• Mitch Keamy Photo Mitch Keamy is an anesthesiologist in Las Vegas Nevada Andy Kofke Photo Andy Kofke is a Professor of Neuro-anesthesiology and Critical Care at the University of Pennslvania Mike O'Connor Mike O'Connor is Professor of Anesthesiology and Critical Care at the University of Chicago Rob Dean Photo Rob Dean is a cardiac anesthesiologist in Grand Rapids Michigan, with extensive experience in O.R. administration.

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Mike O'Connor

Surgery with a warranty?

More like surgery with cost-averaging. Big systems, like Geisinger, the VA, and Kaiser, can calculate fairly precisely their total cost of providing care and average this across the entire market segment. They track these costs carefully anway, for a variety of very good business reasons. This warranty is nothing more or less than a marketing gimmick. TANSTAAFL.

It might have some downsides... but I'll explore those in other posts.

As for report cards - they're only as good the people reporting the data are honest and the people assembling it are insightful. My direct experience is that they are almost completely uninformative.


sure, looked at from the hospital perspective. But looked at from the buyer perspective, it aligns an incentive. Now one concern you might raise is that it provides a perverse dis-incentive to additional interventions (let's wait to put in that pacer, and bring him back in a few months...)

As to report cards and the like; nothing is going to be very good at first, but until outcomes centered quality becomes a competitive "metric" (I hate that word) it's all just snake-oil, in my opinion.


I thought it was an interesting concept and have often thought that you get paid for your complications in medicine a perverse fact. They are a big system with a staff model that doesn't exist in many private practice hospitals. Given that I doubt their cost accounting is any better than any other medical center and would like to see if they make or lose money on this venture. I agree with Mitch it alings incentives between medical staff and hospital. Gotta go, more on the subject later.

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