for patient characteristics that may impact access to care. 2. Hospital outcomes (a) Payment adjustments for hospital outcomes Section 1886 of the Social Security Act ( 42 U.S.C. 1395ww ) is amended by adding at the end the following new subsection: (t) Hospital outcomes (1) In general In the case of an applicable hospital for an applicable prospective period beginning on or after October 1, 2018— (A) for each discharge of such hospital occurring during such period, in addition to and after application of any increase under paragraph (6) of subsection (o) and any adjustment under paragraph (7) of such subsection to the base operating DRG payment amount (as defined in paragraph (7)(D) of such subsection) that would otherwise apply to such hospital during such period without application of this subsection, such operating DRG payment amount shall be adjusted by the value based outcome adjustment factor described in paragraph (2) for the hospital for such period