"For the first time, providers are beginning to ask how much their recommended interventions cost and whether there isn't a way to reduce those costs," said Robert Reischauer, former director of the Congressional Budget Office. "Younger physicians are more tech savvy and more interested in a balanced work-family life and more willing to work in teams. So there is lots going on that quite frankly never happened in a convincing way before."
President Barack Obama's health care law, awaiting a Supreme Court decision on its fate, attempts to nudge Medicare into a leading role in the wave of experimentation. The program is trying various strategies to change the behavior of service providers, such as penalizing hospitals with too many preventable readmissions, offering to share savings with medical networks that can operate more efficiently, and promoting coordination among hospitals, rehabilitation centers and home health agencies.
Stream, the Spokane-area doctor, says he hopes such reforms do work. He doubles as president of the American Academy of Family Physicians, a professional society heavily committed to the new direction. But in the meantime, Stream worries about his economically pressed patients.
The woman at risk for liver cancer is doing well, but Stream said he is concerned she may eventually develop a tumor that is not detected early enough.
The tech worker with diabetes is on maximum doses of generic pills, the best he can do on his budget. But his blood sugar is not well controlled. He is beginning to develop complications.
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