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Comment by nradov | Hacker News Reader

The US healthcare system is slowly migrating from a fee-for-service model to a value-based model where at least some of the financial risk is shifted from employers and insurers to providers. The managers running those provider organizations thus have a direct incentive to adopt new technology if it actually works, even over radiologist objections. So far most radiology automation software hasn't generated a clear cost savings. That may change as technology improves.

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Things are changing but as of 2019 by a whisker, most radiologists own their practices and accross all specialties 56.6 percent of physicians in the US are members of small practices. Physicians especially specialists tend to work for and with other physicians. In my area, at least in the recent past, all the cardiologists and all the urologists work for the same small practices organized around their specialties. I'd guess that tends to blunt pricing pressure on providers at least locally (see here for some stats https://www.mpo-mag.com/issues/2019-10-01/view_columns/a-loo...).

The general trend is that smaller practices are going away. More and more physicians are becoming employees of larger provider organizations. Small practices just aren't very viable any more because they lack the negotiating power to get high reimbursement rates from payers, and they don't have the economies of scale necessary to comply with interoperability mandates.

When new physicians complete their training fewer and fewer go on to start or join smaller practices.

Cost savings doesn't have to be near term. Imagine a doctor misses something on a reading and doesn't get the care they need... lawsuits are expensive. So you can have software which helps doctors do their job better which results in better patient outcomes. That is something hospitals are buying today for their radiology groups.

> where at least some of the financial risk is shifted from employers and insurers to providers

Do you have any evidence to back that up?

The ACA created a capitated payment system for medicare that providers can opt into. I'm not sure what evidence you're looking for other than the definition of capitation is "fee per patient" as opposed to "fee for service." Some states like California also have capitated plans on from private companies. https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-...

Quality of care provisions in Medicare/Medicaid/ACA all help to shift shift costs to the practitioner if care is poor or has bad outcomes.

Here's one for you: https://innovation.cms.gov/innovation-models/bundled-payment...

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