Health Affairs September 30, 2025
Over the past several decades, an appealing idea rapidly gained popularity: The government could advance a health care system that rewarded the quality of care rather than the volume of care. Medicare began leveraging its economic might to require physicians and hospitals to measure and improve quality.
In tandem, Congress embarked on a 20-year journey to incentivize providers to report on quality and pay for good patient outcomes. Initially, physicians and hospitals were paid to report on quality measures developed by physicians and physician-led organizations. Over time, quality measurement development and associated improvement programs became decoupled from front-line clinical care as government and quality-improvement organizations evolved organically into today’s massive medical-industrial quality bureaucracy.
The 2006 Tax Relief and Health Care...
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