1. Echemendia, Janette RN, ONC, BSN

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I had the opportunity of reading the article titled "Pay-for-performance: Will it work?" in your July 2006 issue. After reading this article, I felt compelled to respond to the writer in regards to the utilization of evidence-based practices and the indication of payment based on performance.


Today's healthcare consumers are well informed about their condition and possible treatments. Patients can log on to the Internet and explore information on hospitals, physicians, nursing, and much more. These informed healthcare consumers know what treatments have shown high-quality results and what measures hospitals are implementing to continue to provide positive patient outcomes.


The author of this article expressed that evidence-based medicine is used to provide the right amount of services to the patient that is justified by the best available evidence or the best clinical judgment when evidence is lacking. I believe our patients deserve no less than the highest level of quality evidence-based care. Evidence-based medicine is the foundation of payment based on performance.


The CMS/Premier Demonstration Project is a prime example of pay-for-performance. As stated in the article, this 3-year demonstration project will reward top performing hospitals by increasing their payments on Medicare patients and also award bonuses based on performance of evidence-based quality.


I'm currently pursuing a masters degree as a clinical nurse leader. The clinical nurse leader places the patient's needs first and is responsible for overseeing and advocating for the patient's care. The discipline of nursing isn't a stranger to evidence-based practices. The implementation of evidence-based medicine will ensure that patients receive treatment based on quality measures for the best possible outcome. As a nurse leader, ensuring that these quality measures are met is an integral part of my role.


Our healthcare system has been through several changes in the past when it comes to payment for services rendered. I believe the CMS/Premier Demonstration Project is a positive incentive for the use of evidence-based practice. Evidence-based care and payment based on performance is the wave of the future, and I believe nursing has paved the way.


Janette Echemendia, RN, ONC, BSN


Miami, Fla.