Care Patterns in Medicare and Their Implications for Pay for Performance

March 15, 2007
New England Journal of Medicine356;11
Hoangmai H. Pham, Deborah Schrag, Ann S. O'Malley, Beny Wu, Peter B. Bach

Two assumptions underpin the implementation of pay for performance in Medicare: that with the use of claims data, patients can be assigned to a physician or to a practice that will have primary responsibility for their care, and that a meaningful fraction of the care physicians deliver is for patients for whom they have primary responsibility. Using Medicare claims from 2000 through 2002 for 1.79 million fee-for-service beneficiaries treated by 8,604 respondents to the Community Tracking Study Physician Survey, this study found that the dispersion of patients' care among multiple physicians will limit the effectiveness of pay-for-performance initiatives that rely on a single retrospective method of assigning responsibility for patient care.

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