The immutable Law of Unintended Consequences cannot be ignored, even by those who think they have a better way of paying for health care --- "Quality Improvement Incentives May Backfire on "Safety Net" Hospitals."
Between 2004 and 2006, the hospitals with the highest proportion of Medicaid patients -- which had the worst performance on the three measures to begin with -- also saw the least improvements in quality. Hospitals that achieved the most improvement had the smallest proportion of Medicaid patients..."Pay for Performance" initiatives simply are a euphemism for "decreasing your reimbursement" for these hospitals. They do not have the ability to refuse care for the sickest and poorest patients, who will have less than ideal outcomes at times. P4P may be seen as a solution to some, but I do not see that it does anything other than aggravate a multitude of problems.