For those readers who routinely follow the dialogue of the health care community, it is no surprise that on some issues of implementation of universal health care, my point of view is dramatically different than that of Dr. David Himmelstein, a vocal advocate of the single payer system. However, after reading his CommonHealth blog entry, it is clear that Dr. Himmelstein and I agree on at least two fundamental issues that have the potential to improve the nation’s health status and save significant health care dollars. One, the inappropriate and overuse of technology in health care is not good medical practice and is a major cost driver that affects all of us. And two, wellness and prevention warrant more attention and hold real promise as meaningful ways to manage health care costs and improve health status.

In a study released earlier this week, PriceWaterhouseCoopers predicts that the nation’s medical cost will increase 9.9 percent in 2008 and an additional 9.6 percent in 2009, which is more than double the annual inflation rate. We simply must do something to address the unsustainable increases facing all of us. The timing is right for a societal shift in thinking. Read more…

Boston Medical Center (BMC) will pay the state $562,000 to resolve allegations that the hospital gave private patient information to its insurance plan for Commonwealth Care members. The plan, “HealthNet,” allegedly used that information for what the state calls deceptive marketing to 2,600 members of competing plans. In this letter, BMC told roughly 2,6000 Network Health and Neighborhood Health Plan members that they had to switch to the BMC plan to “continue getting care at Boston Medical Center.” BMC does not admit any wrongdoing. The consent judgement is here.

The initial data from the Department of Revenue found that, so far, about 62,000 uninsured residents (2% of tax filers) would not be penalized for being uninsured because
there was no affordable insurance available to them. When the full DOR data is received, that number may grow slightly higher.

I would predict that a large number of these folks are people who are offered employer-sponsored insurance, but at rates that are unaffordable to them. Over a year ago, the Connector predicted that there could be 60,000 people who would not be penalized because insurance was unaffordable.

At the last Connector Board meeting, the Connector set up policy workgroups to begin tackling hard issues, including how to help workers who are low income, but can’t afford the insurance they are offered at work. We want to help them obtain coverage, but we also want their employer’s money to help fund that insurance.

The Massachusetts Health Reform law was built to maintain employer-sponsored insurance, so that costs would not be shifted from employers onto state taxpayers. Read more…

(note – Atrius is one of 2 provider groups that has decided to switch to a new Blue Cross Blue Shield contract model. The other group is Mount Auburn Cambridge Independent Practice Association in association with Mt. Auburn Hospital.)

Andrew Dreyfus of Blue Cross Blue Shield of Massachusetts recently wrote on the need to overhaul the healthcare provider payment system; over the last few months, Atrius Health and Harvard Vanguard Medical Associates have aligned with BCBS to recognize the inherent rewards of the proposed alternate quality contract model. This model uses capitation as the primary method of payment and, in this current year, has built a broad list of 30 measures, from preventive health to chronic care, on which to base incentives. Providers are paid a flat rate per patient with bonuses allotted for improvements in patient care.

For Atrius Health, it was a natural decision for us to work with Blue Cross Blue Shield as they engage various providers across the state in a dialogue about the shifting landscape of payment. Read more…

As a primary care doctor, I live with one foot in the horse and buggy era and one in the silicon age. I spend most of my time talking to patients and wielding a stethoscope, and I also use the latest high tech gadgets. But the gadgetry is getting out of hand; its overuse threatens patients and is blowing the lid off health care costs. Here’s one example. Last week, when a patient came in complaining of a cough that had lingered longer than usual, I sent him down for a chest x-ray. The x-ray was absolutely normal to my eye, a reading confirmed by the radiologist. But he added one key phrase after the word “normal.” “Consider obtaining a CT scan.”

Now the radiation from a single chest CT is equivalent to about 500 chest x-rays, which carries a real risk of causing cancer down the road. And there’s virtually no evidence that a CT would help a patient like mine. But it would certainly benefit the radiologist. Read more…

Today, we are proud to announce that Blue Cross Blue Shield of Massachusetts has partnered with Google Health to expand options for members who want to create their own Personal Health Record (PHR).

We believe Google Health will be an important tool used by our members to improve the safety and effectiveness of their health care. The partnership demonstrates our continuing leadership in using technology to make health care better. We have funded the Massachusetts eHealth Collaborative and we are a founding member of the Massachusetts eRx Collaborative.

Our members tell us they want easier and more portable access to their health care information. Having this information in one place can play an important role in managing a member’s health and helping members and their doctors make health care decisions that can improve the quality of care they receive.

Many patients have primary care doctors, specialists, labs, pharmacies, and non-traditional providers at multiple institutions. Read more…

We know this: Black and Hispanic children and those from low-income families are much more likely to experience severe oral infections, but much less likely to receive treatment. Recent Catalyst Institute reports have provided the hard data behind these blatant inequities. Now it’s time for a solution.

A myriad group of oral health professionals and advocates is attempting to do just this. They took the first step earlier this month, in the form of an Oral Health Summit in Sturbridge, MA. Their goal? The creation of a comprehensive Oral Health Plan for Massachusetts. The list of supporters is impressive – dentists, dental hygienists, doctors, lawmakers, public health officials and insurers have all signed up for the challenge.

Why are so many involved? Because good oral health is critical to overall health. It’s a simple, but often overlooked fact. Oral infections inhibit learning, sleep, speech and eating. They are also a harbinger for future disease, including diabetes and stroke. Read more…

Last week, Massachusetts General Hospital celebrated its new four-part mission during a special ceremony to recognize the hospital’s community benefit programs, newly named the MGH Center for Community Health Improvement (CCHI). The June 3rd program featured David Satcher, MD, PhD, former US Surgeon General, who spoke about the role academic medical centers can play in improving community health. The new MGH Center for Community Health Improvement has more than 35 robust partnerships with community organizations, residents, schools, law enforcement, and the faith community to address some of the state’s most complex health-related issues – substance abuse among young people, domestic and community violence, access to care for immigrants and refugees, and closing the educational achievement gap for Boston public school students. In addition, 19 MGH clinical departments will be working with the CCHI to develop community-oriented initiatives of significant scope and impact. These are historic and important changes that affirm and strengthen the hospital’s deep commitment to community health.

Last week, MGH President Peter L. Slavin, MD distributed the following message to hospital caregivers and staff: Read more…

A Harvard study finds the 20% decline in cigarette smoking over the past decade doesn’t mean people are kicking the tobacco habit. Researchers at the Harvard School of Public Health say a third of those who stop smoking take up small cigars, snuff or chewing tobacco. Study author Gregory Connolly blames the lower tax rates on these other tobacco products as well as a lack of education about them.

“Given the attention we’ve given to cigarette smoking, we’ve really focused on the dangers; we may have neglected other areas of tobacco. But tobacco is tobacco is tobacco — it’s going to kill you no matter what. And we need to get that message out to the public.”

Massachusetts lawmakers are considering a tax increase on small cigars to better match the $1.51 tax per pack on cigarettes. To see the different tax rates for various tobacco products click here.

There are many reasons why healthcare costs are growing so fast. There is one set of causes that should be particularly frustrating: well-intentioned but ill-conceived regulatory changes that aim to fix one problem but inadvertently create others. A case in point is the recent Medicaid requirement for “tamper-proof” prescriptions. Designed to curtail narcotics abuse by making prescribing less prone to forgery (a good thing), the rule substantially increases costs and complexity for hospitals and physicians who have adopted electronic prescribing.

Last May, this new Medicaid rule was tucked into an Iraq war and Katrina recovery funding bill. On October 1, 2008 the use of tamper-resistant prescription pads becomes mandatory to prevent unauthorized counterfeiting, copying, erasure or modification. This is fine for those who are still hand writing prescriptions (all you need are special paper pads) but what are the consequences for electronic prescribing – the efficient, modern, safer approach to ordering medications?

Unfortunately, the US Drug Enforcement Administration (DEA) doesn’t allow physicians to electronically prescribe certain medications. Read more…