PQRS

 PQRS was established as a voluntary program providing bonus payments to qualified professionals for reporting certain results from their medical practice  under the guidelines of Physician Quality Reporting Initiatives to Medicare from 2006 to 2014 (created under the Tax Relief and Health Care Act of 2006). Obamacare, the recently passed Patient Protection and Affordability Health Care Act, mandates this reporting after 2015 and beyond.

Reporting on management and results of management can return a small financial reward, a gradually decreasing percentage of the physician's Medicare billing, until 2015 when a fine will be imposed for not reporting or demonstrating desired results.

In essence, milestones of medical care have been established by the Washington leadership and physicians will be fined for not achieving them. How these milestones will be created, what and how they will be measured and whether they will be meaningful  is yet to be determined. Current milestones are limited, for example having electronic records or sending prescriptions by fax to pharmacies. Future milestones might be considerably more grand, like changing complication rates of diabetes or fracture rates in osteoporosis. This appears to be similar in nature to the government solar energy initiatives: If you build a theoretical framework, real working individuals will fill it in.

Whether or not physicians will allow themselves to be held responsible for such results will be interesting.