FIGURE 5-1 Example of initial timeline from data collection to pay for performance.

cific measures must be shared with the public and that such public reporting should be a requirement for performance-based payment. Many proponents of public reporting believe this strategy in itself can be a useful tool for improving all aspects of quality, regardless of its association with rewarding performance. To date, the limited evidence presented in the literature is mixed, but overall it does suggest that public reporting can have an impact on provider behaviors and improve quality (Marshall et al., 2000; Hibbard et al., 2005; Jha and Epstein, 2006; Robinowitz and Dudley, 2006).

At the same time, public reporting could have unintended adverse consequences. For example, some providers might avoid sicker patient populations, and others might choose not to participate in Medicare if public reporting on performance became a condition for participation. Notwithstanding the literature that argues otherwise, some low-performing providers might fear that public disclosure of performance data would attract malpractice claims in which the data could be used against them (Werner and Asch, 2005; Kesselheim et al., 2006).

Through the development of the Compare websites by the Centers for Medicare and Medicaid Services (CMS),¹ many providers are already publicly reporting performance data. In 1999, the Medicare Personal Plan