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In an effort to improve quality of patient care, the pay-for-performance initiative was begun in the U.S. as a pilot program in 2003 by a nationwide organization of nonprofit hospitals and the Centers for Medicare and Medicaid Services. The program specified that participating hospitals with better performance on certain process-of-care measures (based on treatment guidelines developed by professional organizations with input from clinicians) would be reimbursed at a higher rate than those meeting fewer of the guidelines. Now, investigators have evaluated whether participation in the program led to an improvement over time in the quality and clinical outcomes of medical care for acute myocardial infarction. Treatment guidelines were those r…