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—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
Goldzweig CL, Mangione CM. Cataract Extraction Rates and Insurance Status-Reply. JAMA. 1997;278(18):1490–1491. doi:10.1001/jama.1997.03550180040024
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