Can you be both right and wrong?

Implications: Fred is both right and wrong by history.  Ranking of physician performance is akin to work (or payment) for performance.  Since I was around at the beginning of this movement and watching its development, it is clear that work efficiency particularly will high acuity patients is very difficult to measure and our metics are immature to say the least.  Misrepresentation of performance will be rejected and health care savings will return to a contracting strategy (known to work).

Analysis: Ranking physicians except at 3 standard deviations from quality and cost is neigh impossible given poor definition of metrics used, their complexity, and finally their subjective interpretation.  Health care EMR is as only as good as what is put into the data base--guess what--physicians will control this and they will control their own destiny by what they enter.  EBM and finite protocols and their adherence is not a part of this process as it is with Retail Based Clinics so use of anecdotal medicine by physicians will continue with much variance and will be justified by what is entered into their EMR. 

Yes it may prevent some duplication of services and yes help communications with specialists (although PCP are specialists) and facilities, labs, etc--but this is all chipping around the edges of cost and is not yet an effective tool for performance evaluation .  It will frustrate providers and their patients who will hear of it as they did of HMOs and ultimately die by acclimation.