Hospitals are increasingly linking chief executive pay to quality, although adoption of the approach is not consistent. Research suggests incentive pay tied to quality plays a role in improving performance of a hospital, and Dr. Ana Pujols-McKee, who is executive vice president and chief medical officer of the Joint Commission, says the connection makes sense and speaks to the public. "Quality is the product we're paying for as the consumers. That's what we expect," Pujols-McKee said. Payers are increasingly tying pay to performance, with Aetna expected to link 50% of commercial reimbursement to performance by year's end, up from 30% at the beginning of 2014.