As readers of this blog know, Medicare costs loom large in our nation’s future. If we do not find a way to control Medicare spending, it’s hard to imagine any way to remain a solvent nation. As we continue to explore ways of controlling these costs, it is important to remember that a great deal of Medicare spending occurs after people leave the hospital. Consider this picture, reproduced from a February article in the New England Journal of Medicine.
(Note: COPD is emphysema.)
One reason that post-acute care is so expensive, of course, is that Medicare has put so much pressure on hospitals to hold on their expenses. As students in my health policy class get sick of hearing: “if you squeeze the balloon in one location, it just expands in another.” That’s why I expect to see lots more efforts to “bundle” medical payments, so that when a person gets admitted to the hospital with emphysema, the hospital – actually healthcare system that the hospital is part of – gets money to take care of that patient for the next, say, six or eight weeks. That gives the healthcare providers an incentive to provide the best possible care, in the most efficient manner. If it means an extra day in the hospital will reduce a lot of post-hospital spending, so be it.
I wonder if growing up in Minnesota is what has made me such a fan of bundling up!