Heart attacks and broken hips cause much suffering and worry as people grow older. This year, Medicare wants to start changing how it pays for treatment of these life-threatening conditions, to promote quality and contain costs. Beneficiaries and family members may notice a new approach.
Hospitals and doctors in dozens of communities selected for large-scale experiments on this front are already gearing up. The goal is to test the notion that better coordination among clinicians, hospitals, and rehab centers can head off complications, prevent avoidable hospital re-admissions and help patients achieve more stable and enduring recoveries. If results back that up, Medicare can adopt the changes nationwide.
The cardiac and hip fracture experiments are the latest 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’s unclear whether Donald Trump as president will continue the pace of change, slow down or even hit pause.
Trump’s Health and Human Services nominee, orthopedic-surgeon-turned-congressman Tom Price, has expressed general concern that the doctor-patient relationship could be harmed by Medicare payment changes seeking to contain costs. And the Medicare division that designed the experiments — the Center for Medicare & Medicaid Innovation — is itself under threat of being abolished because it was created by President Barack Obama’s 2010 health care law.
Some outside groups, including AARP, worry that Medicare may be moving too fast and that focusing on cost containment could lead to beneficiaries being shortchanged on rehab care.
Innovation center director Patrick Conway, who also serves as Medicare’s chief medical officer, is plowing ahead nonetheless. “Delivery system reform and paying for better care are bipartisan issues,” Conway said. And quality ranks ahead of cost savings in evaluating any results, he added.
The cardiac and hip fracture experiments focus on traditional Medicare, which remains the choice of nearly 7 in 10 out of Medicare’s 57 million beneficiaries. The cardiac experiment involves both heart bypass and heart attack patients. The trials join similar ongoing tests involving surgery for hip and knee replacement, as well as care for cancer patients undergoing chemotherapy.
In the experiments, doctors, hospitals, and rehab centers get paid the regular Medicare rates. But hospitals are given responsibility for overall quality and cost, measured against benchmarks set by Medicare. If the hospital meets or exceeds the goals, it earns a financial bonus, which can be shared with other service providers. If the hospital falls short, it may have to pay the government money.
“Now your doctor and hospital are working together to make sure they are well coordinated,” said Conway.
Under the old system, if a patient 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 continued. “In this model, the hospital is going to have a strong incentive to make sure you follow up.”
Overall, about 168,000 Medicare beneficiaries are treated for heart attacks in a given year, while 48,000 undergo heart bypass surgery for clogged arteries and 109,000 have surgery for broken hips.
Around the country, hospitals in 98 metro areas will be involved in the cardiac experiment. The hip surgery experiment involves 67 areas that are also part of Medicare’s ongoing test with hip and knee replacements.
Areas in the cardiac test include Boston, as well as Akron, Ohio; Charleston, South Carolina; Fort Collins, Colorado; Utica, New York; and Yuma, Arizona. A smaller group of communities will be involved in a related experiment that pays hospitals for coordinating rehab care for heart patients. Although the benefits of cardiac rehab are widely recognized, only a small share of patients receives it.
The hip fracture test includes the Miami, New York, and Los Angeles metro areas, as well as Austin, Texas; Bismarck, North Dakota; Flint, Michigan, and New Orleans.
Hospitals are not happy with the changes, though doctors have generally been supportive. A big concern for hospitals is that Medicare requires mandatory participation by all the facilities in areas selected for these tests. But Conway says that’s likely to lead to even better results. The idea is that hospitals will watch each other’s performance closely, and the ones that have room to improve will try to catch the high achievers.
The Associated Press contributed to this article.
I have to comment on the part of this article concerning hip replacement. On December 23rd 2013 I had a total replacement preformed by Dr Wendt at Lawrence Memorial hospital, Lawrence ,kansas. All I can say that he is a wonderful surgeon and the hospital is the best I was transfered to a rehabilitation on December 26th and was there about 6 weeks aND was home till March 19 then back to work full time. Have had absolutely no problems, doing this was a life saving experience. I can never thank the people involved in the operation and rehabilitation enough.
Start first with waste & fraud elimination!
Mandatory PRISON -min. of 5 years – for all involved when convicted of fraud-stealing $ from this program.
Get tough in right way – not on backs of innocent citizens.
Ilene Richman Dr. Price is a doctor that is trying to eliminate Medicare and Medicaid. My husband and I have regular Medicare and supplement that cost us about $4000 a year. We now have a $166 deductible each for 2017. The federal government is gouging seniors and taking away their rights. They just want us to die and not have the best medical care. Seniors do not want to have Medicare changed. Also, seniors do not believe we should have to pay for a supplement as we paid into Social Security all our lives. We also do not believe we should have to pay for a supplement and have our deductible raised each year. Our government wants to give away money to illegals and refugees instead of to American citizens. I dislike Dr. Tom Price as Health and Human Services. He and traitor Paul Ryan want to eliminate Medicare and Medicaid. These politicians want to take high salaries, money from lobbyists, Chamber of Commerce, know stocks coming on market to make big profits, but want to slice the throat of honest seniors who have Medicare and those who need Medicaid. I want to purchase Medicare (with no supplements) across state lines so there is competition and I can get the best price possible. But Dr. Tom Price and Paul Ryan want to demolish Medicare and Medicaid and privatize these programs. They are two politicians that only care about themselves. Trump said he is going to clean the swamp. By appointing Dr. Tom Price, Trump is adding to the swamp and not cleaning it. I hope President Elect Trump cleans up Medicare so seniors can have competition across state lines. My daughter has Obamacare and it is a disaster. Her deductible is $5000 for her and $5000 for her daughter and she pays $1.048 a month. Insurance companies are ripping off American citizens and Obamacare was the worst program ever put into legislation. Obama and family and Congress have the best medical care free at the government’s expense. So should seniors who have worked hard all their lives. Price should be replaced by Trump. I am disappointed Trump broke a promise to keep Medicare and have it go across state lines. And get rid of the deductibles. Seniors have enough money just to keep themselves afloat. WE do no need deductibles and this new program cited above for heart attacks or hip breakage. We need to be under the care of the doctor who operated and not our own physician. The operating specialist should always be in charge, not our physician. I knew Price would come up with a gimmick so seniors do not get the care they deserve. He is a disastrous choice by Trump. Disappoionted? You bet.
Obama’s NWO never contained seniors, mentally ill or children with special needs….his agenda was through Obamacare kill off these people….just start looking at this disastrous piece of legislation done ENTIRELY by the Democommunists.
Dont ever let anybody try to tell you that you are not stupid
Your advantage plan or Medigap suplemental plans are ‘across state lines’. many suplemental plans pay the Medicare Part A deductible. Other than that your accessment of Ryan and Price is right on!
Regarding your daughter if she has a 5000 deductible as opposed to a max out of pocket of 5000 with 0 to 5000 deduvctible she did not buy her policy from the exchange but bought it from an insurance company not on the exchange that was or wasn’t Obomacare complient. A $5000 deductible plan (IE you pay the first 5000) should run between 200 and 400 per month.
Hey Ilene, Trump hasn’t broken any promises. He hasn’t been sworn in yet. Everything you’ve heard is speculation and rumor. Take a breath and wait and see what really happens. But the truth is that Social Security and Medicare costs are unsustainable. Something has to give soon. Former US Congressmen, Senators, and Presidents have made promises that they can’t keep. And millions of people in the near future will witness major changes. Sorry, Ilene, but don’t hate Trump. He didn’t build this mess.
As Ronald Reagan said about the government and how it works, best be scared when someone from the government comes along and is ready to help you….be afraid, be very afraid.
Do you remember how Sara Palin was mocked and ridiculed for mentioning ‘death panels?’ Well here’s your proof that what she predicted is starting. If the US Government takes control of the Medical and Health Care industry, then they will decide who gets treated and who gets paid. This will obviously mean that some people will not ‘qualify’ for treatment and either live with their ailment or die. Brave New World is coming.
Hoping for the best overhaul of Medicare benefits. Though it helps us, we still need to make out-of-pocket payments and Medicare supplement plans to support the original plan.