The “health care reform” juggernaut continues to roll, much of it above the public discourse. An article by a Harvard Business School professor in the current New England Journal of Medicine suggests “value based system.” What does that mean? A lot of bureaucracy. From the article by Michael E. Porter (my emphasis):

In order to achieve a value-based delivery system, we need to follow a series of mutually reinforcing steps. First, measurement and dissemination of health outcomes should become mandatory for every provider and every medical condition . Results data not only will drive providers and health plans to improve outcomes and efficiency but also will help patients and health plans choose the best provider teams for their medical circumstances . . .

Outcomes must be measured over the full cycle of care for a medical condition, not separately for each intervention. Outcomes of care are inherently multidimensional, including not only survival but also the degree of health or recovery achieved, the time needed for recovery, the discomfort of care, and the sustainability of recovery. Outcomes must be adjusted for patients’ initial conditions to eliminate bias against patients with complex cases. We need to measure true health outcomes rather than relying solely on process measures, such as compliance with practice guidelines, which are incomplete and slow to change. We must also stop using one or a few measures as a proxy for a provider’s overall quality of care. Performance on a measure such as mortality within 30 days after acute myocardial infarction, for example, says little about a provider’s care for patients with cancer. Active involvement of the federal government will be needed to ensure universal, consistent, and fair measurement throughout the country , like that already achieved in areas such as organ transplantation.

That isn’t all, either. Click here for more details about this and other threats that would upend our health care system.

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