Get ready for the ownership society, MedPAC style.(In Medicine & Health Perspectives this week ...)

Publication: Medicine & Health

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Under the Bush administration, Washington's hottest new buzzword may be "the ownership society." As with most political buzzwords, though, what the phrase means--or ought to mean--in the eye of the beholder. Among those echoing the coinage of late is the Medicare Payment Advisory Commission, where panel members described their takes on the mantra and what it means for Medicare and the healthcare system generally at the group's January meeting.

Key to MedPAC's definition: inducing providers, especially physicians, to take ownership--read "responsibility"--of the outcomes and value of care they provide.

It's not the first time American health care has sought to give physicians a compelling stake in improving quality and efficiency. A decade and a half ago, managed care organizations launched with high hopes for capitation, giving providers set per-patient budgets rather than paying for services rendered. But a combination of fierce provider resistance and flaws in capitation schemes attributable to insufficient data, among other problems, saw that effort go down in flames in the backlash that followed.

Soaring costs and middling quality remain problems, however, and numerous commissioners last week noted that it's providers, particularly doctors, who determine what care the system provides. Unless physicians take ownership of outcomes--both health outcomes and financial ones--the difficulties won't be overcome.

This time around, MedPAC--and Congress, which largely determines what major topics the panel will pursue--seeks more targeted payment policies that nevertheless give providers a financial stake in outcomes. Topping the list are pay-for-performance schemes that would put increasing amounts of provider income at risk for achieving quality goals.

But "the Holy Grail for me is to combine efficiency, quality, and longitudinal...

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