title: Does payment drive procedures? Payment for specialty services and procedure rate variations in 3 HMOs.
abstract: OBJECTIVE
  To study how payment for specialty services affects the rates of performance of invasive procedures by physicians in a number of specialties.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Administrative data from 1996-1997 and 1997-1998 from 3 large health maintenance organizations (HMOs) in the Midwestern and western United States were used to study variations in procedure rates associated with different methods of paying for cardiology, gastroenterology, ophthalmology, orthopedic, and ear, nose and throat services within each HMO. The age-, sex-, and comorbidity adjusted probabilities of undergoing selected, potentially discretionary procedures, were compared within each plan by payment method.
  
  
  RESULTS
  After adjustment, rates under fee-for-service payment tended to be higher than those under capitation or salary payment, whereas there was no clear pattern for salary versus capitation payment. Even within a single specialty in a single plan, however, rates did not always follow the same pattern for different procedures.
  
  
  CONCLUSIONS
  The payment method for specialty services used by these 3 health plans was variably associated with how likely patients were to undergo a variety of invasive procedures. The effects of contract payment methods for specialty services on health care costs, quality, and outcomes should be further studied, but such studies will challenge the capabilities of health plan data systems.
authors.affiliation: Department of Family Medicine, University of Washington, Seattle, Wash 98195-4696, USA. saver@u.washington.edu
authors.forename: Barry G
authors.initials: BG
authors.lastname: Saver
authors.forename: Debra Pearson
authors.initials: DP
authors.lastname: Ritzwoller
authors.forename: Michael
authors.initials: M
authors.lastname: Maciosek
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goodman
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Conrad
authors.forename: Eric
authors.initials: E
authors.lastname: Finkelstein
authors.forename: Martin
authors.initials: M
authors.lastname: Haase
authors.forename: Paul
authors.initials: P
authors.lastname: Barrett
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Cain
mesh_terms: D000328:Adult; D019937:Diagnostic Techniques and Procedures / Q000191:economics* / Q000706:statistics & numerical data; D004470:Economics, Medical; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D008875:Middle Aged; D012051:Reimbursement Mechanisms; D013038:Specialization; D013514:Surgical Procedures, Operative / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States