In Do Physicians Need a “Shopping Cart” for Health Care Services? (JAMA), Robert Brook asks,
What if every time a practitioner used an electronic medical record system to order a procedure or test for a patient, an electronic shopping cart appeared, indicating how much that “purchase” would cost? What if at the end of the day the practitioner received a statement indicating precisely how much money he or she had ordered to be spent on behalf of patients? What would happen? Would anybody care?
Well, if the practitioner were employed by an ACO or operating under a capitated arrangement with an insurer, his or her organization would certainly care. In that case, likely incentives would be put in place to translate that motivation to the point of delivery. So, if we want clinicians to care about cost, if we think they should care about cost, we can try to arrange the system so they will by putting them and their organization at risk for that cost. In fact, that seems to be the wave of the future, both for public insurance programs and private plans. (Well, it’s one wave, anyway.)