Medicare seems to feel that the method of paying doctors called “fee-for- service” may encourage some, shall we say, unnecessary tests and services.  My mother has Medicare backed up by a Senior health plan. Last summer when she was in the hospital I had to beg to get her bathed.  The parade of doctors in and out of her room however, was endless.  She got a bill from each and every one of them.  A few days ago Medicare began a plan to change reimbursements to hospitals from being based on the amount of care they give to also paying for quality of care.

Kaiser Health News in an article dated April 29 by Jordan Rau, noted that “Medicare’s new “value-based purchasing” program was mandated in last year’s health care law.”

He goes on to write “Under the final rules announced Friday, Medicare will cut payments to hospitals 1 percent and set that money aside for a bonus pool.  Hospitals that do better than average on a variety of measurements, or show the greatest improvement from the previous year, would earn bonus payments, totaling $850 million in the first year. The bonus pool would increase to 2 percent of Medicare payments in October 2016.  Ashish Jha, professor at the Harvard School of Public Health said “It’s a really important step toward paying for better care and not just for more care.”

Seventy percent of the bonuses initially will be based on how often hospitals follow guidelines on 12 clinical care measures.  The other 30 percent of the bonuses will be determined by the patients themselves.  The hospitals will conduct the surveys for Medicare (I hope at the point of discharge).  Hospital groups are not just crazy about this claiming that the surveys don’t always reflect reality in regions where the patients were grumpy. I think it’s a great idea.  Hopefully they will realize that freshly bathed patients are less grumpy!

The measures CMS plans to use are published for each hospital on Medicare’s Hospital Compare website.  I thought I would list the criteria here for you so here it is:

  • Patients who reported that their nurses “Always communicated well.
  • Patients who reported that their doctors “Always” communicated well.
  • Patients who reported that they “Always” received help as soon as they wanted.
  • Patients who reported that their pain was “Always” well controlled.
  • Patients who reported that staff “Always” explained about medicines before giving it to them.
  • Patients who reported that their room and bathroom were “Always” clean.
  • Patients who reported that the area around their room was “Always” quiet at night.
  • Patients at each hospital who reported that YES, they were given information about what to do during their recovery at home.
  • Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest).
  • Patients who reported YES, they would definitely recommend the hospital

Medicare Advantage