I (Amer) had the privilege to participate in the NQF discussion  about Linking Cost and Quality Measures  on May 1, 2014. Below are my comments to the group. 
  1. I feel that the highly knowledgeable group has quickly dived into the complex details. I urge the group to divide the massive problem into smaller portions and  offer a multistage process for recommendations. Baby steps before we run.
  2. I pulled up financials of some hospital groups. Specifically Johns Hopkins made $1.8B in patient revenues with an operating income of $70M in 2013. I believe most hospitals publish their financials. The business world uses financial ratios to measures efficiency. I urge the group to explore recommending reporting financial ratios to show efficiency. For example, some efficiency and measurement rations could be doctor salaries / revenue, bad debt / revenue, total salaries / revenue, supplies / revenue. 
I come from the semiconductor world. Based on the current discussion it feels like we are we trying to pay chip vendors based on “chip defection rate” which vendors do not want to report and in most cases do not report.  I suggest the group zoom out and define efficiency at the macro level and measure patient outcomes instead of measuring error rates.

The above analogy is related to healthcare as follows: Paying providers based upon on their defect (error) rates will deter the market from incentivizing innovative advances that promote efficiency and reliability. This is because when payments to providers focus on error rates they raise the price of care because of the natural tendency to add redundancy to reduce error rates. I suggest focusing payment to providers based solely on outcomes which would include mandatory disclosure of  errors rates. The market will self correct to providers with lower defect (error) rates and reward safer providers with more business [added for clarification].