I think there's going to be a huge backlash in a few years with this proposal, I believe. The problem is that we are "shoeboxing" care. That is, everyone one is expected to get the same treatment no matter what their individual characteristics determine they should. The irony is that we expect individualized care, but huge systems tend to be overly protocol-driven and create a cookie-cutter approach.
I worked (temporarily) in a huge system. There did not seem to be much concern about individualized care. Now I'm back in a much smaller system that allows more time to treat individuals and pay attention to their specific problems. Eventually, I think the outcomes will prove to be better in such systems. The only downside is that the denominators are much smaller so the occasional bad outcome, that is diluted in a bigger system, will look statistically bigger than it is.
Also we have to change the entire concept that we can't know what the guy down the street is making for the same procedure. Until they open the books (so to speak), you will have a system where the big guys have negotiating power and the little guys get screwed. The deck is certainly stacked in the insurance/reimbursement guy's favor. So the tendency is for healthcare delivery systems to get bigger so they have more negotiating power. This is why big corporations and systems will prevail until this changes.
The original article is a bellwether of the future until the system changes. I predict an onslaught of anti-trust litigation over the next few years. And we all (as physicians) will inevitably get screwed as more and more of individual and independent decision making is taken away.
