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He said hospitals and doctor groups were merging into oligopolies and raising prices.
In the predecessor program, the Medicare Physician Group Practice Demonstration, participating doctor groups were eligible for up to 80percentt of any savings they generated if they could also show improvement on 32 quality measures.
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The American Medical Association and other doctor groups are making an all-out push for Congress to scrap the formula used to calculate their payments.
The internal debate creates uncertainty about antitrust enforcement policy at a moment when scores of hospitals, clinics and doctor groups are eager to band together and test innovative ways of delivering care.
Most doctor groups aren't opposed to altering the law, but don't want more than 20 million Americans who gained coverage to lose it.
Finally, looking at manpower utilization appropriate to implement consultation recommendations, little difference between the 2 doctor groups was found, and use of nurses or community resources seemed to not be considered often.
These views on family doctors were not obviously related to gender or age, and therefore the fact that those in the 'no regular doctor' group were somewhat older on average and mainly female (Table 1) did not seem to account for these findings.
Since working conditions and work strain in the two doctors' groups were comparable, we assumed that these variables would not have a major impact on the outcome variable.
The cause of the lower follow-up in the doctor group is unclear and may be due to chance variation.
Though in absolute terms there were (slightly) more contacts in both primary and secondary care in the nurse group than in the doctor group, the doctor group was associated with more costly resources, particularly salary costs.
A fourth consideration is that while the Doctor group are likely to be equivalent but possibly cheaper than the ESPs or ENPs the sensitivity analysis showed they were randomised to more of the relatively expensive lower-limb injuries.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com