The Commonwealth Fund contends that: "reforms physicians could champion to eliminate waste and avoidable complications, such as integrated systems of care, innovative payment models including shared savings, bundled payments, or global fees for primary, acute, or comprehensive care, and performance measures that promote care coordination." I say that docs aren't happy about any of that. I can hear them now....

Take on risk? Why should I? Worry about the 'downstream costs'? I can't control what the specialist does? I cannot be responsible for what the patient doesn't do (for themselves). This is merely cost-shifting and a squeeze.

As a former medical director, on the other hand, I'd say it doesn't go nearly far enough.

Ref.: "Physicians Can Lead Health Care Reform Through Payment and Delivery System Reforms Linked to Guaranteed 1.5 Percent Annual Savings in Health Care Costs and Health Coverage for All."

Elsewhere, I've tried to redefine "the value equation" in such a way that these opposing views are brought together, re-aligning the incentives, as it were; that's the preferred outcome of healthcare reform. The process is measuring and managing; managing and measuring." Easier said than done and harder to do it fairly, the information we need is:

1. "Who" does "what," "where" and "when" and "how well."
2. 'Apples must be compared with apples.' In other words, we need to know how sick the patients are; this is called "acuity" or "case mix" adjustment.
3. The best construct with which to view care is a comparable, longitudinal picture of all care over time, regardless of setting and that is called an "episode of care."  

(Note: for those shrugging their shoulders, saying an electronic medical record (EMR) is the answer to all of this, it's only a baby step.) There's a huge danger in making invidious comparisons so let's demand acuity adjusted, comparative data that reflects an entire episode of care. That way if a doc is too costly, at least it won't be because his or her patients are sicker.