The United States health care system is undergoing the greatest transformation in the country’s history. Health care is rapidly moving away from volume-based reimbursement towards value-based models. The Hospital Value-Based Purchasing (VBP), a Center for Medicare and Medicaid pay-for-performance program, makes Medicare reimbursement contingent on performance in four quality categories. Clinical care, person and community engagement, safety, and efficiency determine an organization’s total performance score (TPS), which is used to impose positive, negative, or neutral payment adjustments. Nursing, more than any other health care profession, impacts hospitals’ TPS and subsequently Medicare reimbursement under VBP. While the literature indicates nurses should be educated on VBP, it offers no examples of VBP education for direct care nurses. This quantitative scholarly project assessed nurses’ baseline understanding of VBP, nurses’ perceptions of nursing impact on hospital finance, and prior exposure to VBP education. The first two factors were reassessed following a VBP educational intervention to assess for changes post intervention. Finally, three months after the intervention, participants were sent a survey to assess changes in care delivery. A mean baseline score on the pre-intervention quiz of 51% indicated low-level understanding of VBP. While post-intervention scores increased to 70%, a statistically significant improvement, this score does not indicate proficiency in VBP concepts or application. While some participants report taking VBP into consideration when caring for their patients following the intervention, fewer reported changing or altering how they care for or communicate with their patients. Even though a majority of participants denied taking actions to incorporate VBP into their practice, a majority also denied obstacles preventing them from doing so.



Document Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)

Level of Degree


First Committee Member

A. Christine Delucas, DNP, MPH, RN, NEA-BC

Second Committee Member

Manuelita Chapman, DNP, MSN


Value-Based Care, Value-Based Purchasing, Nursing Education, Donabedian, Pay-for-Performance, P4P

Included in

Nursing Commons