Managed Care

Does payment method drive procedure rates?













In a study involving three large HMOs, researchers reviewed encounter and claim data for specialty services associated with different rates of performance of invasive procedures. Barry G. Saver, MD, MPH, and colleagues hypothesized that procedure rates would be higher for physicians paid using fee-for-service methods, intermediate for salaried specialists, and lowest for physicians paid under negotiated capitation rates.

"That wasn't the case," Saver reports. "We ended up with substantially mixed findings. It was reassuring that we didn't find lower rates under capitation. There's nothing suggesting that patients are being deprived of needed care any more than if they were seeing salaried physicians."

Below, HMOs are labeled A, B, and C.

Payment method has minimal effect on rate of procedure

Rate per 1,000 person-years

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