The remainder of this report presents the findings of RAND’s environmental scan of hospital P4P. Chapter 2 reviews the empirical literature on the impact of hospital P4P. It also draws from the economics and organizational management theoretical literature that has examined the effect of incentives on behavior to assess possible implications for P4P program design. Chapter 3 summarizes our discussions with hospital P4P program sponsors nationally, focusing on a description of the measures being used by these programs, the structure of the incentive payments, operational issues associated with implementation, and lessons learned. Chapter 4 summarizes our discussions with hospitals that have been exposed to P4P and P4R efforts (such as the CMS RHQDAPU program, the Premier P4P demonstration, or private-sector P4P programs), hospital associations, and data vendors that support hospitals in their data submissions to the array of performance-reporting efforts. Our emphasis in these discussions was on learning what hospitals thought about the set of performance measures for which they were being held accountable, the structure of the incentive payments, issues related to data submissions and the quality and validity of data used to score their performance, the importance of public reporting, barriers they saw as hampering their ability to comply with the program requirements, and lessons they had learned. As part of these discussions, we also focused on understanding the unique issues of small, rural, and Critical Access Hospital (CAH) hospitals that would affect their ability to participate in P4P programs. Chapter 5 concludes by summarizing the key findings from the environmental scan.