While Accountable Care Organizations and bundled payments and other fiscal models offer some hope for change, too often healthcare moves glacially, and can't deal quickly enough with problems, de Brantes told me.
When a healthcare academic paper is written, for instance, by the time the major focus prompts debate and change, it is often too late, de Brantes says. "We need to encourage rapid-cycle implementation where folks learn, and figure out what is appropriate," de Brantes says.
Current financial incentives to physicians "negatively affect the professional's motivation by influencing provider treatment choices and potentially harming patients who lack of easily accessible information on the value of treatments," de Brantes writes.
Among the immediate obstacles to true reform that undermines physician "motivation," de Brantes says:
Variability of Care
Health systems need to continually restructure payment models for various disease conditions and overcome variability of its funding for care, from disease to disease, specialty to specialty, subspecialty to subspecialty and region to region. As for many proposed payment models that now exist, certain modes of care, variations in oncology or cardiology, for instance, are not properly defined for proper physician payment, he says.