To be a useful tool for assessing quality of physician care, pay-for-performance must be designed to include process measures and to not penalize physicians for treating patients with difficult-to-manage conditions.
A review of the case of a physician accused of euthanizing four patients following Hurricane Katrina and the state attorney's unethical conduct in releasing information to the media.
Appropriate use of the pay-for-performance system may improve quality of care by counteracting physician incentives to overtreat in fee-for-service situations or undertreat in capitation plans.