A part of the issue is that it's hard to define "best outcome", you'd have to make sure to not accidentally incentivize drastic short-term procedures like open

A part of the issue is that it's hard to define "best outcome", you'd have to make sure to not accidentally incentivize drastic short-term procedures like open heart surgery, where the immediate affect is positive (patient hasn't died) but a longer term view would have questioned the care that led the patient to that state in the first place.