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September 20, 2000

Should Physicians Manipulate Reimbursement Rules to Benefit Patients?—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(11):1382-1383. doi:10.1001/jama.284.11.1378

In Reply: We agree that manipulating reimbursement rules to obtain needed care for patients is risky in the long run. In the short-term it may seem the only feasible solution, but it can lead to mistrust and even harm to patients.1 It is not the case, however, that physicians always gain from these manipulations. For example, misrepresentation by a physician to help a patient obtain a screening test or an off-formulary medication is not likely to accrue any direct financial benefit to the physician. Despite Dr O'Neal's impression, to the best of our knowledge, it is quite rare for capitated compensation plans to base physician payment on risk-adjusted outcomes.

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