In fiscal year 2013, the Centers for Medicare & Medicaid (CMS) began withholding a portion of hospital payments based on their performance. CMS makes adjustments to measures and domain weights each year to reflect an emphasis on those areas most in need of improved performance. Four domains will impact up to 2% of a hospital’s Medicare reimbursement in FFY 2017: process of care (core measures), patient experience (HCAHPS), efficiency of care and outcomes.