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Pay for performance (P4P) is no longer a nascent concept on the distant horizon, nor has it established itself as a permanent and welcome fixture on the healthcare landscape. Now that most medical group practices have experience with P4P programs-62.5% of medical groups participate in some type of P4P program, according to a recent survey conducted by ECG Management Consultants and the AMGA-P4P has entered a transitional stage in which payers, providers, and other stakeholders are attempting to work out the kinks in their programs to better meet the P4P goals.