To some extent, federal health reform is going to accelerate change already occurring in Wisconsin: how care is provided and how it's paid for. For example, a patient may see physician assistants and nurses practitioners more often. And hospitals will get Medicare payment based on the quality of care. Reforms could also affect the doctor-patient relationship.

One of the provisions of federal health reform is designed to minimize unnecessary care. It's a conversation some doctor's dread: how to explain to a patient in a short clinic visit why they don't need a particular treatment they want. Dr. Randy Linton is CEO and president of Eau Claire's Mayo Clinic Health System. He spoke at a roundtable event in Madison featuring health system administrators from around Wisconsin, "It's not an easy, simple conversation to have. I think that's why this conversation has not been in the public front by now, other than from a fear perspective."

Whether the fear on the part of patients is real or perceived, Linton says their concerns will have to be addressed. As a business health providers need to keep customers happy. But they also have to be concerned about cost, "The difference between getting all the care I need and not more is very confused with all the care I'm used to getting and think I want. That's a very fundamental shift that's going to take that education and the relationship is going to have to happen at the individual patient level."

Another panelist, Dr. Dean Gruner, says this conversation may not be as difficult as expected. Gruner is CEO and President of ThedaCare in northeast Wisconsin. He says increasingly, patients are concerned about out-of-pocket medical costs, and so in some cases, the provider and patient may both be looking at the bottom line.