Ever since 2001, when the Institute of Medicine recommended that public and private purchasers of health care build stronger incentives to enhance quality, there has been a proliferation of pay-for-performance (P4P) demonstrations.1 But despite this growth in new initiatives for quality-based incentive programs for hospitals, physicians, nursing homes and home health providers, there is limited evidence of the effectiveness of early private-sector demonstration projects.2 As efforts to link reimbursement and performance continue to increase, a careful review of the lessons learned from early initiatives should be an important component of the design, implementation and evaluation of any new P4P initiatives.
