A random side fact: right now, there are health plans that categorize doctors by "quality and cost-effectiveness", and have different co-pays set for each "tier". Harvard Pilgrim has one such plan - they give points for things like having electronic records, etc. And probably for things like "not being at MGH or other insanely expensive places", I imagine. I have no idea if there is any corresponding incentive on the practitioner side. I would be curious to see if they have any numbers for assessing whether they think this has had any effect.

Disclaimer: I don't know. Somewhat tangential discussion follows.

So if this is still worth reading :) then my point is that How does the evaluation of doctors, and resultant feedback mechanism for improvement over time, compare is missing a key clause: and funding to enact improvements.

My understanding is that No Child Left Behind was an unfunded mandate, so sure, you could have perfect feedback, but nothing could change due to lack of funding.

I know that there already exist Medicare measures (PQM? Physician Quality Management, maybe?) where doctors get a slight percentage boost to their Medicare re-imbursements if they go through slightly more paperwork which is designed to catch errors. My understanding is that it's something like: for this procedure associated with this diagnosis, errors X Y and Z often crop up, so if the doctor explicitly checks off "Yes I checked for conditions X Y and Z and they are not present", then Medicare will pay an extra 2% of what is reimbursed for this procedure.

Is this useful? I believe the idea is that the money you save by 1, not doing unnecessary procedures or 2, not dealing with complications pays for the extra 2% (or whatever the percentage is). Does the data back that up? No idea.

Now, is this initiative extended into healthcare reform? No idea.

I'm not sure how to find out the answer to either question. I think it'd be nice if they were. :)

If you're talking about something in the House bill, the closest thing I can find is this, which mentions "performance or utilization based payments". It's a bit vague. So I guess it would be up to the officials in charge to come up with something effective.