With the impact of pay for performance likely to broaden and deepen in the coming years, ensuring that the quality measures used in these initiatives are based on the best possible clinical evidence and expert consensus is paramount. Two types of organizations greatly influence the content of quality measures: measure development organizations-such as the National Committee for Quality Assurance-and medical professional societies. The process by which emerging measures of quality are created is subject to bias resulting from organizational and individual conflicts of interest in both types of organizations. This article examines the financial ties between those who-both directly and indirectly-help create the standards used in pay-for-performance programs and those firms whose revenues will increasingly depend on the substance of these measures. Several examples of inappropriate industry influence in the drafting of clinical practice guidelines by professional societies illustrate that these groups' future management of conflicts of interest may ultimately affect the success of pay-for-performance programs. Finally, policy options for minimizing the effects of these conflicts on the development of quality measures are discussed.
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