The Reform Agenda · Layer 2 of three · what should happen
The Reform Agenda
The record says what changed. This says what is wrong with it, what should replace it, and in what words — drafted so a legislator, a regulator or a board could use it, and labelled so nobody could mistake it for law.
Three layers, and the rule that keeps them apart
1 · The record
What happened
Primary authority, one lifecycle state per record. Unchanged and still the foundation: the desk, enforcement, litigation, legislation.
2 · The reform agenda
What should happen
KPSGILL positions, model statutory and regulatory language, model board guidance, comment proposals, litigation questions. Labelled as proposals on every surface.
3 · The future of medicine
What is likely to happen
Forecasts and scenarios, each with stated confidence, stated assumptions, and a competing scenario. A forecast without a competing scenario is a defect.
The publication spent its first stage answering one question well: what changed, stated exactly, with the instrument and the primary source. That function does not move. What is added here is the second and third question — what is structurally wrong, and what should replace it — carried in objects that can never be mistaken for a statement of law.
The discipline is the same one the record layer already runs on. A proposal names the problem, cites the documentary baseline it rests on, states the recommendation, drafts the actual language, and then states the strongest argument against itself. A proposal with no opposition section is unfinished, not persuasive.
Open positions
Artificial intelligence & medicine
Flagship institute — clinical judgement, generated records, liability, board guidance
Certification & credentialing
A parallel route, and the competition question under the single-board requirement
Medical board reform
Guidance before enforcement, not after the first case
Primary care
Prospective payment for the work that is currently unbilled
Payer & prior authorization
Duration, algorithmic denial, and who answers for a model's output
Professional liability
Liability follows control
Payer & prior authorization
Duration floors, a named decision-maker, and no automated final denial
Physician independence & ownership
The levers that determine clinical latitude, enumerated
Drug & device regulation
Clinical reliability as a condition of payment, not a theory of liability
Healthcare financing & coverage
Opened as an evidence gap — what would have to be read first
Physician payment
An update that tracks practice cost, and redistribution nobody can hide
Health data & digital medicine
Duties that follow the data, and treat an inference as data
Public health
Powers that expire, findings by geography, orders reviewable in three days
Litigation & courts
What a responsible case would require, and where it fails today
Future of medicine
Forecasts with confidence, assumptions and a competing scenario
What is published now
| Label | Object | Domain | Status |
|---|---|---|---|
| MODEL LEGISLATION | Physician payment: fix the update, then fix the redistribution | Physician payment | OPEN FOR CRITIQUE |
| MODEL LEGISLATION | Medical board process: the decisive moments happen before the accusation | Medical board reform | OPEN FOR CRITIQUE |
| MODEL LEGISLATION | Health data outside HIPAA: a duty attached to the data, not the holder | Health data & digital medicine | OPEN FOR CRITIQUE |
| MODEL LEGISLATION | Emergency powers that expire, and a state determination that is not a foreign one | Public health | OPEN FOR CRITIQUE |
| LITIGATION FEASIBILITY ANALYSIS | Challenging an algorithmic coverage denial | Litigation & courts | OPEN FOR CRITIQUE |
| FUTURE-OF-MEDICINE FORECAST | Three further forecasts: automation disclosure, certification unbundling, provenance certification | Future of medicine | PUBLISHED |
| MODEL PAYER STANDARD | Prior authorization: a duration floor and a named decision-maker | Payer & prior authorization | OPEN FOR CRITIQUE |
| MODEL REGULATION | Corporate control of clinical judgement: naming the levers | Physician independence & ownership | OPEN FOR CRITIQUE |
| MODEL CMS POLICY | Laboratory quality as payment integrity | Drug & device regulation | OPEN FOR CRITIQUE |
| EVIDENCE GAP | Coverage architecture: what we do not yet know | Healthcare financing & coverage | NO POSITION TAKEN |
| MODEL LEGISLATION | Model AI Medical Record Integrity Standard | Artificial intelligence & medicine | OPEN FOR CRITIQUE |
| MODEL LEGISLATION | Physician payment: fix the update, then fix the redistribution | Physician payment | OPEN FOR CRITIQUE |
| MODEL LEGISLATION | Medical board process: the decisive moments happen before the accusation | Medical board reform | OPEN FOR CRITIQUE |
| MODEL LEGISLATION | Health data outside HIPAA: a duty attached to the data, not the holder | Health data & digital medicine | OPEN FOR CRITIQUE |
| MODEL LEGISLATION | Emergency powers that expire, and a state determination that is not a foreign one | Public health | OPEN FOR CRITIQUE |
| LITIGATION FEASIBILITY ANALYSIS | Challenging an algorithmic coverage denial | Litigation & courts | OPEN FOR CRITIQUE |
| FUTURE-OF-MEDICINE FORECAST | Three further forecasts: automation disclosure, certification unbundling, provenance certification | Future of medicine | PUBLISHED |
| MODEL PAYER STANDARD | Prior authorization: a duration floor and a named decision-maker | Payer & prior authorization | OPEN FOR CRITIQUE |
| MODEL REGULATION | Corporate control of clinical judgement: naming the levers | Physician independence & ownership | OPEN FOR CRITIQUE |
| MODEL CMS POLICY | Laboratory quality as payment integrity | Drug & device regulation | OPEN FOR CRITIQUE |
| EVIDENCE GAP | Coverage architecture: what we do not yet know | Healthcare financing & coverage | NO POSITION TAKEN |
| MODEL LEGISLATION | Parallel Certification Recognition Act, and the competition question underneath it | Certification & credentialing | OPEN FOR CRITIQUE |
| KPSGILL REFORM POSITION | Liability should follow control | Professional liability | OPEN FOR CRITIQUE |
| MODEL MEDICAL BOARD GUIDANCE | When AI use becomes a disciplinary question | Medical board reform | OPEN FOR CRITIQUE |
| MODEL CMS POLICY | A prospective primary-care payment design worth commenting on | Primary care | OPEN FOR CRITIQUE |
| FUTURE-OF-MEDICINE FORECAST | The first AI-adjacent board discipline cases arrive before the guidance does | Future of medicine | OPEN FOR CRITIQUE |
The Policy Lab holds the template every one of these is built on, and the queue of domains where the documentary record is strong enough to support a position but none has been drafted yet.
Domains open, not yet drafted
Listed rather than implied. Where the record is thin, the honest first object is an evidence gap, not a recommendation — and that is how these will be opened.