Fragments of bone and cartilage arced across the operating room as Dr. R. Michael Meneghini drilled into the knee of his first patient at a hospital here at dawn. Within an hour, the 66-year-old woman had a replacement joint made of titanium and cobalt chrome, and she was sent home the next day.
But the Obama administration was watching over her caregivers’ shoulders. If, over three months, her medical costs exceeded a target amount set by President Obama’s health regulators in Washington, Dr. Meneghini’s employer, Indiana University Health, stood to lose money.
Such efforts to squeeze spending out of the nation’s health