Using nationally representative, all-payer discharge data, these authors examined temporal changes in AHRQ’s patient safety indicators (PSIs) and their association with national pay-for-performance reforms. From 2000 – 2013, the researchers found decreased rates for ten of thirteen PSIs and an increase in the rate of three PSIs (iatrogenic pneumothorax, postoperative sepsis, and postoperative physiologic or metabolic derangement). The authors discuss major CMS payment policy changes and their intersection with the PSI; except for pressure injuries, the implementation of payment policy reforms did not precede the decline trends in PSI rates.