Whether it’s coverage for end-of-life counseling or an experimental payment scheme for common surgeries, Medicare in 2016 is undergoing some of the biggest changes in its 50 years.
Grandma’s Medicare usually just paid the bills as they came in. Today, the nation’s flagship health-care program is seeking better ways to balance cost, quality and access.
The effort could redefine the doctor-patient relationship, or it could end up a muddle of well-intentioned but unworkable government regulations. The changes have been building slowly, veiled in a fog of acronyms and bureaucratic jargon.
So far, the 2016 change getting the most attention is that Medicare will pay clinicians to counsel patients about options for care at the end of life. The voluntary counseling would have been authorized earlier by President Barack Obama’s health care law but for the outcry fanned by former Republican vice presidential candidate Sarah Palin, who charged it would lead to “death panels.” Hastily dropped from the law, the personalized counseling has been rehabilitated through Medicare rules.
But experts who watch Medicare as the standards-setter for the health system are looking elsewhere in the program. They’re paying attention to Medicare’s attempts to remake the way medical care is delivered to patients, by fostering teamwork among clinicians, emphasizing timely preventive services and paying close attention to patients’ transitions between hospital and home. Primary care doctors, the gatekeepers of health care, are the focus of much of Medicare’s effort.
Patrick Conway, Medicare’s chief medical officer, says that nearly 8 million beneficiaries — about 20 percent of those in traditional Medicare — are now in “Accountable Care Organizations.” ACOs are recently introduced networks of doctors and hospitals that strive to deliver better quality care at lower cost.
“Five years ago there was minimal incentive to coordinate care,” said Conway. “Physicians wanted to do well for their patients, but the financial incentives were completely aligned with volume.” Under the ACO model, clinical networks get part of their reimbursement for meeting quality or cost targets. The jury’s still out on their long-term impact.
Still, a major expansion is planned for 2016, and beneficiaries for the first time will be able to pick an ACO. Currently they can opt out if they don’t like it.
“We’re all trying to understand where is that threshold when things will flip,” said Kavita Patel, a Brookings Institution health policy expert who also practices as a primary care doctor. It could be like the switch from snail mail and interoffice memos to communicating via email, she says, but “I’m not sure we have reached critical mass.”
Glendon Bassett, a retired chemical engineer, says he can vouch for the teamwork approach that Medicare is promoting. Earlier this year, a primary care team at SAMA Healthcare in El Dorado, Arkansas, prevented what Bassett feared would turn into an extended hospitalization. It started with a swollen leg.
SAMA is part of Medicare’s Comprehensive Primary Care Initiative, an experiment in seven regions of the country that involves nearly 400,000 beneficiaries and a much larger number of patients with other types of insurance. The insurers pay primary care practices a monthly fee for care coordination, and the practices also have the opportunity to share in any savings to Medicare.
The primary-care teams at SAMA consist of a doctor, a nurse practitioner, three nurses, and a care coordinator. The coordinator shepherds patients to avoid gaps in care. The nurses can be an early warning system for the doctor.
Bassett said he had a history of circulatory problems in his legs, but this was different. “It was scary,” he said. “Within a week’s time it turned from red to dark.”
He thought about the emergency room, but he got in right away to see the nurse practitioner working with Dr. Gary Bevill, his longtime physician. The nurse fetched other clinicians to look at Bassett’s swollen right leg. He was immediately given antibiotics. And the doctor referred him to a cardiologist for an outpatient procedure that has since improved his circulation.
While the medical treatment may have followed fairly standard protocols, Bassett believes the team approach prevented serious consequences.
“If I hadn’t seen the nurse practitioner when I did, I feel like I would have been in the hospital,” he said. Bassett has since moved to Hot Springs, in another part of the state, but stays in touch.
Medicare is weighing whether to expand the primary care model. Conway said more data is needed.
Other notable changes coming in 2016:
— Hip and Knee Surgery
Joint replacements are the most common surgical procedure for Medicare beneficiaries. Starting in April, hospitals in 67 metro areas and communities will be responsible for managing the total cost of hip and knee replacements. The experiment covers a 90-day window from the initial doctor’s visit, through surgery and rehabilitation. At stake for the hospitals are potential financial rewards and penalties.
Medicare’s goal is to improve quality while lowering cost. But hospitals worry about financial consequences and advocates for patients say there’s a potential to skimp on care.
“What we are discovering with all this change is that trying to get to value over volume is very difficult to do,” said Herb Kuhn, who heads the Missouri Hospital Association.
— Hospice Flexibility
Patients choosing Medicare’s hospice benefit at the end of their lives have traditionally had to give up most curative care.
Under Medicare’s new Care Choices model, patients with a terminal illness will be able to receive hospice services without giving up treatment. A cancer patient could continue to get chemo, for example.
Seventy hospices will start the experiment Jan. 1, and another 70 will join in two years.
The Associated Press contributed to this report.
If we stopped all the illegals from jamming in at our borders we would not have a Medicare or Medicaid shortfall. This stems from Barrack O’Bama telling the Border Patrol to ” stand down “.O’Blabba should follow the laws that are on the books.
There is only one way to fix the trolley of the Obama Clinton gang : Vote for Trump , Cruz – or whoever is nominated as a legitimate presidential candidate !
Donald J. Trump is the only answer I see. The man speaks what is on his mind all the rest that are running are big ass liars. I see a lot of F.D.R. coming from Donald Trump. And F.D.R. pulled this country out of going broke and brought the country back big and strong!! Donald Trump will make sure this country is safer then it is now. And he is 100% right on keeping out all muslims out of the country. after all the terrorist are calling on all Muslims to attack all American’s and to kill as many as they can. When I here the word Muslim all I see is TERRORIST. VOTE FOR TRUMP FOR A SAFER AMERICA!
Yes!!
I wanted Trump years ago he is honest and forthright I want trump for president he is our only hope for the future
I agree, the illegals should be deported. I am in agreement with Trump, send them all back, and stop Muslims from coming in to America. To quote Clinton regarding Taking Syrians into America, “That is not who the United States is” I don’t see her ass in the public mingling with them or any of the rude illegals that we support. I agree with Trump Make America Great Again. PLEASE VOTE FOR TRUMP.
Years ago, we worked and paid into our retirement…called SOC. SEC., however our GOVERNMENT dipped in it, never putting back, they must had seen a lot of money and knowing it was the peoples…our GOVERNMENT has gave it to people that has came into this country, never worked or paid SOC. SEC. and we now are slowly losing it…we should hold our GOVERNMENT accountable for there actions…pay back and stop taken taxes out for MEDICARE or SOC. SEC. on the younger people…..can’t anyone see where our money has gone being paid in all these years?
Yes Judith you are exactly right! The Government has stolen the SSA money that Citizens have paid in 4 times that I know of and they have had to put it back! The first time was when demoncrats saw they had spent so much that we had a deficit and they saw how much money eyes had accumulated in the SS fund and figured we would never know, and every time after that when they needed money this is where they looked!
When they illegally passed obamacare they took 5 billion, billions not millions from SS now back in October behind closed doors in the middle of the night they took1.800. Billion again from S S, this is our gov. Doing this with the traitor and chief obama
Yes!
To cut costs dramatically while improving outcomes, invite alternative health care practitioners to participate in the health care system. It seems the current unholy trinity of the AMA, the FDA and the Pharmaceutical industry are bound and determined to protect the profits of Big Pharma at all costs, including the death of patients.
True so true
They just turn people into cash cows to fund big pharma and the over priced hospital “care”. It’s really torture!!!
I agree with you Kent! While obumbler let’s 15 million illegals stay unimpeded and brings in possible terrorist by the hundreds of thousands and then puts them all into welfare and Medicare medical programs at the expense of the American people, we are left with the poorest quality medical care possible! If obumbler and his rich cronies want to give them free medical care then they should have to pay for it out of their own pocketbooks instead of forcing American Citizens to pay for it while we are left with subhuman medical care. The lazy freeloading demoncrats can get these crooks to pay for their free stuff as well, Republicans and Conservatives have always paid their own way along with paying for everyone else’s way too and we are tired of it. Giving American Citizens low cost Quality Medical care should be our goal but Not giving it to everyone else who happens to cross our borders and claiming they have a Constitutional Right to it! Those who work and pay taxes or who have retired from doing so deserve to have the Quality Medical Care that we have been paying for our whole entire working lives, those who refuse to work or come here to America looking for a free ride should get nothing but if they are going to get it then those that want to give it to them should be forced to pay for it. You say they can’t force them to pay? Why not, they force the working class to pay for it now!
Don’t get me wrong, I don’t mind helping a neighbor out of a jamb but that doesn’t mean that I plan on supporting him the rest of his life! And I refuse to help the Lazy Freeloaders!
Dam Right Brother!
I’ve never taken a dime of handout/welfare money in all of my 55 years! It used to be the most embarrassing, shameful thing a Man could do, when He had to ask for welfare. It was just an unthinkable thing when I was younger! A Man is supposed to provide for himself and his family, by working honestly for a living! There were no other options!
That’s the way I was raised anyway!
3 things America has lost, Truth, Honor & Justice! They’re just not here anymore, and they’re certainly not on any dam cellphone/computer either!…………………………………….May God help us, we’re going to need it!
I think the Government should put all the medicare deducted from citizens wages and put it back into it’s own account and not be in the general budget
The comments are excellent .. The awareness increases that the US government is controlled by a den of thieves and connivers .. The voters can change the politicians , but the policies will continue to be crafted ( warped) to benefit the quasi invisible special interest lobbies that finance the election of both parties ,,, Corruption , confusion and misappropriation of national resources will be rampant regardless of election outcome .. Exception? Donald Trump …He is not a hostage to special interest financing … The “old boys net work” will stop at nothing to prevent his election , using the propaganda and disinformation machinery of the Mainstream News organs .The vast majority of the US public will .continue to suffer .
I hope these greed driven, dishonest, treacherous gov’t. people realize that most of the folks that ARE PAYING for medicare, and HAVE PAID for Veteran Benefits, are from the Greatest Generation on down to the Vietnam era Generation, and most of them are Battle Hardened U.S. Military Veterans……………………………………just something for “them” to chew on, while they’re plotting their next atrocity against America!
TRUMP,is the man to vote for, he’s shaker and mover. The rest are just lips service so if you want things to changes in our country he’s the man! God Bless American for this man Amen.