Last year, Congress changed the way Medicare pays physicians, It scrapped a system that paid docs based largely on the number of procedures and tests they do, and instructed federal Medicare officials to come up with a design that rewards quality and value. Medicare has already moved in this direction for hospitals and health systems, and the new law was [...]
Public opinion surveys show that most Americans incorrectly think Medicare pays for long-term supports and services (LTSS). It does not. But should it? Should Congress add a long-term care benefit to the program’s current package of insurance for hospital care, doctor visits, and drugs? Three highly respected health researchers, Karen Davis, Amber Willink, and Cathy Schoen, think it should. In [...]
We’ve all seen those best- places-to-retire lists. Inevitably, they are based on low taxes, good weather, or lots of activities. But how about this metric: Where will you get the best care if you are old and frail? Hint: Oregon is good. Rural Louisiana is not. The Dartmouth Institute for Health Policy and Clinical Practice, which has access to an [...]
Prodded by Congress, Medicare will tie more of its compensation for doctors and hospitals to the quality of their care. And who, you might ask, could be against such pay for performance--besides incompetent providers trying to preserve their reimbursements? Doesn’t it make sense to pay docs and hospitals for improving the health of their patients rather than for the volume [...]
Discharge planning is often a broken link in the chain of care for hospital patients. Older adults and others with complex care needs nearly always need follow-up after they are discharged. They’ll almost certainly have to take new medications. They may need bandages changed after surgery, or physical therapy after a stroke. Unfortunately, they and their families rarely get the [...]
Older adults are getting too much medical treatment. No, I am not suggesting we ration treatment for seniors or empower the mythical death panels. Rather, the health system should replace aggressive but ultimately useless medical interventions with more care. This means rethinking the way we care for older adults with chronic disease. We should organize care around the goal of improving their quality of life rather than on [...]
Cancer researchers are closer than ever to achieving their long-held dream of turning the disease from a death sentence to a chronic illness. This would be a remarkable scientific achievement. But while people may soon routinely live decades with their cancer in remission or even cured, they will not become immortal. Most will eventually suffer from some other debilitating condition and [...]
In a recent essay in The Washington Post, geriatrician and author Jerald Winakur described the recent hospital experience of his 91-year-old mother. You won’t be surprised to learn it was a nightmare: Poor pain management, overworked staff, insufficient training, little communication among physicians and no communication between his mom and the waves of medical professionals who treated her each day. [...]
Want to know what’s wrong with the health care system for older adults in the US? It can be summed up in that 10-word response on a physician’s voice mail. One evening last month, I got a panicked call from a friend: She came home from work and discovered that her widowed mother, who has been living with her for [...]
We spend more on our health care as we age. No news there. But you may be surprised to learn that all health spending is not created equal. For most of us, as long as we can stay out of the hospital or a nursing home, our costs are relatively modest--and steady--even as we grow older. But that can change [...]