Medicare will launch on April 1, 2016 an ambitious experiment, “Comprehensive Care for Joint Replacement,” changing how it pays for knee and hip replacements. The purpose is to raise the quality of the care they give and by doing so, lower costs.
The idea is to follow patients more closely and do any knee or hip replacement before there are complications. By catching the need for replacements earlier it will smooth patients’ recovery and help prevent unwanted complications. The more complications there are with surgeries, the more money it costs the hospitals.
Hip and knee replacements are the most common surgeries for Medicare patients. Medicare is pushing for this change within hospitals, doctors, and rehab centers. They are using penalties to further coordinate this change. Improved care should reduce costs.
The new system is established in 67 metro areas across the country, home to around 800 hospitals. Similar experiments may be in store for other procedures, such as heart bypass surgery. It is all part of a broader effort under President Barack Obama’s health care law to align traditional Medicare with changes pushing the U.S. health care system toward greater accountability.
Patients may not notice a difference initially, except a few more forms to sign. Patients can still choose their doctors and hospitals. If this new system works, then patients will notice smoother coordination as they leave the hospital and begin recovery and rehab. The overall results should be significant.
One of the predicted unintended consequences is that hospitals are only going to want the patients who are expected to do well with surgery, making it more cost-effective. While Medicare disagrees with this prediction, consumer groups will be watching to see if it is an effective change.
Medicare paid for more than 400,000 knee and hip replacements in 2014 costing the taxpayers $7 billion in hospitalizations alone. For some patients, recovery can be difficult, but surgery can relieve pain and add years of mobility.
The joint replacement experiment is projected to save Medicare $343 million over its five years, and could be expanded nationwide.