the disparity decreased as time went on. In each of the three years of the value-based purchasing program, the vast majority of participating hospitals (from 74% to 93%) experienced bonuses or penalties of less than 0.5% of their Medicare payments, a rate GAO calls "modest," with roughly the same number of hospitals receiving either a bonus or penalty.

HRC Recommends: Although such findings may not seem encouraging, organizations must still identify ways to strengthen and support the care provided to patients. Risk managers, quality assurance managers, clinical leaders, and others involved in quality measurement and reporting must not only understand the measures they are required to report on but must also ensure that data to fulfill those requirements is being captured and transmitted appropriately. Organization risk and quality staff should also review and use such data internally to identify opportunities to improve care quality and patient safety.