“For decades ever more patients have been arriving at emergency departments (EDs). As concern has mounted, and emergency department crowding – most evident in wait times – has increased, fingers have been pointed. Health systems, politicians and researchers have blamed the decline of primary care, “inappropriate” use of the ED, a fragmented health system, and more recently, social determinants of health. The solutions offered follow from these diagnoses. Improve primary care access, encourage patients and their doctors to use more primary care, penalize patients who are deemed retrospectively by simple algorithms to have used the ED inappropriately, improve care coordination,…

“Medicare’s voluntary bundled-payment program for hip and knee replacements reduced spending by 1.6% from 2013 to 2016 — less than previously estimated — with no overall change in quality, according to a new study in Health Affairs. Another new Health Affairs study reported that lower extremity joint replacement is the only type of clinical episode in Medicare bundled-payment programs that has produced savings so far. The meta-analysis found no evidence of reduced spending or quality improvement for other clinical episodes. The two studies highlight the challenges facing federal policymakers, hospitals and physicians in using bundled payments to achieve cost savings and…