[tinokid]

Right, it's not easy and there are adverse selection issues when you start incentivizing doctors to avoid complex cases that are more likely to involve complications. And the scientific basis for a given procedure is likely more important than minor variations in doctors' technical competence levels.

That said, insurers have better insight into this than almost anyone else. If they see a young person with almost no medical claims go in for an elective foot surgery with Doctor Lexus, and then all of a sudden that person is attending physical therapy and filling opioid prescriptions every month, that's a bad sign. If it happens more than once, insurers should feel empowered to go ahead and shut the good doctor down. But this does not happen.