THE STATE’S SECOND LARGEST HOSPITAL CHAIN IS IN TRANSITION. THE SEARCH FOR NEW PRESIDENT AND C-E-O OF CARITAS CHRISTI IS UNDERWAY AFTER TALKS WITH THREE MULTI-STATE CATHOLIC NETWORKS DID NOT LEAD TO A DEAL. THE SYSTEM IS MAKING MONEY, BUT HAS SUBSTANTIAL DEBT. CARITAS EXECUTIVES PLAN TO EXPLAIN THEIR FINANCIAL STRATEGY TO ATTORNEY GENERAL MARTHA COAKLEY TOMORROW. MANY CARITAS LEADERS, DOCTORS AND NURSES SAY THE VIEW THAT CARITAS IS FAILING IS JUST PLAIN WRONG. W-B-U-R’S MARTHA BEBINGER TAKES A LOOK AT THE CHALLENGES AND FUTURE OF CARITAS CHRISTI.

BEBINGER: Doctor John Chessare steps aside in the Emergency Department at Caritas Norwood as a patient in a wheelchair, comes through large double doors.

CHESSARE: This is a very, very busy place, with EMS providers, and doctors and nurses…it’s the ninth busiest in the Commonwealth

BEBINGER: Chessare, the interim President and CEO for the 6 hospital system, is optimistic about the future of Caritas…even though he knows the public is not.

CHESSARE: We are very concerned that the man on the street believes that we are a sinking ship. No, the time for alarm was in 2004 on the 6th consecutive year of spending down the assets of the corporation. Now we’ve had 3 consecutive years in the black.

BEBINGER: But Caritas still has 324-million dollars in pension and loan debt. Standard and Poor’s has assigned the network a negative bond rating…which raises the cost of borrowing for repairs and new equipment that Caritas needs to compete. Caritas does expect to close the books on the fiscal year that ended September 30th with an extra 2 million dollars…and projects a 20 million dollar profit this year. Chessare says Caritas has some of the lowest costs and best outcomes for patients in the state…and would be in much better shape financial shape if all hospitals in Massachusetts received equal payments.

CHESSARE: In the Commonwealth of Massachusetts there is dramatically different levels of payment to hospitals for the same services.

BEBINGER: Chessare says health insurers and the state routinely pay Caritas 30-40% less for say, delivering a baby as compared with payments to some of the larger Boston teaching hospitals that have more bargaining power. He hopes to persuade insurers to shrink that gap…but it does make it hard to retain doctors.

CHESSARE: Why would a hard working physician contract with one hospital where the payment is 30% less at that hospital than at a different hospital. I would ask rational thinkers, who is it that should be under the looking glass. Read more…

If no further action is taken, the Commonwealth Connector board will soon require that residents of Massachusetts buy policies with drug coverage in order to comply with the individual mandate imposed by the new health reform law. Health plans have traditionally offered policies with or without drug coverage. If drug coverage becomes mandatory, the Connector will stop selling no-drug policies through Commonwealth Choice early next year and individuals who have already purchased a no-drug policy, either through the Connector or in the broader marketplace, will face the choice of either buying-up by the start of 2009 or paying the penalty for noncompliance.

Unfortunately, about a third of those who have enrolled through Commonwealth Choice have purchased no-drug policies, and approximately 160,000 people have no-drug policies in the broader marketplace. Is it consistent with the goals of health reform to raise the premiums of thousands of currently insured people? Wouldn’t more people be insured, if they were able to choose policies with or without drug coverage, especially with the availability of very low-cost generic drugs?

The mandatory drug benefit controversy is really about the goals of reform. Read more…

In the small window of time remaining in 2007 for Massachusetts residents to enroll in health insurance and not pay a penalty, the question of the hour is what can be done to close the gap for people who have not yet signed up? Some important efforts are focused on bringing young, healthy, higher-income uninsured individuals into the fold – key to ensure that risk is well-shared. But what can we do to reach the low-income individuals who are not signing up – especially for Connector programs with premiums – and who are likely to feel a greater sting from the mandate?

Let’s go to the experts: case managers, community health workers and others working directly with low-income uninsured residents across the state. Here at the Blue Cross Blue Shield of Massachusetts Foundation, a report from some community-based health access programs that we support shines a light on barriers for low- to moderate-income residents. We asked grantees who was not enrolling and why. This is what we learned.

Legally present immigrants who misunderstand the consequences of signing up
One program reports that documented immigrants are avoiding enrolling because they fear that enrolling in Commonwealth Care will adversely affect their immigration status.

People who could not get the paperwork needed to enroll
Read more…

The increasing cost of providing care to the uninsured is making health industry and health reform insiders nervous. Some suggest that they want to “control costs” by increasing insurance costs for the working poor. For them, cost shifting to the backs of the working poor and uninsured may give them more control, but it certainly does not constitute cutting the cost of health reform. Here are two current examples of Connector doublespeak on cost containment vs. cost shifting:

Example #1: There are more uninsured than the Romney Administration projected. There are more people signing up for CommCare than expected. We might have a cost problem because of this. So, as the Connector Board is preparing to bargain with the insurance plans that are covering this population, we are being asked to prepare for a fight of “cost containment”. Last month, at the Board meeting, hidden in a slide show were bullets that mentioned the possibility of higher premiums, co-pays or cuts in benefits. While expecting people to pay higher premiums or limiting some benefits is controlling costs for the state (who strongly subsidizes CommCare), it is also shifting costs to consumers who sign up for CommCare. The cost problem of an increased number of uninsured cannot just be shifted onto those least able to pay.

Example #2: Everyone agrees that in today’s medicine, prescription drugs are an essential part of treatment for many diseases. Read more…

Many people have written in this space about cost control, and agreement is widespread that doing so is critical to the success of the new state health plan.

One effective way to decrease overall costs would be to guarantee preventive health care services for all the state’s children.

In child health, prevention is the cornerstone. Prevention is cheaper than treatment of illness, healthier children grow up to be healthier adults, and health care for children is much cheaper than health care for adults. Health care for children is an investment; healthcare for adults is often payment for services long overdue.

We need to re-order our priorities, which will make the cost of health care much less in the long run. First we must offer universal access to preventive services. As long as we have a system that creates disparities in access to care, holes in health care will cause pockets of illness in every community, and these spread like wildfire through families, to newborns, the elderly, and the chronically ill, and through schools, churches, stores, and public transportation to whole communities.

Massachusetts needs to guarantee access to certain preventive child health services. The plan must be universal, simple to administer, seamless, and provided by health care professionals who know the children and have their medical records.

This guaranteed care could be limited to three basic services: Read more…

Now that Massachusetts has the attention of the nation as we move forward in providing residents with access to more affordable health care, it’s time to take up the next challenge of ensuring that the medical care provided is of the highest possible quality.

Quality improvement efforts generally focus on hospitals and other medical institutions. These efforts are very important – but they are not enough. I say that as someone who has spent a good part of his professional life involved in these efforts. I strongly believe that to be effective, we need to do more. We need to make sure that patients – whose health depends on the quality of the care they receive – and their caregivers have a stronger voice in the quality conversation.

That is why I am so excited about a new effort called The Partnership for Healthcare Excellence. Read more…

DISSECTING HEALTH INSURANCE PREMIUMS, PAYING HOSPITALS AND DOCTORS BASED ON PERFORMANCE…AND MAKING PRIMARY CARE A MORE ATTRACTIVE FIELD FOR DOCTORS ARE PARTS OF A PACKAGE OF HEALTH CARE COST CONTROLS FROM SENATE PRESIDENT THERESE MURRAY. IN HER FIRST MAJOR ADDRESS SINCE SHE BECAME THE SENATE PRESIDENT…MURRAY OUTLINED PLANS TO TACKLE HIGH ENERGY AND HOUSING COSTS AS WELL. BUT HEALTH CARE IS THE MAIN ATTRACTION.

BEBINGER: Therese Murray was a key player in passage of the health care law…still in an early phase…that includes mandatory health insurance.

MURRAY: Now comes phase two: out health care costs are squeezing young people, families, small and large businesses, and our state finances…So how do we make health care sustainable for the next 20 years?

We have some ideas…about how to meet that challenge.

BEBINGER: Murray told an audience at the Greater Boston Chamber of Commerce that she will take on one of their top issues… health insurance rates that are rising by about 10-percent for the 8th straight year.

MURRAY: In a market where we are requiring every citizen to purchase health insurance, there should be a process to document the need for premium increases in excess of 7% in any given year.

BEBINGER: Murray proposes hearings triggered by any increase of more than 7%.

CHARLIE BAKER: I think given the rate of health care increases in Massachusetts I think that’s an idea whose time may have come. Read more…

The most recent enrollment numbers indicate that approximately 200,000 individuals in Massachusetts, who were uninsured 16 months ago, have health care coverage today. That certainly is great news and should be celebrated by all of those who have been involved in the health reform effort in the Commonwealth. However, a closer examination reveals that most of those newly covered individuals are either enrolled in the state’s Medicaid program or are receiving heavily subsidized insurance through the state’s new Commonwealth Care program. Although that is not totally unexpected – why wouldn’t anyone enroll in programs that provide free or almost free health care – the increased costs to the Commonwealth could present future fiscal concerns. Additionally, it will be very interesting to see whether higher income residents not eligible for subsidized care comply with the looming December 31st deadline when penalties begin to kick in.

The Massachusetts health care reform law mandates that individuals over the age of 18 must have health insurance. Recent profiles of the uninsured indicate that there are significant numbers who a) are relatively young and b) earn above 300% of the federal poverty level and are therefore not eligible for state subsidies. Many of these individuals do not perceive the value of having health insurance because they are young and healthy and do not want to pay premiums that are not inexpensive, even for the young adult plans which have recently become available for 19-26 years olds through the Connector.

The requirement that individuals must have health insurance is a novel one which has never been tried anywhere else in the country. It should not be expected that we can change attitudes and perceptions overnight Read more…

I have enjoyed reading this forum for the past several months as there has been interesting, provocative and intelligent commentary on the early implementation of health care reform.

Let’s face it, though—most of the contributors and the readers are actively engaged in the political process, delivery of health care and/or health care coverage, and know full well that the Dec. 31 deadline for coverage is looming. But as John McDonough, executive director for Health Care for All, has recently pointed out in this forum, there is a tremendous need for education aimed at the working person who is barely aware of his or her responsibilities under health care reform. Moreover, there is even less awareness of the penalties that go into effect on January 1, for those who do not sign up for health insurance. November and December provide us with a unique teachable moment. We all—the Connector, providers, health plans, advocates and communities—must join with the media to raise people’s consciousness.

The Department of Revenue intends to highlight the issue when tax forms go out in January. That’s too late for people to avoid the penalty. In fact, enrollment by November 15 for a December 1 effective date is necessary to avoid the penalty. The legislature should permit enrollment effective January 1, to satisfy the mandate. Read more…

The state and health insurers are stepping up efforts to enroll uninsured residents before penalties for failure to have coverage begin on January 1st.  The Connector holds the first of ten forums tonight to answer questions about mandatory coverage and help people sign up.  The Greater Boston Interfaith Organization is in the midst of 50 such workshops at schools, churches, synagogues and mosques.  And health insurers plan major ad and direct mail campaigns starting next month.  Blue Cross will keep its call center open until midnight on December 31st for same day enrollment, says spokesman Chris Murphy.

We think that people are gonna take their time to decide what plan works best for them and their families, so we want to just give them as much as we can. 

Residents applying for subsidized insurance won’t be able to wait until the last mintue.  They will have to begin the enrollment process by mid-November to avoid the $219 penalty on this year’s tax return.