In my eyes you are guilty of drive-by blogging.

The point of a blog is to have a dialogue, to learn from others’ POV, to advance our collective knowledge and wisdom.

Dropping off a posting and then disappearing from the conversation does not fit the spirit of blogging.

1) Changes in the Skilled Nursing Facility and Home Care use / Public company stocks after the Balanced Budget Act in the mid 1990’s (1997?) — Act comes out. Payment changes. Industry responds within a year or so.

2) Changes in rates of hospital reporting for less than 1% in medical fee difference in the last few years — Incentive in place, Reporting rates skyrocket…

Bottom line — Healthcare is really really smart when it comes to seeing incentives that matter and responding to them. For now, it may be (and likely is) completely rational for a Physician, especially a small practice physician, to consider holding off on purchasing an electronic health system / record…Why? a) Lots of friends who bought systems in the last 5 or 10 years have had to replace them (tech changes, didn’t work well, etc) – “Spend $20K and not solve my problem issue”. b) Lots of friends bought systems and lost productivity – handwritten notes for primary care docs who were not doing transcription anyway cost less than any extra documentation time with the electronic tools. – The “I might cut my revenue issue” c) Systems are getting cheaper – Who bought their first calculator in the 70’s for $500? $200? $20? $2?… d) Low revenue and pressure on primary care due to current reimbursement policies – the “Send my kid to college or get an EMR issue” – the kid goes to school and the system I buy next year or the year after is cheaper, more patient centric and will meet the emerging policy PAYMENT changes coming downstream… Medicare 1/2% (75 cents a visit +/-) coming to primary care in July may be just the beginning…

We are nowhere close to getting those incentive changes. Mediare collecting a few quality indicators, Leapfrog involving 2% of big employers in minor P4P in small parts of their networks, and a few medical groups in California and Boston being paid 10% more for stuff they were already doing, does not a sea-change in payment systems makes.

Meanwhile the great mass of doctors, hospitals, pharmaceutical companies and suppliers who are responsible for basically all health care spending as you say are rewarded for concentrating on the “acutely sick on a FFS scheme, resulting in episodic, disconnected care” with the “damaging consequence is the homogeneity of provision models and their inertia to change.” And worse they have a discincentive to change because if they move to these other models they will get picked apart and go bankrupt given our current “zero-sum competition” model.

Yet P/T, you et al give no indication of how a global change to the incentive system will come about, and worse they dismiss it as being unimportant. Particularly as the consumers on whom most of the money is spent are the last people to become as you say “equipped to make informed decisions (considering cost and quality) and ha(s)ve the incentives to shop around”.

But of course if most providers change in the way P&T suggest, they’ll go under. P & T dismiss this problem out of hand

That’s why their work is intellectually shallow.