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MANUSCRIPT: Word of Mouth and Physician Referrals Still Drive Health Care Provider Choice

Sponsors of health care price and quality transparency initiatives often identify all consumers as their target audiences, but the true audiences for these programs are much more limited. In 2007, only 11 percent of American adults looked for a new primary care physician, 28 percent needed a new specialist physician

MANUSCRIPT: Care Patterns in Medicare and Their Implications for Pay for Performance

Conclusions In fee-for-service Medicare, the dispersion of patients’ care among multiple physicians will limit the effectiveness of pay-for-performance initiatives that rely on a single retrospective method of assigning responsibility for patient care. http://www.nejm.org/doi/pdf/10.1056/NEJMsa063979

MANUSCRIPT: Dropping the Baton: Specialty Referrals in the United States – MEHROTRA – 2011 – Milbank Quarterly – Wiley Online Library

Findings: PCPs vary in their threshold for referring a patient, which results in both the underuse and the overuse of specialists. Many referrals do not include a transfer of information, either to or from the specialist; and when they do, it often contains insufficient data for medical decision making. Care across the primary-specialty interface

MANUSCRIPT: Primary Care Physician Specialty Referral Decision Making: Patient, Physician, and Health Care System Determinants

Conclusions. PCPs’ referral decisions are influenced by a complex mix of patient, physician, and health care system structural characteristics. Factors associated with more discretionary referrals may lower PCPs’ thresholds for referring problems that could have been managed in their entirety within primary care settings. http://mdm.sagepub.com/content/26/1/76.full.pdf html