Financial incentives to improve quality: skating to the puck or avoiding the penalty box?

Wayne Gretzky once explained how he became a hockey player of genius: “I skate to where the puck is going to be, not where it has been.” Since the Affordable Care Act (ACA) enacted the Hospital Readmissions Reduction Program, hospitals have been ever more focused on playing to the puck to avoid financial penalties for high rates of early readmission. This Viewpoint examines the Hospital Readmissions Reduction Program as an example of similar initiatives by the Centers for Medicare & Medicaid Services (CMS) and discusses the increasing use of financial penalties for changing the behavior of hospitals.