Medicare Hospital Bonus

Do you know about the Medicare hospital bonus program? Hospitals can get cash for better results. The idea sounds good in theory, but there is a dangerous underbelly to this plan.

Medicare last month announced bonuses and penalties for nearly 3,000 U.S. hospitals as it links almost $1 billion in payments to the quality of care given to patients.

It’s part of a move by government and private insurers toward rewarding medical providers based on their quality of care, not the quantity of services.

Georgia Health News

Quality of care bonuses. What could possibly go wrong?

So how does Medicare decide winners and losers?

Eight of the current 25 quality standards, Yahoo News reported, are based on patient satisfaction: communication with nurses; communication with doctors; responsiveness of hospital staff; pain management; communication about medicines; cleanliness and quietness of hospital environment; discharge information and overall rating of the hospital.

The rest are based on  how often hospitals followed clinical standards of care, such as controlling heart surgery patients’  blood sugar levels and giving them beta blockers to lower their blood pressure.

All sounds so simple. If a hospital delivers better results, and you are a satisfied customer, they can get a Medicare hospital bonus.

Do you think hospitals might “cherry pick” the Medicare patients they take in and the type of services they will provide to Medicare patients? And does it matter if you have a Medicare Advantage plan or original Medicare and a Medicare supplement plan (where you can choose your doctor and hospital)?

The maximum amount any hospital could gain or lose was 1 percent of its regular Medicare payments.

For nearly two-thirds of the hospitals, the changes are less than a quarter of a percent, KHN said. Still, for hospitals with a high number of Medicare patients, hundreds of thousands of dollars are at stake.

The caps will rise to 2 percent over the next four years.

The maximum Medicare hospital bonus (or penalty) now is 1%, rising to 2%. But will it stop there or keep climbing?

If a hospital can game the system in hopes of qualifying for the maximum bonus, how many really sick patients with expected poor outcomes do they have to reject in order to earn the highest kickback from Medicare?

This is about more than money. It is about your health and quality of care. Georgia Medicare Plans is concerned about your health and the health of your wallet. Save money by comparing your existing Medigap rates with an instant GA Medigap quote.

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