Forget about pay for performance (P4P)

The principles of behavior modification demonstrate the importance of incentives. What is also well documented is that extrinsic rewards, i.e., financial incentives, have limited impact on complex behaviors.  Moreover, extrinsic rewards are most effective with young children. 

Consequently, based on the science of human behavior P4P would result in the desired performance in very limited settings and situations. We should not be surprised by the outcomes that we have experienced by applying P4P to health care...more money is not the answer.  

http://content.healthaffairs.org/content/31/9/1932.abstract?sid=6eb2c26a-18b9-4a35-a1cc-5b44b41c8ca2