Mention innovation and regulation in the same sentence, apparently, and you're bound to get a spirited reaction. That's what I figured when I wrote about a provocative keynote speech by Connie Jastremski, a VP for nursing and patient care services at Bassett Health Care in upstate New York, during the  Joint Commission's Conference on Quality and Patient Safety earlier this month. Jastremski's argument that hospitals could use the array of emerging federal regulations and payment pressures to spur creativity and innovation got this response from reader Patrick Plemmons:

"In a 'post reform' world, there is going to be heavy-handed, top down government regulation. It won't matter a bit how innovative you might be. If you find a way to do something better and make a decent return, they are going to ratchet that down even more. The point is, 'healthcare reform' has taken away the industry's freedom. If you don't understand that, you have missed the whole point of the legislation."

Reader Tracy Poured had a slightly different take on the same column:

"Creativity, collaboration and executive rounding … those are never news in thriving industries. Welcome to the table, healthcare. It's about time."

Eliot Schreiber, President of Brand and Reputation Management, responded to my blog on the rising importance of hospital customer service to Generation X health care consumers like myself:

"This is an excellent example of how customer service will increasingly become the differentiator of value. In the hospital business, price is at parity. The hospitals, as you noted, relied on prestige and reputation of certain physicians or specialties, but unless the patient feel they have no choice, they will exercise choice. Reputation is actually related to the ability to meet or exceed stakeholder expectations of value versus alternatives, and the 'line of expectations' can change. This may be a new day for hospitals, as you note."

And finally, Bill Demarco of Demarco Health responded with some timely commentary on a recent blog I wrote about the rollercoaster reaction to the proposed ACO rules, and the differing reactions from would-be ACO participants:

"While everyone, including ourselves and our clients, believe the proposed regulations need improvements, there are many organizations that are continuing to move towards an ACO readiness and implementation process either because they believe they are an ACO already or because they believe the organization across the street is going to do this.

If employers, insurers or Medicare have a choice between working with providers who accept accountability standards and patient protections versus providers who decline to participate and be un-accountable for care, which model will purchasers choose?

If CMS wants to have many ACOs competing on quality not just cost, then encouraging providers who are pioneers as well as those who want to participate but are in need of capital and technical assistance should be encouraged and supported to send the message to others that ACOs are not a dream, they are the future of the health care system and essential to survival."