The Centers for Medicare & Medicaid Services’ (CMS’) Hospital Value-Based Purchasing Program has just received a dose of unintended consequences.

A new study in Health Affairs shows that high-performing hospitals aren’t the only ones that have been rewarded by CMS: 231 hospital with below-average scores on quality measures received bonuses in 2015 due to low spending per Medicare beneficiary.

According to the study, Medicare patients in those 231 hospitals cost, on average, $2,300 less than hospitals with higher quality scores. The hospitals received 0.18% Medicare payment increase per patient, despite scoring low on quality measures including pneumonia, heart attack, and heart failure.

“The Centers for Medicare & Medicaid Services should consider incorporating a minimum quality threshold into the Hospital Value-Based Purchasing program to avoid rewarding low-quality, low-spending hospitals,” the study authors wrote. CMS is considering such a revision.

Look for more coverage on this topic in an upcoming issue of Hospital Peer Review.