Will Value-Based Purchasing Increase Disparities in Care?

U.S. hospitals caring for more disadvantaged patients fared worse in the first year of Medicare's Hospital Value-Based Purchasing program. Over time, such resource reductions may cause the quality of care to deteriorate in hospitals serving more disadvantaged patients. Financial incentives for improving quality and efficiency have gone mainstream in U.S. health care. After years of small-scale pilot projects, demonstrations, and experiments, the Affordable Care Act mandated that Medicare payment to hospitals and physicians must depend, in part, on metrics of quality and efficiency. The first program to do so is Hospital Value-Based Purchasing (HVBP), which began affecting Medicare payments to acute care hospitals in October 2012. In the first year of HVBP, hospitals received incentives for performance on clinical-process and patient-experience measures. In subsequent years, hospitals will also receive incentives for performance on outcome-based measures, such as 30-day ...