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Jury still out on global payments

THE GLOBE report and statement by state Representative Steven Walsh read too much into the results of a weak study that hints at a 3.3 percent health cost savings after a new global payment contract that pays doctors bonuses for cutting costs (“Blue Cross plan shows reduction in spending,” Page A1, July 12).

Certainly, Walsh’s assertion — “This proves. . . you can save money” — is unfounded. Michael Chernew, the study’s senior author, was the only person who reasonably stated that the findings were inconclusive.

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Such savings are essential to avoid dire economic consequences for the United States. But it’s too soon to declare victory. A major study flaw is the biased selection of “volunteer practices” that may have signed on because they were already on track to lower costs and were motivated by bonuses that ate into the touted savings. Other unstated differences between the self-selecting practices and non-participants could easily explain such results.

Moreover, the study doesn’t include enough years prior to these contracts to know whether trends in costs and quality were already occurring. Previous studies demonstrate that physicians “game” pay-for-performance systems; they play when they have already won. Such unintended consequences are the rule, not the exception.

Stronger controlled trials are essential before mandating such policies throughout the Commonwealth.

Stephen Soumerai

Professor of population
Harvard Medical School


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