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  1. Spaulding, Aaron PhD, MHA
  2. Zhao, Mei PhD
  3. Haley, D. Rob PhD
  4. Liu, Xinliang PhD
  5. Xu, Jing PhD
  6. Homier, Nicole MHA


To help influence the health care environment as well as the flow of resources into and out of hospitals, the Centers for Medicare & Medicaid Services has implemented a performance incentive initiative called the Hospital Value-Based Purchasing (HVBP) program. As such, this study utilizes the lens of Resource Dependency Theory to evaluate the effect of the external environment on hospital performance as measured by the HVBP program. This study utilizes data from the 2014 American Hospital Association (AHA) Annual Survey database, 2014 Area Health Resource File (AHRF), the 2014 Medicare Final Rule Standardizing File, and the 2014 Medicare Hospital Compare database. The associations between external environment and hospital performance are assessed through multiple regression analysis. Hospital performance scores in the HVBP program are sensitive to environmental factors; however, not all domains are influenced to the same degree. It would seem that hospitals do not have either the same ability or motivation to make changes in each of the value-based purchasing domains. Ultimately, the findings from this study indicate that environmental forces do play a role in hospitals' performance in the HVBP program.