Defragmenting Health Care Delivery Through Quality Reporting
One of the many factors that contribute to fragmentation in the delivery of health care services is the law. While laws hindering efforts to coordinate care take multiple forms, many share an aim of blunting problematic incentives in a world in which patients and payers are unable to assess the quality of care. Examples of such laws include licensure-related limits on the corporate practice of medicine, which may preclude direct employment of physicians; and the anti-kickback and self-referral statutes, which circumscribe potential relationships between hospitals and physicians. Private forms of regulating relationships among providers, such as hospital medical staff bylaws preserving physician independence, may also fit this mould. The recent movement to collect and disseminate information about provider quality, however, may make it reasonable to weaken these restrictions, allowing providers to engage in quality- and efficiency-enhancing integration. Payment tied to quality reporting may give them the incentive to do so.
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