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Great commentary, Merrill, as usual. You did not mention the parallel impact of risk adjustment coding on the Med Advantage and ACA payment rates, which further complicates the picture. In the end, I believe in a balanced scorecard approach: comparative costs-of-care, health outcomes, and HEDIS scores on an apples-to-apples basis. Patient satisfaction deserves a mention, as well. Now we also have emerging measures for health equity performance, which should be part of the equation. My other concern is that primary care physicians get paid fairly without pumping up the relative pay of specialists and super-specialists.

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