BACKGROUND Starting in fiscal year 2013, the Hospital Value-Based Purchasing (HVBP) program introduced quality performance–based adjustments of up to 1% to Medicare reimbursements for acute care hospitals. METHODS We evaluated whether quality improved more in acute care hospitals that were exposed to HVBP than in control hospitals (Critical Access Hospitals, which were not exposed to HVBP). The measures of quality were composite measures of clinical process and patient experience (measured in units of standard deviations, with a value of 1 indicating performance that was 1 standard deviation [SD] above the hospital mean) and 30-day risk-standardized mortality among patients who were admitted to the hospital for acute myocardial infarction, heart failure, or pneumonia. The changes in quality measures after the introduction of HVBP were assessed for matched samples of acute care hospitals (the number of hospitals included in the analyses ranged from 1364 for mortality among patients admitted for acute myocardial infarction to 2615 for mortality among patients admitted for pneumonia) and control hospitals (number of hospitals ranged from 31 to 617). Matching was based on preintervention performance with regard to the quality measures. We evaluated performance over the first 4 years of HVBP. RESULTS Improvements in clinical-process and patient-experience measures were not significantly greater among hospitals exposed to HVBP than among control hospitals, with difference-in-differences estimates of 0.079 SD (95% confidence interval [CI], −0.140 to 0.299) for clinical process and −0.092 SD (95% CI, −0.307 to 0.122) for patient experience. HVBP was not associated with significant reductions in mortality among patients who were admitted for acute myocardial infarction (difference-in-differences estimate, −0.282 percentage points [95% CI, −1.715 to 1.152]) or heart failure (−0.212 percentage points [95% CI, −0.532 to 0.108]), but it was associated with a significant reduction in mortality among patients who were admitted for pneumonia (−0.431 percentage points [95% CI, −0.714 to −0.148]). CONCLUSIONS In our study, HVBP was not associated with improvements in measures of clinical process or patient experience and was not associated with significant reductions in two of three mortality measures. (Funded by the National Institute on Aging.)

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IMPORTANCE Medicare is experimenting with numerous concurrent reforms aimed at improving quality and value for hospitals. It is unclear if these myriad reforms are mutually reinforcing or in conflict with each other. OBJECTIVE To evaluate whether hospital participation in voluntary value-based reforms was associated with greater improvement under Medicare's Hospital Readmission Reduction Program (HRRP). DESIGN, SETTING, AND PARTICIPANTS Retrospective, longitudinal study using publicly available national data from Hospital Compare on hospital readmissions for 2837 hospitals from 2008 to 2015. We assessed hospital participation in 3 voluntary value-based reforms: Meaningful Use of Electronic Health Records; the Bundled Payment for Care Initiative episode-based payment program (BPCI); and Medicare's Pioneer and Shared Savings accountable care organization (ACO) programs. We used an interrupted time series design to test whether hospitals' time-varying participation in these value-based reforms was associated with greater improvement in Medicare's HRRP.MAIN OUTCOMES AND MEASURES Thirty-day risk standardized readmission rates for acute myocardial infarction (AMI), heart failure, and pneumonia. RESULTS Among the 2837 hospitals in this study, participation in value-based reforms varied considerably over the study period. In 2010, no hospitals were participating in the meaningful use, ACO, or BPCI programs. By 2015, only 56 hospitals were not participating in at least 1 of these programs. Among hospitals that did not participate in any voluntary reforms, the association between the HRRP and 30-day readmission was −0.76 percentage points for AMI (95% CI, −0.93 to −0.60), −1.30 percentage points for heart failure (95% CI, −1.47 to −1.13), and −0.82 percentage points for pneumonia (95% CI, −0.97 to −0.67). Participation in the meaningful use program alone was associated with an additional change in 30-day readmissions of −0.78 percentage points for AMI (95% CI, −0.89 to −0.67), −0.97 percentage points for heart failure (95% CI, −1.08 to −0.86), and −0.56 percentage points for pneumonia (95% CI, −0.65 to −0.47). Participation in ACO programs alone was associated with an additional change in 30-day readmissions of −0.94 percentage points for AMI (95% CI, −1.29 to −0.59), −0.83 percentage points for heart failure (95% CI, −1.26 to −0.41), and −0.59 percentage points for pneumonia (95% CI, −1.00 to −0.18). Participation in multiple reforms led to greater improvement: participation in all 3 programs was associated with an additional change in 30-day readmissions of −1.27 percentage points for AMI (95% CI, −1.58 to −0.97), −1.64 percentage points for heart failure (95% CI, −2.02 to −1.26), and −1.05 percentage points for pneumonia (95% CI, −1.32 to −0.78).CONCLUSIONS AND RELEVANCE Hospital participation in voluntary value-based reforms was associated with greater reductions in readmissions. Our findings lend support for Medicare's multipronged strategy to improve hospital quality and value.

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