Lora Pellegrini, President & CEO, MA Association of Health Plans, hammers home the point (made by the AG, academic researchers and Beth Israel CEO Paul Levy, on his blog today) that certain hospitals with leverage in the marketplace are the key drivers of spiralling health care costs:

How much evidence do we need?

This week, yet a third independent and authoritative source weighed in with the core reason for skyrocketing health care costs –escalating costs charged by hospitals and doctors.

The report by two leading researchers at Boston University follows investigative reports by the Division of Health Care Finance and Policy (DHCFP) and the state Attorney General. They are must reading for anyone concerned about the problem.

Pages 3 and 4 of the AG’s report, an “Examination of Health Care Cost Trends and Cost Drivers,” is a good place to start. They say:

Price variations are not correlated to quality, severity of services, the number of patients on Medicare or Medicaid or whether it is a teaching or community hospital;

Price variations are correlated to market leverage and higher priced hospitals are gaining market share at the expense of lower priced hospitals, which are losing volume; and

Price increases, not increases in utilization, caused most of the increases in health care costs during the past few years in Massachusetts.

Put simply, the AG’s report states that bigger or more powerful hospitals aren’t always better, but they’re often a lot more expensive, and use their clout and member base to command much higher fees for even the most basic medical care.

Meanwhile, DHCFP, in advance of the hearings it’s holding this week on health care costs, issued a series of reports that came to similar conclusions about what’s driving costs up.

According to its reports, in just three years, medical spending on privately insured Massachusetts residents grew more than 15 percent, fueled in large part by outpatient care in expensive hospitals.

The DHCFP and AG reports are the foundation of the most important hearings that state government will hold this year. If you haven’t already, I encourage readers of this blog to head over to today’s hearing at UMass-Boston or check out the information from the hearings.

But there’s more. Earlier this week, researchers at Boston University’s School of Public Health issued a report stating that Massachusetts hospitals, as of 2007, were charging 55 percent more than the national average for a variety of services. Read more…

Dr. Don Goldmann is Senior Vice President of the Cambridge-based Institute for Healthcare Improvement, Professor of Immunology and Infectious Diseases, and of Epidemiology, at the Harvard School of Public Health, and Professor of Pediatrics at the Harvard Medical School.

He submitted testimony for this week’s state hearings on cost control and offered a 10-step plan to address shortcomings in the current system:

Massachusetts has tackled the issue of access to health care and now faces the challenge of providing better care while controlling costs. Fortunately, both are possible, but they will require a series of systems improvements. Here are 10 steps that are particularly important, along with some caveats and cautions. They should be applied throughout Massachusetts – and across the nation, no matter what happens with health care reform in Congress.

1. Improve patient safety and reduce harms. Great progress has been made in reducing the rate of costly infection in hospitals, but there still is room for improvement. Hospitals must also continue to address other avoidable harms, such as pressure ulcers, falls, and adverse drug events.

While focusing on individual harms certainly is beneficial, it is inefficient and may have significant opportunity costs by shifting hospital resources from other quality and safety issues. Harm prevention needs to be addressed as a system property – part of a broader effort to transform the way we work so that the overall rate of harm and mortality declines. Patients want to know that they will be safe and will have no harm in the hospital; period. They don’t want or need to pay attention to multiple types of adverse events.

Prevention must also extend beyond the hospital walls, especially following discharge from the hospital, and errors of commission are no less important than errors of omission. A 60-year- old patient who did not receive an indicated colonoscopy and presents with colon cancer, and a patient who has a wound infection following colon cancer surgery, both have suffered terrible harms.

2. Reduce avoidable hospitalizations, re-hospitalizations, and emergency department visits. The Commonwealth is taking a leadership role in addressing these issues, especially re-hospitalizations, but significant challenges remain. Maximum benefit will be achieved, for instance, only if patients – especially those with complex medical and social problems – are supported across the continuum of care. Yet, currently, neither hospitals nor primary care providers are rewarded for avoiding re-hospitalizations. Read more…

The Congressional Budget Office this morning put a pricetag on the Democrat’s health reform bill — $940 billion over 10 years — but also said the plan would do more to reduce the deficit than either of the previous House or Senate proposals.

Kaiser Health News offers the roundup of coverage, which also lays out the end-game for a vote on the bill, which could come as soon as Sunday.

Amnesty International, the global human rights organization, took an unprecedented step earlier this month and issued a report that examines a critical aspect of the U.S. health care system — and its findings are troubling. The report, “Deadly Delivery: The Maternal Mortality Crisis in the U.S.A,” documents a steady increase in the number of deaths, “near misses,” and severe complications experienced by women during pregnancy and childbirth:

Maternal mortality ratios have actually increased from a low of 6.6 deaths per 100,000 live births in 1987 to 13.3 deaths per 100,000 live births in 2006. While some of the increase may be due to improved data collection, the fact
that maternal mortality ratios have doubled is a cause for concern.

African-American woman are at greater risk, the report says, but white women and the wealthy are not immune. Indeed, the report says, despite the fact that the U.S. spends more on health care than any other country in the world:

Women in the USA have a greater lifetime risk of dying of pregnancy-related complications than women in 40 other countries. For example, the likelihood of a woman dying in childbirth in the USA is five times greater than in Greece, four times greater than in Germany, and three times greater than in Spain. More than two women die every day in the USA from pregnancy-related causes.

Maureen Corry, executive director of Childbirth Connection, a research and advocacy group in New York (and a past CommonHealth contributor) said in a statement that the increase in maternal mortality is directly linked to greater reliance of medical interventions in maternity care:

“Primary among the many factors behind the crisis in maternity care is the simple fact that routine maternity care is not following the best evidence on what is safe and effective for women and babies. Instead, we’re overusing certain interventions like c-section and elective induction, and underusing beneficial ones like smoking cessation during pregnancy and continuous support during labor, that we know lead to better outcomes.”

Nancy Turnbull, a senior lecturer in health policy at the Harvard School of Public Health, issued a call to the crowd gathered at U Mass Boston Tuesday afternoon for Day 1 of the Division of Health Care Finance and Policy hearings seeking ways to contain rising health care costs.

“Do not be afraid and don’t be a chicken,” Turnbull said, channeling the story of Chicken Little. She added: “We’ve deluded ourselves into thinking we can reduce health care costs wthout sacrifice,” but, she warned, getting the job done will take “hard choices, political leadership and pain.”

Indeed.

Liz Kowalczyk of The Boston Globe reports that state lawmakers announced they favor a plan to control costs by capping payments to doctors and hospitals.

The hearings continue on Thursday and Friday, with testimony on the health care delivery system and strategies — some of them painful — to contain the skyrocketing costs.

NPR’s Mara Liasson reports on the group Organizing For America, the effective grass-roots coalition built during the 2008 presidential campaign that was supposed to help President Obama pass legislation. So far, according to Liasson’s report, OFA has been a disapointment, and the question is whether it can regroup and help Democrats in time for the midterm elections.

In another in-depth report on OFA, the publication, In These Times offers a lengthy account of the shortcomings of the movement, particularly its push for health care reform.

The Boston Globe is reporting that Cleve Killingsworth, the CEO of Blue Cross and Blue Shield of Massachusetts, has resigned.

Former chief executive William Van Faasen will return to run the insurer on an interim basis, according to a Blue Cross press release, while the company searches for a permanent successor.

The Globe story says:

Earlier this month, Blue Cross decided to separate the jobs of chairman and chief executive of the company. Killingsworth turned the chairman’s position over to Paul Guzzi, a Blue Cross director and president of the Greater Boston Chamber of Commerce.

Blue Cross recently reported a loss of $149.2 million for 2009. About $95 million of that loss was attributed to the company’s write-down of stocks and investment property to a market value below their purchase price.

Roughly four years ago, Van Faasen generated some controversy when he received $16.4 million in a lump-sum retirement benefit when he stepped down as chief executive. The size of that payment was considered extraordinary by some because as a nonprofit, Blue Cross-Blue Shield is expected to use surpluses to support its healthcare mission.

As if the entire weekend of torrential rain wasn’t depressing enough, today’s New York Times offers more gloomy news: it’s a story about the mind-boggling amount of money being spent to influence lawmakers on health care reform.

With a vote on President Obama’s health care legislation expected as early as this week, reporter Jeff Zeleny says the U.S. Chamber of Commerce is leading a group of opponents, who together have already spent $11 million this month (with more to come) to target 27 House Democrats who supported the bill last year and 13 who were against it. Of course, supporters of the measure are also spending millions, the report says. Zeleny writes:

The Chamber of Commerce is leading the opposition to the health care bill with a coalition called Employers for a Healthy Economy. In two weeks, the group has bought more than $7 million in television advertising and plans to spend up to $3 million more. Americans for Prosperity, a group financed by David Koch, the oilman, is also jumping into the fray with an advertising campaign of nearly $1 million.

An alliance of groups supporting the health care plan, which works closely with the White House and Democratic leaders, had been spending far less and focusing on fewer districts. But after pharmaceutical companies made a $12 million investment for a final advertising push, spending by both sides for the first time is now nearly the same.

Meanwhile, President Obama is doing what he can to corral enough Democrats to pass his top domestic priority. Zeleny reports:

Mr. Obama is making daily telephone calls to Democrats who supported the health care bill last year, but have yet to decide how they intend to vote this time. He is also focusing on those who opposed the legislation, including Representative Dennis J. Kucinich of Ohio, who said the measure did not go far enough.

The president’s trip to Ohio includes Mr. Kucinich’s district, and he invited the congressman to join him aboard Air Force One. Mr. Kucinich said he was grateful for the ride and for the president’s visit, but added that he was disinclined to support the bill as it stands.

“Barack Obama is my president; I want him to succeed,” Mr. Kucinich said in an interview. “But I think it’s important to have real health care reform. I wish I could vote for it, but I don’t think I can.”

A recent judicial ruling adds to the mounting medical evidence that vaccines do not cause autism in children, according to a story in today’s New York Times.

Donald G. McNeil, Jr. reports that “three judges ruled Friday in three separate cases that thimerosal, a preservative containing mercury, does not cause autism.”

(Thimerasol, which was routinely used in vaccines more than a decade ago, has been removed from almost all children’s vaccines.)

The judicial rulings, part of the so-called “Omnibus Autism Proceeding,” which combined the cases of 5,000 families with autistic children seeking compensation from a federal vaccine injury fund, were strongly worded, the Times says:

The master in the King ruling emphasized that it was “not a close case” and “extremely unlikely” that Jordan’s autism was connected to his vaccines. The master in the Dwyer case wrote that many parents “relied upon practitioners and researchers who peddled hope, not opinions grounded in science and medicine.”

Patricia Campbell-Smith, the master in the Mead case, also dismissed two subarguments made by a few opponents of vaccines, saying they “have not shown either that certain children are genetically hypersusceptible to mercury or that certain children are predisposed to have difficulty excreting mercury.”

She also echoed a contention by vaccine defenders that a shot is safer than a tuna sandwich. “A normal fish-eating diet by pregnant mothers” is more likely to deposit mercury in the brain than vaccines are, she wrote.

But those arguments — like previous medical studies that have shown no link — did little to dampen the belief of some parents who are convined that the vaccine theory of autism is real.

The Times quotes one parent, Amy Carson, the founder of Moms Against Mercury, who has a son with brain damage, comparing the proceedings of the vaccine court to “the mice overseeing the cheese.”

Mario Motta, M.D., President, Massachusetts Medical Society, suggests that payment reform, evidence-based health insurance, early disclosure of medical errors coupled with non-judicial resolutions, and other measures will be more effective in reigning in health care spending than a plan backed by the current administration:

Governor Patrick’s small business legislation is a well-intentioned attempt to encourage business growth in the Commonwealth and provide relief for small businesses from rising health care costs. But one of his prescriptions for relief, cost control, is not a wise course of action.

We recognize how the recession has battered small business. Rising health insurance premiums are a significant part of this. But we believe that simply regulating rates would trigger a wide range of unintended consequences and would not solve the underlying problem.

A better approach for cost containment comes from the Massachusetts Health Care Quality and Cost Council. Its final recommendations would allow the state to meet its goal of containing cost growth in health care because it employs a comprehensive approach to a very complex problem.

The Council’s recommendations include comprehensive payment reform, support of system-wide redesign efforts, widespread adoption and use of health information technology, implementation of evidenced-based health insurance coverage informed by comparative effectiveness research, development of health resource planning capabilities, enactment of malpractice reforms and peer review statutes, implementation of administrative simplification measures, consumer engagement efforts, emphasis on the prevention of illness and the promotion of good health, and increased transparency. Read more…