CMS (Center for Medicare and Medicaid) is already looking at "value based purchasing" which will look at outcomes for medical services provided by physicians to decide reimbursement. This will change payments which currently are based on quantity to quality outcome reimbursement. The devil will be in the details as the Physician may well provide all the 'best practice" diagnosis and treatments, but patients may still have a bad "outcome" (blood sugar levels and cholesterol still sky high) because the patient chooseto not take their meds or refuse to make lifestyle changes that adversely affect their health. If they are deemed bad outcomes, will there be no reimbursement for their care?

Who will take care of those patients?

Does their behavior mean they really don't want to be cared for?