Sukses Main Mahjong Ways Best808 Pahami Scatter dan Kombinasinya Mahjong Ways Best808 Simbol Scatter Meningkatkan Peluang Menang Kesalahan Umum Pemain Mahjong Ways di Best808 Auto Jackpot Strategi Terbaik Fitur Scatter Mahjong Ways Best808 Mahjong Ways Best808 Panduan Scatter Wild Hasil Maksimal Pola Mahjong Ways Best808 Gacor Scatter Menang Bongkar Misteri Mahjong Ways Best808 Kunci Kemenanganmu Mau Cuan Maksimal di Mahjong Ways Best808 Trik Menggunakan Scatter Agar Lebih Untung Main Mahjong Ways di Best808 Kenali Pola Scatter Free Spin Gandakan Kemenanganmu Rahasia Scatter Mahjong Ways Best808 Strategi Jitu Menang Jackpot Besar Misteri Scatter Mahjong Ways Tol777 Kunci Jackpot Besar Bongkar Rahasia Mahjong Ways Tol777 Fitur Scatter Pola Menang Mahjong Ways Tol777 Simbol Scatter Kemenangan Besar Main Mahjong Ways di Tol777 Cara Memanfaatkan Scatter Strategi Mahjong Ways Tol777 Rahasia Scatter Trik Menang Jackpot Analisis Pola Permainan Mahjong Ways Keunggulan Mahjong Ways Tol777 vs Tradisional Kombinasi Simbol Tertinggi Mahjong Ways Langkah Meningkatkan Keahlian Mahjong Ways Mahjong Ways Tol777 Berbeda dari Permainan Mengapa Mahjong Ways Tol777 Diminati Dunia Optimalkan Putaran Mahjong Ways Tol777 Sejarah Mahjong Ways Tol777 dan Keunikan Simbol Mahjong Ways Tol777 dan Pemanfaatannya Strategi Lanjutan Mahjong Ways Tol777 Live RTP Dan Kasino Online Live RTP Dan Kasino Online Live RTP Dan Kasino Online Live RTP Dan Kasino Online Live RTP Dan Kasino Online Live RTP Dan Kasino Online Live RTP Dan Kasino Online Live RTP Dan Kasino Online Live RTP Dan Kasino Online Live RTP Dan Kasino Online Cara Cepat Kuasai Mahjong Ways Tol777 Mengapa Mahjong Ways Tol777 Populer Mitos & Fakta Mahjong Ways Tol777 Strategi Pemula vs Pro Mahjong Ways Teknik Profesional Mahjong Ways Tol777 Mahjong Ways Tol777: Keberuntungan atau Skill? Mahjong Ways Tol777: Tradisi dan Inovasi Panduan Mahjong Ways Tol777 untuk Pemula Rahasia Menang Mahjong Ways Tol777 Tips Efektif Main Mahjong Ways Tol777 Kasino Online Kasino Online Kasino Online Kasino Online Kasino Online Kasino Online Kasino Online Kasino Online Kasino Online Kasino Online main mahjong ways di malam hari jackpot profit mengamati permainan mahjong ways dengan baik dan benar merasa bosan pada malam hari? coba cara bermain mahjong ways ini minum kopi memotivasi bermain mahjong ways nelayan tebing tinggi pola mahjong ways hasil mencengangkan pelajar bandung download mahjong ways peluang besar trik dan pola mahjong ways pemuda belanda tato mahjong ways mengenang jackpot satu miliar pola rtp mahjong ways terbaik resep bermain mahjong ways dengan mudah slot mahjong ways dikenal sejak abad ke-11 hingga zaman milenial video mahjong ways viral menghebohkan warga indonesia warga jayamakmur dulu diremehkan, bermain mahjong ways hidup berlimpah harta unik keren bali cendera mata mahjong ways rp100000 warga bingung merek cat dinding sama mahjong ways

Bundled payments bad medicine for Medicare seniors

Medicare is changing the way it pays for seniors’ knee and hip replacements. That change could be awfully painful for patients.

The new payment scheme pits doctors and patients against one another by punishing providers for excess costs — and rewarding them for denying access to more expensive, potentially better options for care. What’s more, past experiments with payment reforms like this one have failed to achieve their cost reduction objective.

Medicare launched this new “bundled” payment system in April. The program will pay surgeons, therapists and rehab facilities at about 800 hospitals in 67 metropolitan areas upfront for knee and hip replacement surgeries, as in the past.

But at the end of the year, the feds will calculate the average per-patient cost for each episode of care. If that figure comes in below a preset cap, the hospital gets a bonus. If it exceeds that cap, it faces a penalty.

Medicare officials are calling this move revolutionary. Health and Human Services Secretary Sylvia M. Burwell praised it as “one of the most important steps we will take to improve the quality and value of care for hundreds of thousands of Americans.” The Centers for Medicare and Medicaid Services predict that the model will save $343 million over the next five years.

But previous bundled payment efforts haven’t delivered the savings they promised.

In 2010, several California hospitals tried switching to bundled payments. They failed miserably. Three of the original six insurers withdrew when they concluded that they wouldn’t realize any cost-savings. Six of the eight participating hospitals dropped out after determining that bundled payments wouldn’t improve quality or lower costs. The initiative involved far too much bureaucratic red tape.

Medicare has its own record of failed experiments with bundled payments. In 2009, CMS conducted a demonstration project involving 12 New Jersey hospitals. Ultimately, the program had no effect on costs or quality of care.

The same year, CMS rolled out another bundled payment scheme for cardiac and orthopedic surgery. A 2013 study found some initial savings. But nearly half of them were eaten up by higher levels of spending after patients left the hospital.

There’s reason to believe this new attempt to make bundled payments work will fail as well.

Most hospitals aren’t prepared for them. Participating hospitals gave themselves a readiness score of 55 out of 100 for the new bundled payment system in an online survey. Sixty percent of the hospitals in the regions are likely to face penalties this year under the new system, according to Avalere Health.

To avoid those penalties, hospitals will likely push patients to go home after surgery, even if more expensive post-op care is what they need to fully recover.

Despite the checkered history of bundled payments, federal officials hope that the new knee-and-hip scheme is just the beginning. HHS recently proposed a plan that would pay 20,000 doctors a monthly fee per Medicare patient, plus incentives that the docs might have to repay if they don’t meet “quality and utilization metrics.” An HHS official says that this “model represents the future of health care that we’re striving towards.”

It’s meant as a boast. But patients should take it as a warning. Bundled payments give doctors a strong financial disincentive to treat sicker patients or provide high-cost care, even if it’s necessary.

Federal officials should abandon these misguided bundled payment programs before they devastate patient care further.

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

Scroll to Top