Pay-for-Performance May Be Hindered by Medicare Plan

Individual physician performance unclear since Medicare patients see multiple physicians

WEDNESDAY, March 14 (HealthDay News) -- Medicare patients are typically treated by multiple physicians, which will limit the effectiveness of pay-for-performance initiatives currently being proposed, according to a report in the March 15 issue of the New England Journal of Medicine.

Hoangmai H. Pham, M.D., at the Center for Studying Health System Change in Washington, D.C., and colleagues analyzed Medicare claims data from 2000 to 2002 for 1.79 million fee-for-service beneficiaries who were treated by 8,604 physicians. The researchers determined the number of physicians and practices that were visited annually, the percentage of care received from each physician, and the percentage of a physician's patients that were their assigned Medicare patients.

The investigators found that beneficiaries saw a median of two primary care physicians, many of whom were not their assigned physician, and five specialists working in four different practices. Overall, 33 percent of beneficiaries saw their assigned physician, which changed from year to year.

"A cautious move toward a more rational payment system, with opportunities to fine-tune payment as experience is gained, shows the greatest promise of avoiding unintended consequences," Karen Davis, Ph.D., of the Commonwealth Fund in New York City, writes in an accompanying editorial. "This caution, however, must be balanced against the urgent need to address the financial stresses from ever-rising costs of health care."

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