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A response by Amir A. Ghaferi, John D. Birkmeyer and Justin B. Dimick to a letter to the editor about their article "Variation in Hospital Mortality Associated With Inpatient Surgery" in the October 1, 2009 issue is presented.

The article focuses on the strategies considered by payers to bring about improvements in quality of surgical practices. It is mentioned that the quality of health care should be assessed on the basis of structure, process, or outcomes of any clinical practice. Some payers are re-examining their centers-of-excellence strategies aimed at referring patients to the medical care facilities that are likely to provide the best results with respect to a particular condition or procedure. The payers are also experimenting collaborative model in the hope of effecting improvements in quality by underwriting the costs of clinical-outcome registries and improvement activities on the part of providers.

A letter to the editor is presented in response to the article "Surgeon Volume and Operative Mortality," by Birkmeyer et al. in the November 27, 2003 issue.

A response by John D. Birkmeyer and Emily V.A. Finlayson to several letters to the editor in response to their article "Hospital Volume and Surgical Mortality in the United States" in the April 11, 2002 issue is presented.

A letter to the editor is presented in response to the article "Decision Analysis - Effects of Prophylactic Mastectomy and Oophorectomy on Life Expectancy among Women with BRCA1 or BRCA2 Mutations," by Deborah Schrag, Karen M. Kuntz, Judy E. Garber, and Jane C. Weeks in the May 15, 1997 issue.