Pay for Performance--a Clash of Cultures (Performance Based Payments) (Chronology‪)‬

The experiments with pay for performance portend a seismic shift in the practice of medicine in the United States. Much has already been written about aligning interests of the various health care providers, chiefly being the hospitals, federal government through the Centers for Medicare and Medicaid Services (CMS), health care insurance carriers, and physicians. What has not been clearly addressed is the monumental clash of cultures that will occur with implementation of pay for performance, and the impediments that it presents. As with any medical diagnosis, it is helpful to look to history to identify some of the factors that have brought us to this point.