Can We be “Accountable”? Payment reform and the “Accountable Care” organization. Part I

  Payment reform is an inevitable component of the healthcare reform movement. Our current system of piecework payments for each episode of care encourages providers to do more tests and procedures and to see patients in brief, problem-focused episodes. People with chronic illnesses, who are often prodigious consumers of healthcare, are especially disadvantaged under this kind of arrangement because there is no incentive for their multiple physicians to coordinate their efforts and to provide a consistent message. But, in the end, we all pay the price for our current system because it is very costly without offering many of us additional benefits. Fee-for -service care too often results in tests and procedures being performed for marginal indications and discourages the use of preventative care. If we insure more people and do not alter the current payment system, we will simply spend more money and not be any healthier. One of... continue reading...