OBJECTIVES: In 2011, the US Centers for Medicare and Medicaid Services (CMS) established the Hospital Value-Based Purchasing (HVBP) program in which hospitals were assigned quality scores related to their treatment of inpatients.  The primary objective of this study was to measure, among acute myocardial infarction (AMI) and heart failure (HF) inpatients, the association between hospital quality of care scores and the difference between hospital charges and reimbursement amounts (the Delta).  This research has potential implications related to inpatient procedure quality measures and hospital charging behavior. METHODS: The Delta between hospital charges and reimbursement was calculated for patients with an AMI or HF from 2011 Medicare inpatient claims.  Quality was assessed with CMS’s 2011 Hospital Compare AMI and HF quality component scores.  To measure the adjusted association between the Delta and quality scores, generalized linear mixed models were fit separately for AMI patients and HF patients.  The models controlled for both patient and hospital characteristics. RESULTS: The AMI model was fit using 110,076 claims across 1,383 hospitals.  After controlling for patient and hospital factors, each 1-point increase in AMI quality score yielded a 0.5% increase in Delta (p-value = 0.01).  The HF model was fit using 468,974 claims across 2,813 hospitals.  The adjusted HF model revealed that a point increase in HF quality score yielded a 1.0% increase in Delta (p-value < 0.0001). CONCLUSIONS: After adjusting for patient and hospital factors, hospital quality scores (both AMI and HF) were not strongly associated with the large amounts some hospitals charge beyond the standard reimbursement amount.  The lack of strong associations suggests that either: (1) quality scores were not indicators of hospital resource utilization, or (2) hospital charges were not driven by the expenses incurred as a result of providing high quality services, furthering the argument for increased cost transparency from healthcare providers.