Muristek
In Reply In response to the comments by Drs Navathe and Liao about our recent Viewpoint, we agree that cost reduction incentives are more effective for organizations that do not have competing financial interests. In a profit-driven system, clinicians, hospitals, and post–acute care facilities would naturally prefer to reduce episode-based spending by decreasing utilization of others’ services over their own, as highlighted in our Viewpoint and in the example of physician-led accountable care organization success cited by Navathe and Liao. Whether this tendency suggests that programs should be focused on a narrow group (eg, physicians) or aimed more broadly (eg, clinicians, hospitals, and post–acute care facilities) is an important and unanswered policy question. On one hand, focusing on a single group, such as physicians, leaves that group free to cut others’ revenue, which might not be feasible if all organizations were participating together. On the other hand, including only some sectors in bundled payment results in a patchwork system and market distortions that could potentially be minimized by transitioning all care providers to a single payment structure, such as partial or full capitation, with clear shared objectives.
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