In Reply We agree with Maslove that there is no single rule to attribute patient outcomes to physicians.1 We used 3 different attribution rules: attributing patients to physicians who (1) accounted for the largest Part B spending, (2) derived the largest number of evaluation-and-management claims, and (3) derived the first evaluation-and-management claim. Our findings were similar in each approach. We also found that 51%, 22%, and 11% of Part B spending was accounted for the first, second, and third highest-spending physicians, respectively,2 suggesting that a single physician drives the majority of care rather than multiple physicians delivering care equally.
Tsugawa Y, Jena AB, Jha AK. Limitations Concerning the Association of Physician Sex and Patient Outcomes—Reply. JAMA Intern Med. 2017;177(7):1058-1059. doi:10.1001/jamainternmed.2017.2148