RT Journal
A1 Hollenbeck BK, Nallamothu BK
T1 FInancial incentives and the art of payment reform
JF JAMA
JO JAMA
YR 2011
FD November 9
VO 306
IS 18
SP 2028
OP 2030
DO 10.1001/jama.2011.1630
UL http://dx.doi.org/10.1001/jama.2011.1630
AB 
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.