Amid the changes occurring in the United States, an ongoing experiment involves new reimbursement arrangements called pay-for-performance. In the case of pay for performance, the performance of doctors becomes linked to quality. Pay for performance will likely face challenges as it is implemented and used in the United States through the adoption of electronic health records. This article will cover these possible challenges while addressing general concerns. Clinical practices, especially those on a smaller scale, know their patients in the office or formally get to know them during initial visits. However, with the new reimbursement method called Pay for Performance (P4P) linked to physician payment, this could negatively impact this individual interaction. “Compensating a physician will improve the quality of health care a patient receives, but the costs will also be reduced in order to provide that care” (Journal of General Internal Medicine, p. 10, para. 4). The relationship between doctor and patient could be compromised due to the cost of the care received. A deeper understanding of the implications of a pay-for-performance system and adoption of medical records needs to be addressed. Pay for performance and the adoption of medical records From a technological perspective, every country seeks to be at the top of the list for advancement. The electronic medical record (EMR) is also an upcoming technology that allows physicians to implement more powerful quality improvement programs with paper records (Miller and Sim, 2009). EMR adoption is not an inexpensive endeavor or an easy task. According to Miller and Sim (2009), “quality improvement is highly dependent on a major physical concern for practicing physicians in using a P4P system as well. Overall, P4P could bring great benefits over the next 5-10 years of use, but initial implementation could be risky.ReferencesChristianson, B. and Knutson, D. (2010). Remuneration of physicians based on their performance: implementation and research issues. Journal of General Internal Medicine. 21 (9-13). doi:10.1111/j.1525-1497.2006.00356.xMiller, R. and Sim, I. (2009). Physicians' use of electronic medical records: Obstacles and solutions. Health Affairs. 2(116-127). doi: 10.1377/hlthaff.23.2.116RAND. (2013). Healthcare pays for performance. Retrieved from http://www.rand.org/topics/health-care-pay-for-performance.html UPMC. (2009). Overview of the 2009 Quality Incentive Program (Primary Care). Retrieved from http://www.upmchealthplan.com/pdf/2009_QIRP_Overview.pdf