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To the Editor: In their study comparing change in quality of care between safety-net and non–safety-net hospitals, Dr Werner and colleagues¹ raised important points about the design of pay-for-performance programs linked to publicly reported quality measures and the risk of unintended negative consequences to financially strapped public hospitals. I agree with their caveats about zero sum financial incentives.

However, I take exception to their statement that "the quality of care at these [safety-net] hospitals is lower than that delivered at other hospitals." The New York City Health and Hospitals Corporation (HHC), the largest US public hospital system, performs above the national average on nearly all of the current quality measures by the Centers for Medicare & Medicaid Services (CMS). For example, for the period April 2006 through March 2007, HHC performed better than the national average on measures of heart attack care (87.0 vs 78.6), heart failure care (94.0 vs . . . [Full Text of this Article]

Alan D. Aviles, JD
alan.aviles@nychhc.org
New York City Health and Hospitals Corporation
New York, New York

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