To continue our series on healthcare policy, its time to expand on the idea presented last week – pay for performance. The thought that milestone achievement merits reward is often cited as a strong motivator. However, there are advocates for the opposite philosophy; rather than rewards for accomplishment, some believe their should be penalties for failure to meet a certain benchmark. This suggests, for example, that if a patient did not obtain certain level of blood pressure control, the provider may not be payed for the associated encounters. Beyond that, there is the idea that negative reinforcement, such as penalties incurred for hospital-acquired infections, will drive improved healthcare outcomes and reduce overall cost. For the risk-averse, this makes sense, but does it result in actual improvement in the quality of patient care? Does it appreciably decrease healthcare expenditure on preventable events? Ashish Jha and his group from Harvard (same author as last week) studied the effect of the CMS policy of non-payment for hospital-acquired infections. They note that they have found “no evidence that the 2008 CMS policy to reduce payments for central catheter-associated bloodstream infection and catheter-associated urinary tract infections had any measurable effect on infection rates in U.S. hospitals.” Take a look at the entire article here, at the NEJM. Special thanks to Dr. Johnson for providing us with these articles.