Perspective:

As the Affordable Care Act begins its early implementation phases in the next year, additional research on the effects of different payment models on health care delivery becomes crucial. Substantial geographic variation in use of invasive cardiac procedures like PCI and CABG has been a long-standing observation in health services research. This has led to the perception that financial incentives may push providers to do more in these cases—although surprisingly little empiric evidence is available on how payment models within managed care plans specifically result in this variation. Thus, the current paper by Matlock and colleagues is timely. Their observations suggest that existing managed care plans may lower rates of use for these services, but not be sufficient for diminishing geographic variation. These findings need to be balanced against the fact that no one still knows ‘what rate is right.’ Additional limitations in the current study include that the authors were unable to account for procedural appropriateness and patient preferences or any potential outcome differences that may have resulted from these differences in use. Regardless, these findings are important and should spur further research on optimizing financial incentives.