It’s no secret that one of the keys to cutting health care costs is changing the way doctors are paid.

One proposal that has been used in some integrated health systems, like the Geisinger Health System in Pennsylvania which uses a similar model, is to not pay for complications. Known as the Prometheus model, the system proposes that “half of the costs from avoidable complications must be paid for by the providers themselves.”

In a recent New York Times column, Pauline Chen talks about how realistic implementing the model will be. It seems that large integrated health systems are best to institute such large scale payment reforms, such as the salaried doctors of the Mayo Clinic. but Francois de Brantes, an expert of the Prometheus system, however, says not: “I fundamentally don’t believe you need large integrated systems to make this model work. It doesn’t have to be bigger to be better.”

However, I really don’t see a way how small practices can have a strong enough voice to affect change from the payer side.

Also, I don’t think payment reform should be branded with a “warranty”, per se. A warranty or guarantee implies defect-free care, which is something that is impossible from a medical standpoint. Reinforcing that notion may only serve to heighten some patients’ unrealistic expectations of their medical care.