Pay for Performance and Public Reporting: Risks to Patients Outweigh Benefits (Essay‪)‬

Introduction Governments face pressures from increased entitlement spending on Medicare and Medicaid, and private firms from the cost of employee benefits. Centrally designed and implemented pay for performance (PFP) and public reporting (PR) programs (PFP/PR) are proposed as a solution to perceived quality gaps (1) as well as excess spending, by groups such as the Institutes of Medicine (IOM) and the Institute for Healthcare Improvement (IHI). It is frequently asserted that 100,000 Americans die every year from medical errors and receive only 50% of "appropriate" medical care, while paying excessively. (2)