WASHINGTON - For 2016, Medicare is going through some of the biggest changes in its 50-year history. 

Among them: coverage for end-of-life counseling and testing a new way to pay for the most common surgeries. Also, some hospice patients will be able to keep getting curative treatment.

Grandma's Medicare just paid the bills as they came in. Now, the nation's flagship health care program is seeking better ways to balance cost, quality and access.

Behind it all is the idea of teamwork in caring for patients. Frontline primary care is getting special attention.

The effort could redefine the doctor-patient relationship, or it could end up a muddle of well-intentioned but unworkable government rules. The changes have been building slowly, but this could be the year they start getting widely noticed.