Broken hip fractures and heart attacks cause much suffering and worry as persons grow older. This year, Medicare needs to begin changing how it pays for treatment of these life-threatening conditions, to promote quality and contain charges. Beneficiaries and family members might notice a latest approach.
Hospitals and doctors in dozens of communities opted for large-scale experiments on this front already are gearing up. The aim is to test the notion that better coordination among clinicians, hospitals and rehab centers can head off complications, stop avoidable hospital re-admissions and assist sufferers to acquire more stable and enduring recoveries. If results back up that, Medicare can adopt the changes nationwide.
The cardiac and broken hip fractures experiments are the newest development in a big push under the Obama administration to reinvent Medicare, steering the program away from paying piecemeal for services, regardless of quality and cost. It is unclear either the Donald Trump as president will sustain the pace of change, slow down or even hit pause.
Trump’s Health and Human Services nominee, orthopedic-surgeon-turned-congressman Tom Price, has depicted general uncertainty that the doctor-patient relationship could be ruined by Medicare payment changes seeking to contain charges and costs. And the Medicare division that developed the experiments — the Center for Medicare & Medicaid Innovation — is itself under risk of being abolished because it was established by President Barack Obama’s 2010 health care law.
Few outside groups, involving AARP, worry that Medicare might be moving too fast and that concentrating on cost containment could lead to beneficiaries being shortchanged on rehab care.
Innovation center director Patrick Conway, who also facilitates as Medicare’s chief medical officer, is plowing ahead nonetheless. “Delivery system reform and paying for better care are bipartisan problems,” Conway stated. And quality ranks ahead of cost savings in verifying any results, he added.
The cardiac and broken hip fractures experiments concentrate on traditional Medicare, which sustains the choice of almost 7 in 10 out of Medicare’s 57 million beneficiaries. The cardiac experiment includes both heart bypass and heart attack sufferers. The trials join similar ongoing tests including surgery for hip and knee replacement, as well as care for cancer sufferers undergoing chemotherapy.
In the experiments, doctors, hospitals and rehab centers get paid the regular Medicare costs. But hospitals are provided the responsibility for overall quality and cost, measured against benchmarks set by Medicare. If the hospital meets or exceeds the aims, it acquires a financial bonus, which can be shared with other service providers. If the hospital falls short, it might have to pay the government money.
“Now your doctor and hospital are working together to make certain that they are well coordinated,” Conway claimed.
Under the old system, if a sufferer was discharged from the hospital after a heart attack, “they might hand you a piece of paper that said please follow up with your primary care doctor,” Conway stated. “In this model, the hospital is going to have a powerful incentive to make certain you follow up.”
Overall, about 168,000 Medicare beneficiaries are treated for heart attacks in a provided year, while 48,000 undergo heart bypass surgery for clogged arteries and 109,000 have surgery for broken hip fractures.
Around the country, hospitals in ninety-eight metro places will be engaged in the cardiac experiment. The hip surgery experiment includes sixty-seven areas that also are part of ongoing test of Medicare with hip and knee replacements.
Areas in the cardiac test involve Boston, as well as Akron, Ohio; Charleston, S.C.; Fort Collins, Colo.; Utica, N.Y.; and Yuma, Ariz. A smaller group of communities will be engaged in a related experiment that pays hospitals for coordinating rehab care for heart sufferers. However the benefits of cardiac rehab are identified widely, merely a small share of sufferers receives it.
The broken hip fractures test involves the New York, Miami and Los Angeles metro areas, as well as Austin, Texas; Bismarck, N.D.; Flint, Mich., and New Orleans.
Hospitals aren’t happy with the changes, though doctors typically have been supportive. A big uncertainty for hospitals is that Medicare needs compulsory participation by all the facilities in areas chosen for these tests. But Conway says that is likely to lead to even better outcomes. The idea is that hospitals will watch closely each other’s performance, and the ones that have room to make better will attempt to catch the high achievers.
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