"Care Patterns in Medicare and Their Implications for Pay for Performance," New England Journal of Medicine: The study -- by Hoangmai Pham of the Center for Studying Health System Change, Deborah Schrag of the Health Outcomes Research Group at Memorial Sloan-Kettering Cancer Center and colleagues -- examines the potential effectiveness of pay-for-performance programs under Medicare. Researchers analyzed Medicare claims between 2000 and 2002 for beneficiaries enrolled in the fee-for-service program and then assigned each patient to a physician from whom the patient had received the most care. Researchers also determined how many physicians and practices each beneficiary had visited annually, as well as the percentage of care the patients received from each provider, the stability of patient-physician assignments over time and the percentage of patients doctors saw who were specifically assigned to them. According to the study, beneficiaries saw multiple physicians and specialists among various practices, which could "imped[e] the ability of any one assigned provider to influence the overall quality of care for a given patient." In addition, a physician might be treating a number of Medicare beneficiaries but only have a few specifically assigned to him or her, thus potentially limiting the size of available incentives (Pham et al., NEJM, 3/15). An editorial on pay-for-performance by Karen Davis, president of the Commonwealth Fund, also appears in Thursday's NEJM.

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.