One of Obamacare’s big experiments to lower costs is working surprisingly well

[Aegon]

https://www.vox.com/policy-and-politics/...s-research

A few years ago, under the authority of the Affordable Care Act, the federal government started an experiment: It would pay hospitals a single amount for surgeries to replace joints like knees and hips instead of paying them for each individual service. The hope was that hospitals could lower costs while maintaining or even improving the quality of care.

The program was called “bundled payments,” and it was voluntary under the Obama administration — hospitals could opt in or out. Almost immediately, it seemed to be working. Costs per procedure were going down, and quality seemed to stabilize or even improve. Hospitals didn’t have to worry about squeezing every dollar they could out of Medicare and could start focusing more on the care itself.

But some health economists had two outstanding fears: Would hospitals start performing more surgeries, which would erase any savings to Medicare? And would they start becoming more selective about their patients to avoid particularly costly ones?

According to new research led by Ezekiel Emanuel and Amol Navathe at the University of Pennsylvania published Tuesday in JAMA, the answer to both is: no, not really. The volume of procedures isn’t going up, and for the most part, the kind of patients receiving replacements isn’t changing, either.

Bundled payments got started in earnest under Obama, and now the Trump administration is embracing them too. If hospitals can lower costs while still improving the quality of care under them, then bundled payments could be a potent tool in bending the health care cost curve.


...

The Trump administration is expanding bundled payments, including for knee and joint replacements. The government, in pilots started under Obama, has also begun to test bundled payments for certain kinds of cancer care and for heart stents. The next frontier is more delicate medical conditions, like congestive heart failure or pregnancy.

Obamacare opened the door for a lot of experiments in containing health care costs. Emanuel, who helped craft the law at the White House’s Office of Management and Budget, is a big believer in bundled payments. He told me his original hope was for the feds to be paying for five different procedures by bundle by 2015, though that proved too ambitious for federal officials, who worried that hospitals and doctors wouldn’t be ready.

So instead, the law created a new office within the Centers for Medicare and Medicaid Services to test some of these innovative ideas.

The evidence suggests that bundled payments have been perhaps the most successful cost experiment run under the ACA, in comparison to accountable care organizations (which pay doctors and hospitals collectively for all of a patient’s treatment and for which current evidence is more mixed) and other proposals.

Bundled payments, Emanuel said, encourage hospitals and doctors to find more efficient ways of performing these procedures. Because they receive a flat amount, any savings they achieve go right into their pocket. But bundled payments don’t require providers to “boil the ocean” in the way ACOs might, because the latter requires a much broader overhaul to find savings in treating the full range of a patient’s medical needs.

In other words, it’s easy for hospitals to figure out how to do one procedure more cost-effectively. Figuring out how to treat an entire patient more cheaply is much harder.

[Minimalist]

But now you just told the Orange Fucktard that it was Obama's idea so he'll have to scrap it.

Loose lips sink ships, man.

[Gawdzilla Sama]

Boss Lady broke her knee two years ago. Total bills ~$192,000. Oof. The good news was that she broke it at work. People were allowed to stack trash in the halls and she didn't avoid the obstacles well enough. I can only imagine what people with limited resources go through in this kind of case.

[Minimalist]

Then you'll appreciate this:


https://www.bloomberg.com/news/features/...in-america

What It’s Like Living Without Health Insurance in America

Forced to choose between paying bills and having health coverage, many Americans are risking it and going without.

Sobering.

[Javaman]

Then you'll appreciate this:


https://www.bloomberg.com/news/features/...in-america

What It’s Like Living Without Health Insurance in America

Forced to choose between paying bills and having health coverage, many Americans are risking it and going without.

Sobering.

I'd be very curious to know how the people they profiled actually vote in state and federal elections. As a Canadian, it utterly boggles my mind that so many Americans are passionately and adamantly opposed to universal healthcare.

They profiled one person who's making $117,000 in after tax (US!) dollars, but still finds health insurance to be beyond his financial reach. WTF?

If health care is a priority, then you need to vote for candidates who believe in universal health care. If any of these people voted Republican... well, I just don't know what to say.

[Minimalist]

Oh, I know what to say.




40% of the country is populated with fucking idiots.

[downbeatplumb]

Boss Lady broke her knee two years ago. Total bills ~$192,000. Oof. The good news was that she broke it at work. People were allowed to stack trash in the halls and she didn't avoid the obstacles well enough. I can only imagine what people with limited resources go through in this kind of case.

What are these "medical bills" of which you speak? We only pay a small amount for prescriptions here and not that if we are low earners.
But then I suppose I live in a developed country.

[Minimalist]

Put the phrase    outrageous medical bills   into Google images, DBP.  You'll get a shitload of stuff like this:

[Tiberius]

They profiled one person who's making $117,000 in after tax (US!) dollars, but still finds health insurance to be beyond his financial reach. WTF?

He is likely self employed. I would expect most people earning that much to be employed by a company, which would offer health insurance at massively reduced rates. For comparison, my company insures myself and my wife for $144 a month with a $3000 deductible.

[Pat Mustard]

They profiled one person who's making $117,000 in after tax (US!) dollars, but still finds health insurance to be beyond his financial reach. WTF?

He is likely self employed. I would expect most people earning that much to be employed by a company, which would offer health insurance at massively reduced rates. For comparison, my company insures myself and my wife for $144 a month with a $3000 deductible.

Wow, I'm paying €37 a month for my private insurance (admittedly at the lowest level), and my parents, both retirees with serious health complications (mostly my mother) are paying in the region of 1 1/2 times you are (private insurance is much cheaper when you're young in Ireland).

And if the worst comes to the worst and any of us get caught with something no insurer will cover the public system will cover everything (the public system here is great for emergencies, dead slow for more routine stuff).