Until payers have some way to assess quality, purchasing decisions will necessarily be based primarily on cost. Which of these variables to measure is determined by a combination of the intent of the performance measurement and the degree to which it is feasible to measure a selected variable. Outcomes are, by definition, the results of health care that patients experience and really care about. However, negative consequences of health care must also be considered, outcomes such as persistent pain, new disability or reduced function. It is reasonable to infer that better outcomes will more likely result from better processes.
Most physicians have a strong desire to provide quality patient care.
This should be sufficient motivation for physicians to participate in performance measurement initiatives designed to provide physicians with feedback comparing their performance with national benchmarks. On the other hand, external forces are likely to provide more compelling motivation. Social activists are busy attempting to ensure that health care providers are held accountable for the quality of patient care they render. Payers for health care are becoming more insistent about their need for information on quality of the health care they are purchasing. The ultimate incentive for physicians to participate in an approved program of performance measurement is for participation to become a requirement for physicians to be allowed to provide patient care or to receive payment for providing patient care.