Right now I see the for-profit agencies directing what is quality based on the bottom line. We have a number of for-profit agency medical directors as the physician input into the NCQA, National Committee on Quality Assurance. I see that as being very incongruent. I don't think I want the medical directors of insurance companies being the ones who are setting the quality standards. Congress could set up a variety of incentives and get physicians together to set up some of the standardized terminology so that we could begin to put together, using statistical packages, some ways to determine quality without large federal studies.
Federal studies are very expensive.
If we had standardized terminology we can use all the studies going on across the country and put them together reasonably and for very little cost. We could put up incentives, given that there are safeguards, that allow physicians to work in larger groups. If you have large groups that have reasonable medical information systems, enough to do the job right, then I would like to see physician groups working to take risk and actually cut out the insurance company. But it has to be done carefully and correctly so that they have adequate MIS systems. You have to safeguard the patients in that regard.