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November 9, 2011

Financial Incentives and the Art of Payment Reform

Author Affiliations

Author Affiliations: Departments of Urology (Dr Hollenbeck) and Internal Medicine (Dr Nallamothu), and Center for Healthcare Outcomes and Policy (Drs Hollenbeck and Nallamothu), University of Michigan, Ann Arbor.

JAMA. 2011;306(18):2028-2030. doi:10.1001/jama.2011.1630

During the past 2 decades, physicians have expanded the scope of care provided in their offices to encompass a variety of services including advanced imaging that were traditionally performed in hospital-based settings. In this issue of JAMA, Shah and colleagues1 describe a well-recognized consequence of this shift; namely, that physicians who provide and bill for a service, in this case cardiac stress imaging, tend to do more of it. The authors explored this relationship by linking physician billing patterns to the routine use of cardiac stress imaging after coronary revascularization—a practice with little supporting evidence.2 The main finding was that the use of cardiac stress imaging for this typically discretionary indication was more common among patients evaluated by physicians who billed for the service, particularly physicians whose billing included technical fees in addition to professional fees. At first glance, the solution would appear clear—dampen the incentive to do more by additional regulatory and administrative levers and unnecessary services will be reduced.

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