RT Journal A1 Profit J, Petersen LA T1 PAy for performance is growing up JF Archives of Pediatrics & Adolescent Medicine JO Archives of Pediatrics & Adolescent Medicine YR 2007 FD July 1 VO 161 IS 7 SP 713 OP 714 DO 10.1001/archpedi.161.7.713 UL http://dx.doi.org/10.1001/archpedi.161.7.713 AB More than half a decade after the influential report by the Institute of Medicine “Crossing the Quality Chasm: A New Health System for the 21st Century,”1 America's health care system continues to be riddled with quality problems. For example, adult and pediatric patients receive only about half of the health care services that are recommended.2- 3 One factor contributing to this situation is receiving increasing attention: a reimbursement system that may actively discourage quality improvement (QI). Quality improvement may be discouraged because any financial rewards for improving health care quality accrue primarily to payers and patients, not to the health care providers who fund and implement them.4 Pay-for-performance programs are an attempt to correct this imbalance and provide direct incentives for quality to providers.5