Medicare to make new knees, hips better and cheaper

Some 400,000 such surgeries cost taxpayers $7 billion in 2014

WASHINGTON — From Akron to Albuquerque, New York City to San Francisco, Medicare today is launching an ambitious experiment changing how it pays for hip and knee replacements in an effort to raise quality and lower costs.

The idea is to follow patients more closely to smooth their recovery and head off unwanted complications that increase costs.

Hip and knee replacements are the most common inpatient surgery for beneficiaries, and Medicare will be using financial rewards and penalties to foster coordination among hospitals, doctors and rehab centers.

Hospitals are on board, but orthopedic surgeons have some qualms. Consumer groups will be watching closely.

The new system goes into place in 67 metro areas across the country, including Albuquerque, that are home to millions of beneficiaries and around 800 hospitals. Similar experiments might be in store for other procedures, like heart bypass surgery. It’s part of a broader effort under President Barack Obama’s health care law to align traditional Medicare with changes pushing the U.S. health care system toward greater accountability.

Initially patients and families may not notice much beyond additional forms to sign from participating providers. Patients can still choose their doctors and hospitals. If the concept works, patients will see smoother coordination as they leave the hospital, and take on the challenges of recovery and rehab, with measurably better results overall.

“There’s likely to be greater emphasis on communication and support to ensure that patients, once discharged, aren’t left to fend for themselves,” said Joshua Seidman of the consulting firm Avalere Health, which has been working with hospitals.

Hospitals are supportive, but surgeons have raised concerns.

Over time, surgeons fear, there will be indirect pressure to discourage joint replacement for patients seen as having less chance of a smooth recovery. Picture an obese, lifelong smoker hobbling around on a pain- fully deteriorated knee, for example.

“The overall goal is a good one — they want to see where you can cut the waste out,” said Dr. Alexandra Page, a San Diego clinician representing the American Association of Orthopaedic Surgeons. But “one of the unintended consequences is going to be cherry-picking … hospitals are only going to want to have the patients who are going to do well.”

Medicare says that’s unlikely because the experiment was designed so hospitals can keep treating a wide range of patients. Nonetheless, consumer groups say they’ll be watching. “While we are generally supportive because we think it can increase quality and decrease costs, we really think that monitoring providers is going to be important,” said Joe Baker, president of the Medicare Rights Center, an advocacy group based in New York.

Medicare paid for more than 400,000 hip and knee replacements in 2014 at a cost of $7 billion to taxpayers for the hospitalizations alone.