Couple of points:

- If it were easy we would be doing it already. (Obviously.) We still are not at a point where the industry and the profession have a good understanding, let alone agreement, on how best to measure performance and quality, and then to provide incentives to reward improving quality.

- Regardless of how the industry and providers feel about it, Medicare is already moving towards performance measures as well as financial disincentives for undesirable outcomes (e.g. hospital readmission within 30 days).

- Although the research is conflicting, there is some evidence that outcome monitoring may have some beneficial impact on utilization and results. A California evaluation of CABG reporting rates noted a decrease in both CABG rates as well as risk-adjusted operative mortality rates after requiring hospitals to report CABG mortality rates. Similarly, a JAMA article earlier this month evaluated the impact of cardiac cath reporting rates in New England. It found a decrease in the rates of cardiac cath for acute heart attacks but no change in 30 day mortality, which suggests but does not prove that cath outcome reporting decreased the rate of low-benefit procedures. (This is because it was an observational study. You can only prove causation with a randomized controlled trial.)