ABSTRACT
A discussion on whether to implement pay-for-performance programs for the Medicare population continues to be debated despite all the demo projects and Medicare Advantage experiments to the contrary. Adherence to guidelines allows comparisons of data and process points, which are all part of this mix of pay-for-performance discussions. Structural factors take into account the delivery system resources and setting. The chapter discusses a series of challenges that will need further study and will need further funding to truly represent dynamics of what comparative economics holds for all of us. Many pay-for-performance systems are just starting to understand the true long-term implications of their decisions on not just quality but availability of resources needed to sustain quality long term. The lag time on mortality statistics or need to have a more immediate influence on the quality aspects of care has many researchers looking deeper inside the definitions to find out what the root causes and driving forces in clinical outcomes are.
