 The necessity to have a physician on staff along with all other diagnostic services available every hour of every day is thus a costly arrangement for hospitals.American health payment systems are undergoing significant reform efforts, which include compensating emergency physicians through "Pay for Performance" incentives and penalty measures under commercial and public health programs, including Medicare and Medicaid.This payment reform aims to improve quality of care and control costs, despite the differing opinions on the existing evidence to show that this payment approach is effective in emergency medicine.