Lets put this in perspective.
Can we have the Doctors in total control without accountability? Evidently not. It was called the "Golden Age of Medicine" and most people had FFS insurance with no restrictions. I remember hearing the story of a local Doctor who didn't want to sell his yacht while his new one was under construction. He used to brag that he financed the entire cost of 50' sailboat by,"ordering more EKG's". You say it wasn't you, I know it wasn't me, but it most certainly was the collective, us.
So we have someone looking over our shoulder, and a perfectly good drug like Januvia comes along. It is VERY expensive. If it wasn't, the insurance would not care one wit if you Rx'ed it or not. They are ONLY dealing with the money. That is their job. The drug has 7 more years of patent. For these seven years they have to stem the flow of red ink. They don't care at all who needs it or who gets it. They only care that it isn't too many people. Silly artificial rules are applied to the decision process and the timid or the disinterested are turned away, you jump through enough hoops and you get the meds for your patient.
Now consider the "Outcome Oriented Medical Record". My IPA can keep track of all the costs that they incur for my patients. I manage the patients following all of the best practices I can bring to bear. I predict that when my numbers are at the top of the game, I will be able to say, "I want Januvia for these X number of patients" and the director of the IPA will say, "Give him what he wants". (Thats my fantasy and I am sticking to it!!)
