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 | Average total performance score | Average net patient revenue | Average case mix index | Average # of staffed beds | Average # of discharges | Explore dataset |
|---|---|---|---|---|---|---|---|
| 1 | Alaska | 36.49 | $367,271,060 | 1.74 | 137 | 5,975 | Explore |
| 2 | Minnesota | 34.87 | $470,895,032 | 1.7 | 199 | 9,029 | Explore |
| 3 | Oregon | 33.42 | $444,641,885 | 1.8 | 174 | 9,824 | Explore |
| 4 | Montana | 30.89 | $420,540,211 | 1.85 | 164 | 6,885 | Explore |
| 5 | Wisconsin | 30.31 | $342,446,455 | 1.72 | 144 | 6,213 | Explore |
| 6 | Utah | 29.78 | $327,281,021 | 1.85 | 116 | 6,277 | Explore |
| 7 | Rhode Island | 28.21 | $379,162,431 | 1.58 | 214 | 9,484 | Explore |
| 8 | Iowa | 27.93 | $278,192,667 | 1.69 | 163 | 7,711 | Explore |
| 9 | South Dakota | 27.17 | $316,188,502 | 1.9 | 115 | 5,305 | Explore |
| 10 | Washington | 27.13 | $496,776,690 | 1.84 | 203 | 9,965 | Explore |
| 11 | Michigan | 26.14 | $403,273,320 | 1.71 | 204 | 9,969 | Explore |
| 12 | Hawaii | 25.97 | $337,999,671 | 1.82 | 176 | 7,308 | Explore |
| 13 | Vermont | 25.75 | $451,799,031 | 1.57 | 139 | 6,065 | Explore |
| 14 | Maine | 25.55 | $349,073,675 | 1.59 | 143 | 5,630 | Explore |
| 15 | Idaho | 25.47 | $417,088,335 | 2.1 | 156 | 7,238 | Explore |
| 16 | North Carolina | 25.35 | $510,983,351 | 1.64 | 224 | 11,736 | Explore |
| 17 | Virginia | 25.23 | $410,682,844 | 1.64 | 200 | 9,628 | Explore |
| 18 | Oklahoma | 23.49 | $182,353,618 | 1.74 | 109 | 4,815 | Explore |
| 19 | Wyoming | 23.4 | $147,075,607 | 1.63 | 82 | 2,896 | Explore |
| 20 | North Dakota | 23.1 | $696,875,867 | 1.83 | 206 | 9,544 | Explore |
| 21 | Colorado | 22.97 | $368,588,516 | 1.98 | 157 | 7,927 | Explore |
| 22 | Florida | 22.89 | $459,250,082 | 1.73 | 260 | 15,317 | Explore |
| 23 | Kansas | 22.86 | $208,630,325 | 1.86 | 123 | 5,391 | Explore |
| 24 | California | 22.33 | $508,967,639 | 1.83 | 210 | 10,468 | Explore |
| 25 | New Hampshire | 22.26 | $423,699,994 | 1.7 | 168 | 7,686 | Explore |
| 26 | Massachusetts | 22.22 | $573,949,520 | 1.66 | 218 | 12,130 | Explore |
| 27 | Alabama | 22.09 | $171,750,582 | 1.49 | 149 | 6,387 | Explore |
| 28 | Nebraska | 22.02 | $263,419,174 | 2.14 | 145 | 6,089 | Explore |
| 29 | Georgia | 21.96 | $362,644,324 | 1.63 | 186 | 9,420 | Explore |
| 30 | Pennsylvania | 21.9 | $411,001,210 | 1.67 | 192 | 8,938 | Explore |
| 31 | Illinois | 21.83 | $403,728,048 | 1.66 | 210 | 9,469 | Explore |
| 32 | Ohio | 21.44 | $413,939,100 | 1.7 | 184 | 9,691 | Explore |
| 33 | Missouri | 21.42 | $381,158,231 | 1.67 | 217 | 10,254 | Explore |
| 34 | Mississippi | 21.25 | $141,410,812 | 1.51 | 130 | 4,727 | Explore |
| 35 | New Mexico | 21.08 | $277,032,211 | 1.59 | 111 | 5,882 | Explore |
| 36 | District of Columbia | 21 | $690,252,271 | 2.07 | 339 | 13,400 | Explore |
| 37 | Tennessee | 20.89 | $298,477,748 | 1.69 | 164 | 9,169 | Explore |
| 38 | Texas | 20.74 | $299,924,409 | 1.87 | 171 | 9,185 | Explore |
| 39 | Connecticut | 20.65 | $528,796,875 | 1.66 | 207 | 11,089 | Explore |
| 40 | Arizona | 20.31 | $391,865,849 | 1.81 | 187 | 9,352 | Explore |
| 41 | New York | 20.08 | $689,259,459 | 1.71 | 257 | 13,917 | Explore |
| 42 | Arkansas | 19.74 | $176,376,511 | 1.63 | 147 | 6,433 | Explore |
| 43 | Kentucky | 19.69 | $317,650,540 | 1.66 | 158 | 8,260 | Explore |
| 44 | Indiana | 18.91 | $347,442,358 | 1.74 | 143 | 7,672 | Explore |
| 45 | Nevada | 18.59 | $321,038,254 | 1.74 | 226 | 12,760 | Explore |
| 46 | South Carolina | 18.54 | $359,446,188 | 1.67 | 166 | 9,579 | Explore |
| 47 | Louisiana | 18.16 | $187,700,258 | 1.76 | 131 | 4,977 | Explore |
| 48 | New Jersey | 16.78 | $525,477,105 | 1.72 | 270 | 13,743 | Explore |
| 49 | Delaware | 16.55 | $663,407,955 | 1.71 | 286 | 14,433 | Explore |
| 50 | West Virginia | 14.37 | $275,826,218 | 1.59 | 179 | 7,724 | Explore |
Fig. 1 Data from Definitive Healthcare based on CMS data collection periods for the most recent Quality Metrics Update (October 2024).
What were the average value-based purchasing scores by state?
In the latest performance period, 22 states scored above the national average of 21.4. The range of scores across states is quite wide, from 36.5 down to 14.4, indicating that hospitals in some states are struggling significantly more than others with value-based care metrics.
Alaska ranks highest with an average total performance score of 36.49, followed closely by Minnesota (34.87) and Oregon (33.42). West Virginia has the lowest performance score, with an average of 14.37. Mississippi, with a score of 21.25, also ranks low.
States with lower average bed counts, like Wyoming (82 beds) and Oklahoma (109 beds), tend to score lower as well, possibly because of fewer resources available to handle patients’ diverse needs.
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