Ideally pay-for-performance in chronic diseases would be based on outcomes that really matter to patients, such as death, morbidity, and disability. Instead, many of the quality metrics used in pay-for-performance address process measures (e.g., the percentage of diabetic patients who receive glycosylated hemoglobin [HbA1c] testing or a lipid profile each year). The few measures that attempt to address clinical outcomes actually measure surrogate markers like HbA1c, low-density-lipoprotein (LDL) cholesterol, and blood pressure.
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