[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.205.87.3. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Article
November 12, 1997

Cataract Extraction Rates and Insurance Status-Reply

Author Affiliations

University of California, Los Angeles, School of Medicine

JAMA. 1997;278(18):1490-1491. doi:10.1001/jama.1997.03550180040024

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.

Abstract

In Reply.  —Dr Dahl asserts that the large differences we found in rates of cataract extraction for Medicare patients in FFS and prepaid settings do not result from financial incentives affecting ophthalmologists in the prepaid settings. Dahl refers to the fact that cataract extraction rates in the staff-model and IPA settings were similar even though, as he incorrectly asserts, IPA ophthalmologists were reimbursed "at a higher level than traditional Medicare." Our study demonstrated variations in rates between settings with very different financial and organizational incentives, but it cannot discern at which level these incentives are operating. Nevertheless, we believe it is naive to contend that financial incentives are not affecting ophthalmologists. In the IPAs we studied, ophthalmologists were reimbursed on a discounted FFS basis with rates that generally were lower than those paid in traditional FFS Medicare, and their behavior could well have been influenced by this.As Dahl states, some of

×