The result of the education system doing that has been teachers, schools and school districts gaming the system, and school districts have made their teachers hostage by effectively killing the tenure system. Low income school districts are not attracting employees because they now they will face a firing squad every year, or semester. And these folks have very strict specific tests, not the subjective and paperwork heavy system trying to track PHEMS people would entail.
Might as well borrow a banjo and move out onto the porch after a long day of picking cotton.
Anjel noted paying a little "perk" for doing good paperwork. Sounds good, as well as for good driving, turning a clean unit over to the next shift, etc.
I could see a performance based system being based on following protocol (absence or presence of protocol deviations), attendance (lack of calling in sick etc), lack of overtime; this would generally begin taking the place of good line management. Patient outcome would be impossible to track and attribute to PHEMS performance, other than absolute screwups, and basing it upon satisfaction questionnaires means you succeed if you lie, conceal and sugar coat or blame-away bad news or mistakes.
Perks for areas needing attention, and retention/training of line managers so they can spot, coach, and either save or flag for termination bad employees using management principles and documentation.