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To the Editor: Dr McCormick and colleagues¹ underscore the limitations of voluntary public disclosure of performance data. However, I would not call voluntary public disclosure a complete failure, given this revelation of its attendant gaming and manipulations. The article buttresses the potential and ongoing trade-offs between market dynamics (in principle driven by costs and quality²) and the quality movement in the United States and other industrialized nations with managed care. Thus, there is need to reconcile corporate governance and clinical governance: this may entail reengineering the entire system around the empowered health care consumer.

In addition, while overcoming the ultimate resistance to change,³ it may be worthwhile to explore partial approaches such as public-private cost sharing with an independent oversight or mandatory regular reporting of a specified (high priority) subset of HEDIS measures.

While the science of performance assessment may still be at an early stage,⁴ it is important . . . [Full Text of this Article]

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