We are in general agreement with Jordan VanLare and coauthors on each of the issues they raised. Indeed, the value-based purchasing program of the Centers for Medicare and Medicaid Services rewards both improvements in care and high achievement. Our findings (Oct 2011) show that safety-net providers, which care for vulnerable populations, start at a lower baseline for performance and should have the ability to improve and receive full payments for quality under the program. But will they improve?
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