She says it should be seen as "a call to action for purchasers to get to the negotiating table. You must realign these incentives."
Gawande says that major private insurer incentives such as bundled payments are "the direction we have to go."
For example, he says, "when you see Walmart cutting a deal with hospitals like the Cleveland Clinic, where for a certain operation [Walmart] gets a guaranteed price regardless of the number of procedures or whether there are complications, this is a real shot across the bow. It's a signal to other hospitals that this is something that's going to be asked of them."
"It's a very big cultural shift for medicine to adopt these things," he says.
Certainly hospitals have become safer, especially in the last several years as reporting on Hospital Compare and other efforts have raised awareness, Gawande acknowledges.
"I'll be the first to tell you that there has been substantial improvement that has happened. Death rates, for example, have fallen.
"But if you compare what we really should have as quality control measures, we have known programs that cut death rates from anywhere from 15% to 50%. Those should be norms throughout the healthcare system.
"Instead they're only present in a minority of hospitals. And all of our studies find that we can go in and implement multiple protocols that cut death rates at those kinds of magnitudes, but the puzzle is, why hasn't that spread throughout the system?"