To the Editor: In their study comparing change in quality of care between safety-net and non–safety-net hospitals, Dr Werner and colleagues1 raised important points about the design of pay-for-performance programs linked to publicly reported quality measures and the risk of unintended negative consequences to financially strapped public hospitals. I agree with their caveats about zero sum financial incentives.
Aviles AD. Comparisons of Safety-Net and Non–Safety-Net Hospitals. JAMA. 2008;300(14):1650-1652. doi:10.1001/jama.300.14.1650-b