Payment reform to finance a medical home: comment on "Achieving cost control, care coordination, and quality improvement through incremental payment system reform".

This commentary on R. F. Averill et al. (2010) addresses their idea of risk and quality adjusting fee-for-service payments to primary care physicians in order to improve the efficiency of primary care and take a step toward financing a "medical home"for patients. I show how their idea can create incentives for efficient practice styles. Pairing this with an active beneficiary choice of primary care physician with an enrollment fee would make the idea easier to implement and provide an incentive and the financing for elements of service not covered by procedure-based fees.