 There are some challenges with implementing these quality-based incentives in emergency medicine in that patients are often not given a definitive diagnosis in the ED, making it difficult to allocate payments through coding.Additionally, adjustments based on patient risk-level and multiple co-morbidities for complex patients further complicate attribution of positive or negative health outcomes, and it is difficult to assess whether much of the costs are a direct result of the emergent condition being treated in acute care settings.It is also difficult to quantify the savings due to preventive care during emergency treatment (i.e.