To the Editor.
—The article by Dr Goldzweig and colleagues1 concludes that the incidence of cataract surgery is susceptible to financial and organizational incentives. Although this hypothesis may indeed be accurate, given human nature, the study itself does not necessarily lead to this conclusion.The authors compare traditional Medicare (fee-for-service [FFS]) and a health maintenance organization (HMO) with both staff-model and network-model organizations. For the ophthalmologist-specialist, there is a major difference in reimbursement between the staff model, in which the physician is reimbursed through salary, and the network or independent practice association (IPA) model, in which reimbursement is FFS, usually at a higher level than traditional Medicare. The similarity in rates of cataract extraction between the staff model and the IPA implies that any motivational factors may be organizational, at a level distant from the specialist, but certainly are not based on financial considerations on the part of the
Dahl AA. Cataract Extraction Rates and Insurance Status. JAMA. 1997;278(18):1489. doi:10.1001/jama.1997.03550180039020