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We've heard a lot about how the Affordable Care Act has affect the insurance side of the health care world. But there are potentially big changes happening behind the scenes at hospitals, as well. And these changes could transform the way doctors and nurses care for us. It's the part of the law that's meant to rein in the nation's exploding health care costs. And it's doing it by creating hundreds of little experiments in which hospitals around the country have volunteered to participate.

Lisa Chow, of NPR's Planet Money Team, went to one hospital in Ohio where doctors are preparing for a new way of doing business.

LISA CHOW, BYLINE: Michael Firstenberg is a heart surgeon at Summa Akron City Hospital. And like a lot of doctors, he knows there's something a little funny about the way he gets paid. If a patient comes in for a bypass operation, Dr. Firstenberg earns a certain amount of money for the hospital.

DR. MICHAEL FIRSTENBERG: However, if that patient that night has to go back for bleeding, then I get paid for that procedure as well. And everybody is happy because look at all the revenue I'm generating, independent of the quality.

CHOW: Ken Berkovitz is a cardiologist at the hospital.

DR. KEN BERKOVITZ: Everybody in the health care system gets rewarded for doing more, rather than rewarded for doing the right thing.

CHOW: And more is expensive. But how do you create a less expensive system that still provides good care? To test one possible answer, the federal government, starting January 1st is changing the way Medicare pays this hospital and these doctors. Rather than paying for that bypass operation and then paying again for bleeding, Medicare will pay one lump sum upfront to cover not only the surgery, but any complications that occur after surgery - that's it. If the patient doesn't have any complications within 30 days of being discharged from the hospital, the doctors could actually make more money than they do today, but they stand to lose money if there are lots of problems after surgery.

This shift in how providers get paid is changing a lot about the way things are done here at Summa Akron City Hospital. Change number one, the checklist.

ERIC ESPINAL: All our open heart surgery patient have this.

CHOW: I'm flowing Eric Espinal, a surgeon, as he does his morning rounds. And this piece of paper he's showing me, it's a pretty old and simple idea. Did the patient get her antibiotics on time? Check. Did the catheter come out on time? Check.

ESPINAL: All that is listed here.

CHOW: Research has long shown that documenting simple steps can significantly reduce medical error. And yet hospitals have a hard time implementing checklists, because doctors don't really like them.

ESPINAL: I got to admit, as a physician, when we came up with this, I kind of felt a little silly for the first few weeks following a sort of checklist or menu.

CHOW: But Espinal says, pilots and NASCAR drivers use checklists. They reduce complications, better for patients and, now, better for the bottom line. Change number two is a change in culture. In the old world, Medicare pays the hospital separately from the surgeon, separately from the anesthesiologist. In the new world, as this hospital, Medicare will pay the entire team together, which encourages more collaboration because now everyone shares in the savings or costs of the surgery.

Ken Berkovitz says this change hasn't been easy for everyone.

BERKOVITZ: Physicians are a dedicated, strong-willed independent lot, and many of them went into the practice of medicine because traditionally you've been able to be the captain of your ship, and that's not always equated to good care.

CHOW: So changes number one and two deal with hospital staff. Change number three involves patients, specifically what happens in the month after their leave the hospital.

ESPINAL: How's her activity level? Does she get up and walk?

CHOW: Back on the floor, where patients are recovering from heart surgery, Eric Espinal asks about one patient. She's 63 years old who is about to be discharged. Now, in the old world, it didn't really matter if that patient came back. The doctors would still get paid. In the new world, once they discharge you, they've got to make sure you stay healthy, Even when you're home.

Which, in this patient's case, means having a nurse visit to check her incision, listen to her heart and lungs. Espinal turns to Julie Whitehurst (ph) , the discharge nurse.

ESPINAL: So is the plan for home done?

JULIE WHITEHURST: She's refusing home care. She doesn't want anything to do with it. I tried to talk her into it for eight days now. I can't force her to have it.

CHOW: All of the checklists, teamwork and amped up follow-up care may not help patients like these, some of the most costly to the system. And this gets to an issue that doctors here say Obamacare hasn't addressed. While the law created hundreds of experiments to change the way doctors and hospitals provide their services, it doesn't done nearly as much to change the way patients consume these services.

As hard as it is to change the culture in hospitals, it's even harder to change the culture of us, the patients. Lisa Chow, NPR News.

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