In Medicare's new program that ties about $1 billion in payments to quality of care, hospitals in Fort Wayne, Ind., are faring the best on average while hospitals in Washington, D.C., are doing the worst, according to a Kaiser Health News analysis of the country's 212 major health care markets. All seven hospitals in the nation's capital are having their Medicare payments reduced because they scored poorly in the Value-Based Purchasing program, which rewards places that do better in following basic standards of care and on patient satisfaction surveys and punishes those that underperform. The government began assessing these bonuses and penalties this month as one part of an effort to improve medical quality and to eventually reduce costs. In Washington, hospitals will lose on average 0.33 percent of their payments.