When the Hospital Is Boss Thats Where Doctors Patients Go

3Why did hospitals binge-buy doctor practices in recent years?

To improve care coordination, lower costs and upgrade patient experiences, say hospitals. To raise costs, gain pricing power and steer patient referrals, say skeptics.

Researchers at Stanford University tested those opposing arguments by comparing referral patterns between independent doctors and those working for hospitals.

Ownership by a hospital “dramatically increases” odds that a doctor will admit patients there instead of another, nearby hospital, they found. Worse, from the viewpoint of reformers, it boosts chances that patients will go to higher-cost, lower-quality hospitals.

“One of the things that was most surprising to me about the paper was the quality and cost effect,” said economist Laurence Baker, one of the authors.

While not as pronounced as doctors’ hospital referral pattern, the findings that hospital-physician ownership hurts care quality “head in the direction that might make us concerned,” he said.

The findings were published in August by the National Bureau of Economic Research.

The report is not the final word. More research is needed, the authors say. The 2009 Medicare data they used don’t reflect substantial quality improvements made in many hospitals since then, said Caroline Steinberg, vice president of trends analysis

The Last Gasp of Fee For Service

1Medicare is going in multiple directions at once. On the one hand, it is trying hard to move away from fee-for-service payments to doctors, where each tiny service has its own code and its own payment, and instead, toward more bundled payment or even payment of a fixed amount per person per month to accountable care organizations. On the other hand, the government just proposed, in response to pressure from organized physicians, a new code and a new doctor payment in traditional Medicare for end-of-life counseling. Somewhat oddly, Medicare will currently pay for such a session, as soon as you go on Medicare, but (thankfully, perhaps) few 65-year-olds are expecting an end to their life anytime soon. And so the benefit often goes begging. The new rules would allow you to claim the benefit anytime you feel you need it.

Payment for such advice revives the debate during the passage of the Affordable Care Act about so-called “death panels,” and predictably, lawyers have been weighing in with fears that counseling can turn into pressure to avoid costly care, a benefit to Medicare and the taxpayers, but not necessarily to seniors. But this debate may be

How to Pick the Right Medicare Part D Plan for You

2If you’re just reaching Medicare age, you might be surprised to find out that traditional Medicare doesn’t cover prescription drugs. As drug costs rose, Congress created a Medicare drug insurance program, called Medicare Part D, which went into effect in 2006.

To take advantage of that program, offered by private insurers, Medicare beneficiaries have to choose a drug plan every year, unless they have a Medicare Advantage plan that includes drug coverage or are covered through a former employer.

Plans vary by state, but most Americans have more than 25 plans to choose from, each offering different premiums, alliances with certain pharmacies and varying coverage amounts for the same drugs. That makes choosing the best plan for a particular individual a challenge.

“There are a lot of plans offered for every individual to pick from. It is complicated,” says Jack Hoadley, a research professor at Georgetown University’s Health Policy Institute. “The differences among plans can be hard to sort out. For those who aren’t Web-savvy, it’s even harder.”

Plans for 2016 will be revealed Oct. 1 on the Medicare.gov website, and participants have from Oct. 15 to Dec. 7 to

In Pursuit of Equal Health

Medicare, together with Medicaid, has fundamentally reshaped the American landscape by expanding access to lifesaving health care services, reducing poverty and advancing health equity. So it is appropriate that the new Centers for Medicare and Medicaid Services Equity Plan for Improving Quality in Medicare celebrates Medicare’s 50th birthday by bringing these goals together in a road map for how Medicare can continue to improve its ability to provide high-quality health care for those with the greatest needs, including racial and ethnic minorities, people with disabilities, rural populations and LGBT individuals.

Before Medicare, growing older meant balancing on the knife’s edge of poverty for millions of Americans. Among people older than 65, more than a third lived in poverty, and less than half had health insurance coverage, leaving them exposed to catastrophic health care costs. Since Medicare’s inception, the number of older adults who are uninsured and who are living in poverty has plummeted: By 2014, more than 98 percent of people over age 65 had health insurance, the vast majority through Medicare, and the percentage of seniors living in poverty had dropped by more than two-thirds.

Medicare provides coverage for everyone over age 65, regardless of factors such as income, health status or

Hospitals Are in the Business of Prevention

Last year, Shelly Stroud of Charlotte, North Carolina, 61, was on her way to developing Type 2 diabetes, the disease that puts her father, brother and 29 million other Americans at higher risk of heart attack, stroke, blindness, amputation and kidney failure. “I was overweight – obese – and was considering weight-loss surgery,” she says. So when Carolinas HealthCare System offered a free diabetes risk assessment at her local YMCA and other places in the community, she was one of 53,000 area residents who jumped at the chance – and one of nearly 7,700 who got a big wake-up call.

Stroud found out that she was indeed prediabetic and immediately signed up for a 16-week course offered by Carolinas that included exercise at the Y, classes on healthy eating and lifestyle change, and coaching to help break entrenched habits. “This program helped save my life and changed my life,” says Stroud, who dropped 45 pounds by this past spring and lowered her blood sugar to normal levels.

Welcome to the future of hospital care, where the point, increasingly, is to prevent people from getting sick in the first place. “We’re moving quickly to a world where most care, and the ability to

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