The article on U.S. Reps. Tim Walz and Ron Kind working to link payment to care outcomes raises concerns.

This article points to some nice sounding rhetoric. It is not backed up by good science.

All would agree that Minnesota and Wisconsin providers should not get short-changed. All would agree that good providers should not get paid less.

The devil is in the details.

Encouraging, if not requiring, a hospital to use process improvement practices to create high-quality, cost-effective methods of delivering care is a great idea. Paying them for patient health outcomes will create the wrong incentives unless there is some cost-effective way to control for all the other variables that affect the patient's health outcome.

Location is everything.

Who your patients are and where they come from is everything. If you are located in a poor area, in an area with pollution that is causing more illnesses, in an area with little or much poorer coverage for poor people, you will have worse outcome results. Cherry picking healthy people is already done by insurance companies. We don't need to set up an incentive system for docs and hospitals to do the same.

Again, quality improvement as meaning process improvement is important and will result in better outcomes. But you cannot compare health outcomes without adjusting for all the other variables, and that is a very expensive endeavor. You can make dramatic changes in hospital costs if you:

Make them all non-profit.

Put them all on a budget. That means an independent entity would approve an annual budget and they would be paid out of the money pool to cover that budget.

They would submit annual audits and requests for any changes. There would cease to be incentives to overbuild, and eliminating all of the time spent on those horrendous itemized bills would cut costs dramatically.

No longer would they feel obligated to create the executive jobs with pay and perks set to be like the big U.S. companies that pay ridiculous amounts for top level corporate management.

They can focus on providing health care to their service area instead of focusing on making money. (Mayo is in a world of its own in terms of service area, since it serves the whole world.)

And they must provide services and technical offerings that are approved by the independent entity. No more having two hospitals next to each other buying the same big-ticket items and then competing to get the tests ordered to pay for them. No more closing a unit like an emergency room, even though desperately needed, just to satisfy the stockholders' bottom line.

Brooks lives in Buffalo City, Wis.