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Editorial |

Financial Incentives and the Art of Payment Reform

Brent K. Hollenbeck, MD, MS; Brahmajee K. Nallamothu, MD, MPH
JAMA. 2011;306(18):2028-2030. doi:10.1001/jama.2011.1630.
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During the past 2 decades, physicians have expanded the scope of care provided in their offices to encompass a variety of services including advanced imaging that were traditionally performed in hospital-based settings. In this issue of JAMA, Shah and colleagues1 describe a well-recognized consequence of this shift; namely, that physicians who provide and bill for a service, in this case cardiac stress imaging, tend to do more of it. The authors explored this relationship by linking physician billing patterns to the routine use of cardiac stress imaging after coronary revascularization—a practice with little supporting evidence.2 The main finding was that the use of cardiac stress imaging for this typically discretionary indication was more common among patients evaluated by physicians who billed for the service, particularly physicians whose billing included technical fees in addition to professional fees. At first glance, the solution would appear clear—dampen the incentive to do more by additional regulatory and administrative levers and unnecessary services will be reduced.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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