Pay for Performance Hits Pay Dirt … Sometimes : New York's program paid off, but in California and Massachusetts, clinical outcomes have yet to improve.

But what is really needed is an overhaul of the way the medical system is organized to allow single physicians or groups to actually be responsible for individual patients. Or, alternatively, there needs to be more financial incentive in pay for performance to make it worthwhile for physicians to invest in the infrastructure they need to participate, because they are going to be able to show good performance for only a small proportion of their patients, she added.