Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
To the Editor.—Drs Cher and Lenert1raise important questions about the effect of Medicare
HMOs on intensive services in potential end-of-life situations. Their hypothesis,
that physicians reimbursed by managed care are less likely to provide inappropriate
high-intensity care, is intriguing, and their statistical methods are appropriately
sophisticated; however, we must question the understanding of the underlying
data on which the study is based. The authors commented on some information
that was unavailable to them, and the accompanying Editorial2
remarked on several points on which caution should be taken in interpreting
the study, but there are other issues that affect the generalizability of
the results of the study.
Gilden DM, Valentine DP. Potentially Ineffective Care in Intensive Care. JAMA. 1998;279(9):651–654. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-9-jbk0304
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