In our lead essay, two of the most prominent critics of pay-for-performance we cite are Leape and Berwick. However, in a recent article, they revise their thinking somewhat on the premise that the current method of financing healthcare not only fails to provide incentives for safe care, but also rewards unsafe care. In addition to pay-for-performance, they argue for initiation of negative financial consequences for healthcare providers that continue with unsafe practices and resulting complications. They endorse the recent decision by payers in Minnesota to cease paying hospitals for serious, preventable adverse events and conclude that payment should not reward poor safety (Leape and Berwick 2005).

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