Healthcare Insights
Average value-based purchasing scores by state
The Hospital Value-Based Purchasing (VBP) Program is one of several value-based care programs introduced by the Affordable Care Act. Value-based programs link provider reimbursement to quality of care, not just the number of services provided.
The Hospital VBP Program encourages hospitals to deliver high-quality care to Medicare patients through financial incentives. Under the program, hospitals receive payment adjustments based on the quality of care the hospitals deliver to patients during inpatient stays.
The Centers for Medicare and Medicaid Services (CMS) calculates a total performance score (TPS) for each hospital to determine payment adjustments. The TPS for each hospital is based on performance, as compared to peers, across four measurement domains:
- Clinical Outcomes (25%)
- Safety (25%)
- Person and Community Engagement (25%)
- Efficiency and Cost Reduction (25%)
Hospitals may earn an increase, decrease, or no change to their Medicare reimbursements for the following fiscal year. The actual amount of incentive payments a hospital earns is also linked to the hospital’s value-based incentive payment percentage and the total amount available under the program for value-based incentive payments.
| Rank | State | Total performance score | Net patient revenue | Case mix index | Staffed beds | Discharges | Explore dataset |
|---|---|---|---|---|---|---|---|
| 1 | HI | 48.32 | $245,357,523 | 1.50 | 167.29 | 5,994 | Explore |
| 2 | OR | 48.16 | $385,121,088 | 1.52 | 204.59 | 7,794 | Explore |
| 3 | AK | 48.13 | $159,268,466 | 1.31 | 89.70 | 2,831 | Explore |
| 4 | MN | 47.17 | $356,496,165 | 1.39 | 175.11 | 6,593 | Explore |
| 5 | MT | 45.07 | $110,269,481 | 1.23 | 66.79 | 2,060 | Explore |
| 6 | WY | 41.75 | $77,666,961 | 1.39 | 58.94 | 1,512 | Explore |
| 7 | WI | 40.94 | $283,774,667 | 1.48 | 148.40 | 5,829 | Explore |
| 8 | IA | 40.34 | $165,996,749 | 1.30 | 125.63 | 4,513 | Explore |
| 9 | VT | 39.88 | $255,333,685 | 1.29 | 115.68 | 4,714 | Explore |
| 10 | ND | 38.55 | $115,072,903 | 1.22 | 79.45 | 2,505 | Explore |
| 11 | MI | 38.45 | $548,202,287 | 1.51 | 340.92 | 15,562 | Explore |
| 12 | OK | 38.00 | $147,414,175 | 1.44 | 123.77 | 4,765 | Explore |
| 13 | CO | 37.36 | $307,256,260 | 1.59 | 162.59 | 6,717 | Explore |
| 14 | ME | 36.94 | $287,284,502 | 1.35 | 135.86 | 5,138 | Explore |
| 15 | SD | 36.80 | $217,110,248 | 1.31 | 116.16 | 3,911 | Explore |
| 16 | ID | 36.21 | $198,950,544 | 1.46 | 100.41 | 3,885 | Explore |
| 17 | WA | 36.18 | $559,039,993 | 1.52 | 278.25 | 11,507 | Explore |
| 18 | KS | 36.17 | $114,715,982 | 1.33 | 94.69 | 3,432 | Explore |
| 19 | UT | 35.93 | $387,841,853 | 1.55 | 170.94 | 8,356 | Explore |
| 20 | NC | 35.89 | $507,415,440 | 1.49 | 298.40 | 14,001 | Explore |
| 21 | VA | 35.59 | $392,605,463 | 1.50 | 272.89 | 10,725 | Explore |
| 22 | MA | 34.65 | $558,708,047 | 1.39 | 275.02 | 11,791 | Explore |
| 23 | NE | 34.56 | $128,250,798 | 1.37 | 100.11 | 3,053 | Explore |
| 24 | NM | 34.31 | $207,871,517 | 1.40 | 120.91 | 4,949 | Explore |
| 25 | IL | 34.02 | $570,365,972 | 1.49 | 344.64 | 14,589 | Explore |
| 26 | AZ | 34.01 | $288,029,972 | 1.57 | 200.14 | 8,610 | Explore |
| 27 | OH | 33.94 | $439,868,580 | 1.52 | 247.97 | 10,915 | Explore |
| 28 | CA | 33.74 | $580,453,814 | 1.66 | 316.02 | 14,018 | Explore |
| 29 | MO | 33.68 | $508,301,753 | 1.45 | 363.75 | 14,811 | Explore |
| 30 | AL | 33.40 | $216,318,569 | 1.43 | 234.54 | 8,398 | Explore |
| 31 | LA | 32.51 | $132,434,111 | 1.41 | 139.88 | 4,420 | Explore |
| 32 | SC | 32.46 | $403,913,580 | 1.50 | 236.95 | 11,467 | Explore |
| 33 | NH | 32.27 | $273,242,565 | 1.41 | 119.66 | 5,243 | Explore |
| 34 | PA | 32.25 | $493,573,411 | 1.51 | 374.93 | 14,754 | Explore |
| 35 | GA | 32.06 | $328,186,798 | 1.49 | 214.03 | 9,294 | Explore |
| 36 | CT | 32.06 | $662,494,242 | 1.50 | 295.07 | 15,273 | Explore |
| 37 | RI | 32.01 | $430,746,480 | 1.51 | 295.81 | 11,761 | Explore |
| 38 | TX | 31.93 | $290,954,102 | 1.52 | 233.04 | 9,545 | Explore |
| 39 | KY | 31.59 | $282,719,742 | 1.37 | 235.58 | 8,370 | Explore |
| 40 | AR | 31.15 | $119,941,156 | 1.39 | 129.95 | 4,698 | Explore |
| 41 | NY | 30.78 | $747,045,615 | 1.55 | 384.18 | 16,346 | Explore |
| 42 | IN | 30.71 | $268,250,340 | 1.49 | 171.55 | 6,662 | Explore |
| 43 | WV | 30.71 | $242,508,774 | 1.31 | 180.45 | 6,125 | Explore |
| 44 | FL | 30.31 | $440,185,564 | 1.54 | 322.73 | 16,215 | Explore |
| 45 | TN | 29.93 | $697,658,503 | 1.48 | 573.42 | 26,135 | Explore |
| 46 | MS | 29.25 | $107,045,621 | 1.35 | 141.22 | 3,867 | Explore |
| 47 | DC | 27.94 | $504,795,339 | 1.67 | 1711.30 | 8,705 | Explore |
| 48 | DE | 27.36 | $419,209,857 | 1.52 | 237.95 | 11,375 | Explore |
| 49 | NJ | 27.29 | $417,009,671 | 1.59 | 332.35 | 13,996 | Explore |
| 50 | NV | 27.16 | $239,713,756 | 1.41 | 195.03 | 9,752 | Explore |
Fig. 1 Data from Definitive Healthcare based on CMS Quality Metrics for FY 2021.
What were the average value-based purchasing scores by state in 2021?
In 2021, 27 states scored higher than the national average of 33.9. Nationwide, average value-based purchasing TPS scores ranged from a low of 27.2 to a high of 48.3. Nevada had the lowest average score at 27.2, and Hawaii had the highest score at 48.3 out of 100. Ohio scored closest to the overall average, with a score of 33.9.
Case mix index (CMI) does not appear to strongly influence VBP performance, with all states reporting between a 1.2 and 1.7 CMI. The top five states with the highest VBP scores—Hawaii, Oregon, Alaska, Minnesota, and Montana—reported average CMIs between 1.2 and 1.5.
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