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Comment & Response
October 8, 2014

Primary Care Physician–Led Health Reform

Author Affiliations
  • 1Mt Sinai Beth Israel Medical Center, Mt Sinai School of Medicine, New York, New York

Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2014;312(14):1471-1472. doi:10.1001/jama.2014.10100

To the Editor Dr Mostashari and colleagues1 described a vexing problem—creating incentives that encourage efficiency, not volume. Invoking an ambiguous role model, the corporate CEO, they postulated that primary care physicians, who account for 5% of health care spending, should make the tough calls on the rest.

Supporting their solution proves hard. To set primary care’s contribution equal to estimated avoidable costs, they ignored a key finding: there is an association between costs and primary care physician supply.2 To support physician-led over hospital-led accountable care organizations (ACOs), which must absorb volume-related revenue declines that are off practice balance sheets, they cited similar cost-reduction success rates. The authors asserted that primary care physicians can best pick specialists, diagnostics, and institutions “that provide evidence-based high-value care.”

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