VBP Degree of Implementation Value based purchasing (VBP) is a healthcare system that ties Medicare payment incentives to specific quality measures categorized into domains (CMS, 2016). Unlike the FFS system that focuses on quantity, the Medicare VBP plan rewards providers meeting the predefined set of measures on quality care and best clinical practices. Hospital performance is evaluated based on measures that fall into four domains: clinical process, patient experience, outcome, and efficiency. Providers are awarded achievement and improvement points for every VBP indicator using the 50 th percentile as the threshold. My organization runs various VBP projects, mainly in the finance and clinical support departments, to align its clinical processes with the quality and patient safety goals. The initiatives entail active participation of the medical staff and partnerships with state/national institutions on quality programs. The hospital participates in the ‘Every Patient Counts’, an alliance that promotes quality care delivery and safety to all patients. The hospital has adapted the ‘improvement map’ of the Institute for Health Improvement (IHI) to align healthcare costs with quality through lean practices (Tompkins, Higgins, & Ritter, 2009). The institution has also deployed EHRs for clinical documentation to provide actionable real-time data. The rationale is to satisfy the indicators related to the clinical process and efficiency domains. The facility has established linkages between finance department and quality care staff. Departmental restructuring saw the quality director reporting to the hospital’s chief finance officer. Other VBP initiatives involve stroke prophylaxis projects, free dental/medical clinics to reduce readmissions, and the adoption of telemedicine. These VBP initiatives support quality-finance alignment and measurable progress in the four domains. Departments Impacting VBP The three departments with the most impact on VBP in the hospital are clinical support (ER), nursing, and physician services departments. Explanation of Roles and Functions Emergency room (ER) The ER department promotes the clinical process of care domain (preventive care) and related hospital VBP measures. My rationale for selecting the ER is that the department provides medical and surgical care to patients with a broad spectrum of complications and trauma. Thus, implementing a preventive measure to promote safety and quality in this department, minimize hospitalizations, and lower costs for CMS and the provider would lead to better clinical process outcomes (Cox & Link-Gelles, 2011). Nursing The nursing department promotes patient experience of care domain and related measures. My rationale for selecting the nursing department is that the patient-clinician contact hours is high for the nursing staff (RNs and nurse aides). They provide bedside care and communicate with the patient throughout the hospitalization period; thus, they influence patient satisfaction or care experience. Physician services The physician services department supports the outcomes domain of a VBP initiative. My rationale for choosing this department is that physician services influence key quality indicators, including hospitalizations, readmission rates, and post-discharge morbidity and mortality. For the hospital, readmission rates and