Don.

Another problem is that these schemes inevitably lead to early referral (dumping) to avoid populating panels with patients with intractable and hard-to-control problems.
So that morbidly obese, depressed diabetic with uncontrolled serum glucose and hypertension now becomes a financial and professional liability instead of being just a difficult clinical challenge. In the present climate where caring for difficult problems and patients is already unreasonably discounted, squeezing the physician with one more screw seems particularly unjust. Why haven’t the insurers and Medicare considered giving the compliant patients a break on their premiums instead?

Maybe there needs to be an independent evaluating organization to decide who meets standards of excellence in practice. Consider a Consumers Union or Underwriters Laboratories certification for medical practices. Patients who choose providers who earn good ratings get a break on their monthly premiums, but patients can choose to go wherever they want. The incentive would exist for the practice to meet high standards and the incentive would exist for the patients to choose practices that held high standards.