Should the principle of "pay for performance" be applied to nutrition support?

Americans spent 2.4 trillion dollars on health care in 2008. The massive size of this expenditure has led to perpetual efforts to improve health care quality while attempting to reduce overall cost. A recent development in reimbursement strategies is the "pay-for-performance" model. Retrospective reports showed variable success for this model for the treatment of acute myocardial infarction, pneumonia, and congestive heart failure. As the model gains popularity, there is pressure to apply pay for performance to an increasing number of diseases and treatment settings. In this article, we evaluate the appropriateness of the pay-for-performance model with regard to nutritional support in the hospitalized patient.