Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: Dr Cobin and colleagues, representing
the Physician Consortium for Performance Improvement, suggest that performance
measurement should be used for QI activities and that efforts should be directed
at the development of improved measurement tools and infrastructure. We agree
that performance measurement for QI purposes need not meet the stringent set
of requirements that we suggested in our article.
We note, however, that "pay for performance" systems already are being
implemented, and that many of these systems rely on physician clinical performance
assessment.1 Similar to performance measurement
for competency assessment, the requirements for clinical performance assessment
to reward quality should be stringent because of the potential impact on income
and reputations. There currently are few data on such "pay for performance"
systems, but many of the same issues that we raised in our article are relevant
for this topic as well. Consequently, better evidence is needed to support
the use of these systems and to ensure that their implementation does not
lead to unintended consequences, whether with respect to unmeasured aspects
of care or to access problems for specific types of patients.
Landon BE, Normand ST, Blumenthal D, Daley J. Farming and Slaughterhouse Practices to Reduce Meat-Borne Disease—Reply. JAMA. 2003;290(24):3194-3195. doi:10.1001/jama.290.24.3194-a