According to a recent Government Accountability Office (GAO) report, bonuses and penalties triggered by the Medicare Hospital Value-based Purchasing (HVBP) program have had no apparent impact on quality measure performance trends to date. The HVBP program, which was established by the Affordable Care Act, adjusts inpatient hospital payments based on individual hospital performance on designated quality measures. Payment adjustments began in fiscal year (FY) 2013. In the first three years of the program, most hospitals received an HVBP bonus or penalty of less than 0.5% of applicable Medicare payments, with small hospitals and hospitals with better financial performance generally having higher payment adjustments (positive or negative). Safety net hospitals consistently had lower median payment adjustments. The GAO observes that shifts in quality trends could emerge in the future as new quality measures or added and the weight placed on clinical process measures is reduced. On the other hand, the GAO found that readmissions declined noticeably after the introduction of a separate CMS incentive program that imposes penalties for excessive hospital readmissions, although additional research is necessary to determine the extent of the impact of the financial incentives. The full report, “Hospital Value-Based Purchasing: Initial Results Show Modest Effects on Medicare Payments and No Apparent Change in Quality-of-Care Trends,” is available here.