Key PointsQuestionWhat is the relative importance (ie, weight) of the 4 quality domains in Medicare’s Hospital Value-Based Purchasing (HVBP) program from the perspective of Medicare beneficiaries and what is the estimated impact of using beneficiaries’ weights on Medicare’s incentive payments for hospitals?FindingsIn this survey study of 1025 Medicare beneficiaries, clinical outcomes was the most important quality domain when choosing a hospital (weight, 49%), followed by safety (weight, 22%), patient experience (weight, 21%), and efficiency (weight, 8%).MeaningThese findings suggest that current HVBP program value weights do not reflect the preferences of Medicare beneficiaries, and using beneficiary preferences may exacerbate disparities by rewarding larger, high-volume hospitals.