What’s New in Medicare for 2016?

Drawing of Medicare with Stick Men and Clipping Path

2016 marks a unique year for the 50-year-old Medicare program with some of the biggest changes ever:

• Clinicians will now be paid to offer patients counseling for end of life care options. This type of personalized counseling had been previously removed from Obamacare in its early days. Prior to this year, if a patient chose the hospice benefit, they were not covered for treatment options. However, under the new Care Choices Model, patients that pick the hospice benefit will now be allowed to continue treatment while in hospice.

• Medicare beneficiaries can now choose an Accountable Care Organization, or ACO. Currently, beneficiaries are able to opt out if they are unhappy with an ACO but were not able to pick one. ACOs are new networks of providers touted to provide higher quality care at lower costs, however, the debate continues as to whether or not they will truly be effective. Medicare’s chief medical officer, Patrick Conway, notes that nearly 20% of Medicare beneficiaries, or 8 million people, are in ACOs. Medicare is promoting a teamwork approach to medical care as part of their Comprehensive Primary Care Initiative, in which a provider is paid a monthly fee for coordination of care, with a part of any cost savings going to the provider. Care teams consist of a doctor, several nurses, a nurse practitioner, as well as, a care coordinator. By incentivizing teamwork and easier hospital- to-home transitions for patients, the goal is to reach maximum coordinated patient care at reduced costs.

• The goal of lowering cost, however, have some concerned about patients suffering if savings is put above quality of care. For instance, one of the most common surgeries facing Medicare beneficiaries are joint replacements. Hospitals have the potential to either earn money or be assessed a penalty based on the way they manage a patient’s care from the start of surgery throughout rehabilitation. Critics worry that patients may be rushed through rehab if hospitals make an effort to reach financial reward over individual care. Another issue is that of the primary care physician as Medicare pushes to improve preventative services.

As Medicare looks to redefine their core values and outcomes, only time will tell if these changes will truly advance the quality of patient care, help foster a better doctor-patient-team relationship, and reduce Medicare and Medicaid costs.