Hospitals Brace for New Medicare Payment Rules

A bundled payment initiative related to hip & knee replacements takes effect today - and no - it's not an April Fool's joke!

This could be a huge change in the way that people in need of hip & knee replacements are evaluated & subsequently treated for the surgery.  It puts the onus on hospitals for the costs of the procedure for the first 90 days.  After that, if they've handled the surgery & post operative care "economically", the hospital may benefit.  If not, the providers could potentially OWE Medicare money.

This will most likely have a profound effect on who gets treated and how.  High risk patients, or patients who cannot go directly home after the surgery, would be most at risk for either being denied care or receiving limited care.

It is understood that Medicare spending overall needs to be evaluated and reigned in somehow, but we may find that the net effect of blanket policies, rather than case by case evaluation of long term impacts of care may come back to bite us.

Let's say someone is denied a knee replacement due to high risk, post operative complications.  Overall, short term, it may seem like an expensive procedure, but long term - may provide the patient with necessary mobility to stay in their home without care for a longer term.  Without the surgery - they could potentially become immobile, leading to all sorts of more expensive care & poor quality of life in the long run.

There should be a better way to get at the long term costs and benefits of a given treatment for a patient, rather than making a blanket "rule", for a particular thing that really shouldn't be evaluated in a vacuum.

What do you think?  Read the Wall Street Journal Article below:

Hospitals Brace for New Medicare Payment Rules