Jerry Fingerut, MD
Blackstone Valley CHC, Pawtucket, R.I.
It will be very difficult and will take a considerable amount of time based on fragmentation silos and the history in healthcare. Even though healthcare may be viewed as a single industry at a macro level, when it gets into care delivery you have hospitals, specialists, primary care physicians, and long-term care vendors all appropriately with a level of self-interest, even with the end goal of common patient care. It is very difficult to align the goals and rewards when it's left to the individuals who have legitimate business and clinical interests. It is their livelihood as well as their mission and profession in wanting to do the right thing.
Bundled payments, in many ways, creates its own set of problems because you deal with the same silos in day-to-day operations. To do it in a timeframe where it will truly be redesigned is going to take an external pressure, which becomes the government or the political will to do it. That is difficult to do even regionally because of different practice patterns, public and private hospitals, not-for-profit and for-profit hospitals, and the disparity in payments that exist within the system.
This article appears in the October 2012 issue of HealthLeaders magazine.