Word: careful
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...operating room that the new way of doing things is most graphically illustrated. Surgery in the U.S. is billed the same à la carte way primary care is: separate charges for the hospital, the anesthesiologist, the lead surgeon, the post-op checkups, and on and on. Care itself can be similarly fragmented, with patients finding themselves in the hands of whoever happens to be on duty at any point in the day and a doctor on the night shift knowing little about a patient whose surgeon worked the day shift. Dr. Alfred Casale, Geisinger's chief of cardiothoracic surgery, tells...
According to a study by the AARP, 30% of primary-care physicians already have some kind of pay-for-performance incentive written into their plan contracts, and 28% of group practices include performance benchmarks. Since 2007, Massachusetts has required all its citizens to have health insurance, about 20% of which involves some kind of global coverage - handling all of a patient's health-care needs for the duration of the policy. In July, the state announced plans to go further, eliminating fee-for-service entirely within five years and mandating global care statewide. Similar plans are ramping up in Minnesota...
...Steele decided to fix this, switching Geisinger over to a prix fixe, episode-care model for surgery, starting with the heart bypass. Under the new system, a closely coordinated team of caregivers would be responsible for every stage of a bypass patient's treatment and recovery. The hospital would submit a single bill for all work and include a 90-day warranty. If a patient checked back in with a complication like a postsurgical infection, that work would be on Geisinger's dime. "We'll do it right, or we won't send a bill" was how Steele...
Running the Numbers For doctors, lawmakers and anyone else embroiled in the health-care-reform debate, the question is, Can a system like Geisinger's go national? The short answer: in some ways it has. Pay-for-performance, episode care and global coverage have been seeping into health plans for a while...
...health-care bills making their fitful way through Congress include whacks at fee-for-service too, mostly in the form of programs that introduce episode payments or set up what are known as accountable care organizations, community-based teams of doctors who collaborate on care. The programs would be tested first among Medicare patients, but what happens in Medicare - with its 45 million recipients - ultimately drives the industry. (See more about health care...