Letters Section Editor: Robert M. Golub, MD, Senior Editor.
To the Editor: In his Commentary, Dr Wachter1 elaborated on unanticipated consequences of the quality improvement revolution. One topic that was not discussed was the relationship between quality improvement measures, pay-for-performance, and future research. Hospitals, many of which have small operating margins, appear to be trying to optimize quality measures that have been endorsed by the Centers for Medicare & Medicaid Services2 and other third party payers in order to maximize these payments. I am not aware of an exemption or a guarantee of maximum payment for hospitals that are participating in research to strengthen and clarify the scientific observations that are the underpinnings of the current quality improvement revolution. Without such an exemption or guarantee of payment, hospitals may be motivated to discourage or stop research that could result in a lower reimbursement.
McGovern PC. Consequences of the Quality Improvement Revolution. JAMA. 2006;296(20):2439. doi:10.1001/jama.296.20.2439-a