Should we link payment to quality?

The movement to improve the quality of medical care is accelerating as payers and patients demand greater accountability. Recently, the Center for Medicare and Medicaid Services (CMS) increased the quality assessment stakes even further with a proposal to link hospitals' reimbursement rates to their "performance" on specific quality-of-care indicators. While many clinicians would generally agree with the concept that providing better medical care should be rewarded, putting the idea into practice poses a challenge.