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Patient Hospital Experience Improved Modestly, But No Evidence Medicare Incentives Promoted Meaningful Gains

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With the launch of the Hospital Value-Based Purchasing (VBP) program in 2011, the Centers for Medicare and Medicaid Services (CMS) began tying hospital Medicare payments to patient experience scores, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Commonwealth Fund–supported researchers investigated how these Medicare financial incentives improved patient experiences.

What the Study Found

The researchers focused on 3,452 hospitals that reported HCAHPS data to CMS from 2008 to 2014. They found that overall patient experience ratings increased by 6.1 percentage points for all hospitals over this six-year period. Hospitals with lower baseline patient experience scores improved more than higher-performing ones. In addition, small, rural, and public hospitals saw greater improvements than large and urban facilities. However, most of the improvement in overall patient experience scores occurred from 2008 to 2010, or before the launch of the VBP program. This was true for all hospitals except public hospitals.

Improvements in patient experience scores for hospitals in the VBP program were similar to those in facilities exempt from the VBP program. Both VBP and non-VBP hospitals saw a faster rate of improvement before launch of the VBP program compared to after.


While there were modest improvements in patient experience scores, the researchers could not find any evidence that the VBP program contributed to these gains. A better understanding of patient experiences may be needed to jump-start hospital initiatives, they say. And future pay-for-performance programs may require stronger financial incentives to stimulate hospital investments.

Publication Details



Mary Mahon, Former Vice President, Public Information, The Commonwealth Fund

[email protected]


I. Papanicolas, J. F. Figueroa, E. J. Orav et al., “Patient Hospital Experience Improved Modestly, But No Evidence Medicare Incentives Promoted Meaningful Gains,” Health Affairs, Jan. 2017 36(1):133–40.