Word: payments
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Dates: during 2000-2009
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...December 2008 and again in March 2009, 1,000 people were surveyed and asked, among other things, if they knew anyone who had defaulted on a mortgage, and if they knew anyone who had defaulted on a mortgage even if he or she could afford to make the monthly payment. By taking the ratio of the two answers, the economists calculated that more than a quarter of defaults are, as they put it, "strategic." (Read "Home Sales Perk Up, but Expensive Houses Languish...
Taking the congestive-heart-failure example, here's how the payment scheme would work: A slightly overweight 60-year-old heart-failure patient comes in with coronary-artery disease and acid-reflux disease. According to a Prometheus algorithm, this patient should cost $20,750 a year to treat - including office visits, medications, blood-pressure monitoring and an allowance for complications. The incentive for the heart patient's doctor to spend less than $20,750 is that he gets to keep a portion of the difference (assuming that the patient was managed properly and happy with the outcome). And the best...
...Prometheus project is named after the Greek god of forethought, but it's also a lengthy acronym for "Provider payment reform for outcomes, margins, evidence transparency, hassle reduction, excellence, understandability and sustainability...
Still, overhauling the current health-payment system has other pitfalls. Back in 1983, Medicare initiated a similar plan, bundling payments for hospital stays, but the program acquired the unfortunate label "quicker but sicker." Since hospitals were paid a certain amount of money for each patient no matter how long they stayed, many patients were discharged sooner than was prudent, which transferred the burden of care onto nursing homes and created a "mini-industry of readmissions," according to Gail Wilensky, a former head of Medicare. "Redesigning the reimbursement system is not for the faint of heart," says Wilensky. "This...
With or without physicians' support, the idea may be creeping forward. Last week, De Brantes was part of a group of health-payment reformers invited to the White House to explain how bundling works. Meanwhile, the federal Centers for Medicare & Medicaid Services recently started a three-year demonstration project that will provide bundled payments to hospitals and doctors at five sites for 37 common surgical procedures. The idea is that if hospitals and doctors are paid out of the same pot, they'll coordinate services to be more efficient and cost-effective. The results could help determine how aggressively...