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October 3, 2001

Reimbursement as Incentive to Improve Physicians' Quality of Care—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(13):1575. doi:10.1001/jama.286.13.1573

In Reply: We agree with Dr Finestone that the performance by physicians in our study was far from ideal. We do not, however, agree with his implications. He argues that improvements in physician performance would best be accomplished by tying reimbursement directly to performance. While we agree that this approach might work for some measures, we object to it for theoretical as well as practical reasons.

We believe that physicians should strive to perform optimally, regardless of monetary rewards or punishments. Furthermore, we believe that most physicians do aim to deliver the best care they can. Medical practice is complex, involves systems and not just individuals, and the measurement of quality is a scientific field still in its infancy. Current quality indicators suffer from the "searching for the keys under the lamp-post" phenomenon, in that they represent what we know how to measure, not necessarily what would be most important to change. We hope that our method creates an environment for improvement that has positive effects on performance beyond those indicators we measured. We are testing this effect in ongoing studies.