Scientific Revolutions

CMS got the Medicare Shared Savings Program (MSSP) proposed rule largely right, but not because of the actual shared savings that the ACO model is commonly associated with. Rather, the MSSP will usher in a shift from the practice of medicine as primarily an art, to the practice of medicine as primarily a science. The Battle of Marathon: a victory f... or the Greeks that some attribute to the double-envelopment tactic. Maps Courtesy of the Department of History, United States Military Academy The explosion over the last 50 years of drugs and devices and the studies and guidelines concerning their effectiveness is staggering. Couple this explosion with the lack of effective means for physicians and health care providers to make sense of the information, and its not surprising that we have a bloated, inefficient, and costly system that fails to provide value commensurate with our health care budget. This systemic problem is no secret. The HITECH Act attempts to target the health information technology (HIT) problem with an incentive program, and PPACA attempts to increase evidence-based medicine (EBM) with projects like the Patient-Centered Outcomes Research Institute. But a piecemeal approach does not ensure the necessary integration between HIT and EBM, nor sufficient incentives for industry to embrace them. Why such faith in the MSSP? Because if ACOs want to participate in the shared savings they must meet the dual requirements of EBM and HIT. Its this double-envelopment combined with the carrot of shared savings that will finally usher in a medical revolution. Thomas Kuhn, a trained physicist who is better known for his contributions to the philosophy of science , introduced the idea of paradigm shifts that occur as science evolves. In The Structure of Scientific Revolutions, Kuhn posits that instead of a linear evolution of scientific discovery, the discovery of anomalies can force traditional explanations of natural phenomena to be questioned. If enough anomalies accrue that seriously undermine an accepted ...Read More