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Does Obamacare change the care hospitals and doctors provide?

Obamacare aims to reward doctors who practice better medicine with higher payments.


The drafters of the Affordable Care Act certainly hope so — which is why they included dozens of Obamacare programs that try to move the health care system from one that pays for volume to one that pays for value.

Right now, most of the American health care system operates in a fee-for-service model; a hip surgeon gets paid a set fee for each hip surgery, regardless of whether his patients have complications down the line or come out of the procedure as good as new.

Obamacare aims to tether doctors’ payments, at least partially, to patient outcomes, rewarding doctors who practice better medicine with higher payments. The law’s value-based purchasing program, for example, now ties how much hospitals get paid to whether their patients are getting healthier.

Accountable Care Organizations, another big Obamacare program, has big groups of doctors band together and agree to take a lump sum payment for the care they provide patients. If they can provide care at a lower price than the lump sum — and, again, hit certain quality metrics — they pocket the difference as profit.

Programs like these are scattered throughout the health care law and are more like experiments than systemic reforms at this point. But if the experiments work the federal government is eager to scale them up.

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