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For several decades, a consensus has grown that reining in the United States’ $3.2 trillion annual medical bill begins with changing the way doctors are paid: Instead of compensating them for every appointment, service and procedure, they should be paid based on the quality of their care. The Obama administration used the authority of the Affordable Care Act to aggressively advance this idea, but many doctors chafed at the scope and speed of its experiments to change the way Medicare pays for everything from primary care to cancer treatment. Now, the Trump administration is siding with doctors — making a series of regulatory changes that slow or shrink some of these initiatives and let many doctors delay adopting the new system. (Goodnough and Zernike, 11/12)

The Affordable Care Act required Medicare to penalize hospitals with high numbers of heart failure patients who returned for treatment shortly after discharge. New research shows that penalty was associated with fewer readmissions, but also higher rates of death among that patient group. The researchers said the study results, being published in JAMA Cardiology, can’t show cause and effect, but “support the possibility that the [penalty] has had the unintended consequence of increased mortality in patients hospitalized with heart failure.” (Evans, 11/12)

The clinics are flanked by an atrium, a cafe and a library with an outdoor deck. Their main concourses are dotted with furnished alcoves. One thing they don't have: designated waiting rooms. That's because patients at the clinics in the Health Transformation Building at Dell Medical School, part of UT Health Austin, can either go straight to their rooms, if available, or if they arrive early, to any of those decidedly non-institutional spaces, where in the future they'll be buzzed via a smartphone app. (Arndt, 11/11)