Comment from the mailbag: This is exactly why this trend is likely to go the way the MCOs did 20-30 years ago. It’s a problem of diminishing returns – eventually, as you point out, ya can’t get more without affecting quality of care. Do I think there will be no changes in the business of medicine? Of course not. There will be quality analytics – some of which will be relevant to actual patient care, much of which won’t. So the big question is, will these steps really bend the cost curve? Temporarily, maybe. But over the long haul, patients/employees/consumers of health insurance will make demands, and doctors, who are smarter than average but may not be aware of nuances in payment initially, will learn to exploit the system. It’s already obvious in the ACO environment – those ACOs that maximized their coding were successful, and those who did not, failed or were marginal and quit. We (all of us: medical, insurers, patients, policymakers) have to get our heads out of the clouds and remember the dirty, basic facts about human nature: we are self-centered, self-interested beings. If you want different behavior, get real and incentivize the behavior you want. It won’t be cheap, but it’s more likely to be effective. Sue Ann Sue Ann Jantz, administrator Attorney-at-law Cottonwood Pediatrics