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Volume 355:1845-1847 November 2, 2006 Number 18 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

	Full Text PDF PDA Full Text Interview Perspective Perspective by Rosenthal, M. B. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear Related Article by Rosenthal, M. B. PubMed Citation

Fee-for-service payment and a high degree of autonomy have long been defining characteristics of physician practice in the United States. And for the past 40 years, the Medicare program has protected — and largely reinforced — this traditional professional model. But change appears to be imminent.

The past decade has brought compelling evidence of serious gaps in the quality of medical care. The increased availability of reliable measures of the technical quality of care in both hospital and ambulatory settings has proved that it is feasible to measure quality — and highlighted a remarkable variability in performance. Rising costs are . . . [Full Text of this Article]

Source Information

Dr. Fisher is a professor of medicine at Dartmouth Medical School, Hanover, NH, and the VA Outcomes Group, White River Junction, VT.

An interview with Dr. Bruce Weinstein, medical director for Compass Medical Group, can be heard at www.nejm.org.

An interview with Dr. Fisher and Dr. Karen Davis on pay for performance, Medicare, and the IOM report can be heard at www.nejm.org.

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