The program is changing the way that health care is delivered by fostering teamwork among physicians, hospitals and other providers, and paying special attention to transitions between hospital and home.  For example, almost 20% of Medicare beneficiaries in the U.S. are now in "Accountable Care Organizations" - networks of doctors, hospitals and other providers that strive to deliver better quality care at a lower cost.  Part of their Medicare reimbursement is tied to meeting specific quality and cost targets.  Michigan has 20 Accountable Care Organizations (ACOs), covering 417,000 beneficiaries (approximately 20%).  Fourteen of the 20 achieved cost savings in 2014.  A major expansion is planned this year.

 

Joint replacements are the most common surgical procedure covered by Medicare.  Starting this April, hospitals in 67 metro areas will be responsible for managing the total cost of hip and knee replacements.  This experiment - called "bundled payments" - will cover a 90-day window from the first doctor's office visit through surgery and rehabilitation.  Quality, cost-effective care will reap financial rewards for the participating hospitals.  Hospitals in Genesee, Saginaw, Cass and St. Joseph counties are participating.  This unique payment approach will expand in future years.

 

An ongoing Medicare experiment in seven regions of the country is transforming primary care practices by reimbursing them to provide care management using a multi-disciplinary team of health care professionals.  (Michigan is not one of the regions.)  All of the practices track hospital discharges and provide patients with 24/7 access to a practitioner who can access electronic health records.  Some practices include pharmacists and behavioral health specialists as members of the care team.  Early results show savings in hospitalizations and other costs, suggesting the initiative may be expanded when this experiment ends in December of this year.   

 

Two changes impact care at the end of life.  This area is of special interest to the federal government since 30% of Medicare expenditures occur the last year of life.  Medicare has a hospice benefit, but many terminally ill beneficiaries never use it, or enroll with only weeks or days to live.  One reason is the requirement that hospice patients agree to forego any curative procedures, such as chemotherapy.  But a new pilot program - "Care Choices" - will allow individuals to receive hospice services at the same time as traditional treatments.  Seventy hospices launched this new model on January 1, with 70 more next year.  Ten hospices in Michigan will participate.

 

The second change - Medicare is now paying physicians to counsel terminally ill patients about their options for care at the end of their lives.  Doctors are reimbursed $86 for the first 30 minutes of "advance care planning" if it takes place in their office, and slightly less if it takes place in a hospital.  Research has shown that while the majority of people say they prefer to die at home, in reality, most die in hospitals or nursing homes.  Advance planning could help many realize their hopes for a peaceful death at home.

 

Governor Snyder's State of the State address . . . is scheduled on Tuesday, January 19 at 7 pm.