Health care reform has done a great job of increasing access to health care in Massachusetts. But we need to keep in mind that increasing access to health care is a means, not the end, to a healthier population. And our report out today reminds us that on that score, we still have some work to do.
Every two years, since 1999, the Massachusetts Health Council has released a report tracking costly and preventable public health problems. These include societal issues, such as poverty and lack of education, that have a real and profound impact on the health of our residents. The report also includes policy recommendations.
To me, the most troubling indicators in our report deal with violence. Massachusetts continues to have the highest rate of violent crime in the Northeast. Perhaps even more unnerving, girls and young children are increasingly becoming involved in violence while deaths from domestic violence have tripled in the past three years. Clearly, these are trends we need to reverse.
There are other indicators that have not improved and are of great concern. Read more…
As the recession (?depression) unfolds, the state’s financial crisis will surely deepen. Inevitably, further health budget cuts lie ahead. Unfortunately, the first round of cuts follows the same pattern pursued by the Patrick administration in the past: loudly declare your concern for the poor, while quietly shredding the health care safety net they depend on.
A little noticed feature of the first stage of health reform shipped additional millions of Medicaid dollars to the rich and powerful teaching hospitals and drained them from primary care. In a widely trumpeted move the state upped Medicaid rates for inpatient care – a change that mainly benefited Partners and other financially healthy institutions that provide expensive tertiary care services. (In 2007, the MGH reported a surplus of $354 million, while Brigham and Women’s Hospital had a surplus of $48 million in the second quarter of 2008). But at the same time Medicaid and free care pool payments for outpatient services were shrunken, dealing a body blow to cash-strapped institutions that provide a large volume of primary care to the poor.
On top of this, the state withheld tens of millions promised in the legislation to Cambridge Health Alliance (CHA) (disclosure – that’s where I work) – the only public hospital system left in the Commonwealth. The cash shortage has already cost CHA millions in interest costs.
The latest round of cuts inflicts further wounds on CHA and Boston Medical Center – the other large safety net provider in eastern Massachusetts. Read more…
This afternoon, Harvard University will launch a program designed to advance genome research by having volunteers post their genetic information and medical history online so researchers can access them easily.
The group of ten volunteers, many of them well-known researchers, had their DNA studied by the Personal Genome Project. That’s an effort to understand the genetic basis of disease and other traits.
John Halamka, chief information officer at Harvard Medical School and Beth Israel Deaconess Medical Center, is one of the volunteers. He says he’ll disclose his genetic information no matter what it reveals.
“If you’re told you have a risk of heart disease that’s 20 percent higher than an average person, you have a risk of colon cancer that’s 50 percent higher, I think knowing the probabilities would be of great benefit.”
That’s because you could try to prevent those diseases by changing your lifestyle or taking certain medications.
These are scary times, and it has nothing to do with our struggling sports teams. Consumers and employers alike have taken a beating over the last year, from declining home values, rising energy and food prices, to the recent crashing of our 401(k)’s. Recoveries on all three economic factors are encouraging, yet tenuous at best. Let’s all hope recoveries occur and that the most disruptive economic decline does not happen—job loss.
Yet despite the economic uncertainty, we are on the cusp of further mandated state health care costs and penalties which could make a difficult situation even worse. The possible imposition of a more restrictive Minimum Credible Coverage (MCC) standard at this time is one decision that may significantly delay any hopeful recovery for our families, our employers and our economy. Increased tax penalties on families struggling to decide whether or not they can afford to purchase health insurance may also be ill timed in a recession, and at a time that big health care continues to hammer all of us with double digit premium increases.
Quick, somebody call a time out! Before we go any further, let’s step back and look at our current situation. We do not want to make bad decisions now which will hurt our residents economically and imperil our important health care reform in this state!
The Connector’s Board of Directors faces a vote later this week at which they may decide to unilaterally increase the health insurance costs for hundreds of thousands of Massachusetts residents. Read more…
How often do a health care visionary from Cambridge and a five-term Senator from Montana reach the same conclusion on the same day?
At a conference on the health care quality movement last month, Don Berwick equated the dilemma of our current health care system to “the tragedy of the commons.” He suggested that as long as individuals work to maximize their own benefit — which is how our system impels people to operate — the public good is left unprotected, and ultimately depleted. (Thank you Elmer Freeman for such a clear summary of the full conference.)
Opening one of a series of Senate Finance Committee hearings on health care that same day in Washington D.C., Committee Chairman Max Baucus made a stunningly similar point. He noted that “John Donne wrote that ‘no man is an island entire of itself; every man is a piece of the Continent, a part of the main,’ but the way American pays for health care is driving healthcare providers to become islands unto themselves.”
In their remarks, both influential leaders pointed to similar solutions: changing the way we pay for care to end the fragmentation in the health delivery system, and reverse the incentives that promote volume of high intensity services over quality of care and population health.
If only we could reach a similar consensus here in Massachusetts. Read more…
“Quality is job one” became the advertising mantra of the Ford Motor Company in the 1980’s following the surge in foreign car sales that began to exceed that of manufacturers in the United States as American consumers began to demand fuel efficient and better quality automobiles. The focus on quality came too late for a full recovery, and two decades later the patient’s health continues to decline and the prognosis is not good.
On September 16, 2008, Charles Kenney, former journalist at The Boston Globe, introduced his new book, The Best Practice: How the New Quality Movement is Transforming Medicine, to the health care establishment of Boston, touting such ideas and concepts as the introduction of the principles of quality in the Toyota Production System being employed at the Allegheny General Hospital. The forum was sponsored by Blue Cross Blue Shield of Massachusetts and hosted by its Chairman and CEO, Cleve Killingsworth, writer of the foreword to the book, who issued a “call to action” for transformation of the system to improve quality, and promote affordable patient centered health care.
A quick scan of the room and of the table full of name badges, I determined that the forum drew 350+ people from the major teaching hospitals, medical schools, networks and health plans all interested in identifying ways of improving quality and increasing productivity while also keeping health care affordable. Read more…
The business community in Massachusetts certainly deserves credit for its staunch support of health care reform since the passage of Chapter 58 in April of 2006, despite the new responsibilities which it entailed. Some employers have seen increased costs as a result of their employees signing up for their health insurance plan in far greater numbers in order to comply with the state’s new individual mandate. Virtually all employers have experienced a significant increase in administrative burdens as a result of the reform, e.g., establishing section 125 plans to allow their employees to purchase health insurance with pre-tax dollars, collecting Health Insurance Responsibility Disclosure (HIRD) forms from all of their employees, allowing dependents to remain on their parent’s insurance plan for up to two years and calculating the related imputed income, etc. Despite these additional compliance requirements, business support for health care reform has remained high.
Now, however, the employer community faces a new reporting requirement, effective next year, that serves no useful purpose yet imposes a needless administrative burden on thousands of Massachusetts companies and organizations. Read more…
Health and Human Services Secretary JudyAnn Bigby held the first of three sessions today to lay out the state budget predicament and solicit ideas about the best way to make cuts in her department. When asked if she expected to cut about 280 million dollars (a rumor that’s been around for a month or more), the Secretary said that 280 million is well short of the 7% reduction Governor Patrick has suggested. Bigby said the priority will be to preserve services for the state’s most vulnerable citizens. She told the group at today’s meeting, which included some hospital executives, that if their reimbursement rates are trimmed, the state will try to make sure hospitals don’t recoup those losses by increasing charges to health insurance companies.
Many participants left, grim faced, for further meetings and conference calls. They plan to submit budget cutting options to the administration tomorrow. Governor Patrick and top members of his administration are having dozens of meetings with non-profit groups, business leaders and mayors as they look for the most efficient and least painful ways to trim state spending. Nonprofit group leaders have suggested repealing the film tax credit, requiring a defined contribution from universities that don’t pay property taxes and drawing more money from the rainy day fund.
The Governor is not expected to reduce spending to cover the uninsured. Secretary Bigby reiterated the Governor’s pledge to accelerate health care cost control efforts; but there are few details about how the administration would do that. Aides say Governor Patrick will announce budget cuts next week.
Martha Bebinger
We’re fortunate to be able to hold the National e-conference in Massachusetts, the number one e-prescribing state in the nation.
Last July, buried in the Medicare Improvements for Patients and Providers Act (MIPPA) was a small but valuable gift to anyone who provides or uses health care. These were incentives in the new law to accelerate adoption of e-prescribing.
These incentives are critical for a host of reasons: more efficient practices, more complete information, greater savings to Medicare and the health care system, and most importantly, safety.
The Institute of Medicine says more than 1.5 million Americans are injured every year by drug errors. E-prescribing lets providers know—up front— patients’ medication histories and risk of dangerous interactions.
E-prescribing could save the Medicare program from $13 million to $156 million between 2009 and 2013.
Not only many doctors, but also many independent pharmacies, still need to connect with the technology they need to make e-prescribing a part of everyday office transactions. And even though Massachusetts leads the nation, according to BostonChannel.com, this state’s e-prescribing rate is just 13%.
Not good enough. We can’t stop until e-prescribing is routine, everyday practice everywhere in the U.S. Quality health care depends on it.
Kerry Weems
Acting Administrator, Centers for Medicare & Medicaid Services.