Five reforms we can do now
- Re-empower primary care. This means more than giving them money. It also means giving them tools -- giving them, not telling them they have to buy them. I personally feel a statue of my primary care doctor in the town square would be a nice touch, but I'm not holding my breath.
- Tie payments to outcomes. We're talking big premiums for success, 15-20% premiums. Current success bonuses are in the range of 1-2% and are not worth the trouble.
- Establish a national payments database. Until we can get all charges into a single virtual room we can't know what's fair. But it's in no one's business interest to do this. So have the government do it. Some states already have, they write.
- Create national disease registries. Most registries are still relatively small, and there's no standardization of the data. We need freely-available web-based registries with easy data entry and querying. I'll bet Google would love that contract.
- Release Medicare's physician data. Doctors' groups argue privacy, and private groups argue the data is proprietary. But if you're going to take money you can require cooperation. And this data can help determine real costs.
The main goal of Kibbe and Klepper is that we get enough data so that generalizations can be made which drive both treatment regimens and payment schedules.
I have noted here that some doctors may fear being turned into "bus drivers" by this, forced into rote medicine and unable to practice as they see fit. But it may turn out that your way is, in fact, the right way, and if it's not don't you want to know that, too?
To Kibbe and Klepper data is an important driver of both cost containment and better outcomes. Knowing what works, doing that first, and making payments for the same actions uniform are the goals here.
Are they good goals? Are they achievable?