The new language of medicine.

n engl j med 365;15 nejm.org october 13, 2011 1372 centives to increase labor productivity. The combination of a risk-based payment model tied to outcome goals, on the one hand, and coding rules that are appropriate regardless of how providers achieve their clinical goals, on the other, could inspire the implementation of innovative, technology-based, analytically informed approaches that increase productivity. Alternatives that are not oriented toward substantial improvements in labor productivity will inevitably lead to a future in which health care salaries come under extreme pressure, as payers and policymakers resort to traditional levers of market-basket cuts and utilization controls. Therefore, as the system embarks on initiatives such as accountable care organizations, patient-centered medical homes, and bundled payments, it is imperative to work to optimize both patient outcomes and labor productivity. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.