With considerable fanfare, the Centers for Medicare and Medicaid Services just released a new five-star quality rating system for nursing homes. As the Boston Globe was quick to point out, this evaluation gave Massachusetts a lower percentage of five-star and a higher percentage of one-star nursing homes than neighboring New Hampshire, Connecticut or Maine.

All rating systems are subject to criticism and this latest version of Nursing Home Compare is no exception. Can the overall quality of a facility be inferred from just three measures (health inspections, staffing ratios, and quality indicators), where the quality indicators rely on self-reported data and are not corrected for the severity of illness of the patients in the facility? But what is indisputable is that nursing homes in Massachusetts vary enormously. Facilities awarded five stars are probably pretty good and those with one star are probably pretty poor. What, then, should the state do to promote better quality?

The prevailing approach to ensuring quality relies on an extensive system of federal regulations that are enforced by the state Department of Public Health. Teams of surveyors make unscheduled inspections to determine whether facilities are in compliance with the regulations and issue citations for any “deficiencies.” Read more…

The report released this month, Health Insurance Coverage in Massachusetts: Estimates from the 2008 Massachusetts Health Insurance Survey, shows that more than 97% of Massachusetts residents have health insurance, marking yet another milestone for Massachusetts health reform. While we should be proud of what we have achieved, universal health insurance coverage is not the panacea for a health care system that provides such a poor return on investment…ranking lower in health status and life expectancy than nearly every developed country; has an infant mortality rate comparable to underdeveloped countries; and accepts persistent disparities and inequities in the health of its racial and ethnic minority populations. The current realities of uncontrollable health care costs and the state’s budget crisis, begs the question, will Massachusetts health reform survive its fiscal storm?

Adding to these realities are reports in the Boston Sunday Globe of significant increases in the number of unemployed Massachusetts residents applying to the state’s Medical Security Program. A remnant of universal coverage from the Dukakis era, the Medical Security Program, provides assistance to middle and low income residents who are collecting unemployment by paying up to 80% of their health insurance premium. Read more…

There’s the morbid joke in health care… of job security. People will always get sick. And the industry has been one of the strongest engines of the Massachusetts economy recently – adding jobs – as so many other sectors have been taking their lumps. But now there’s growing evidence the state’s nine billion dollar health care industry is not so healthy. Especially hospitals. And that’s unwelcome news in a state where more than a half million people work in health care.

Story transcript:

CURT NICKISCH: Steve Tringale runs a health care consulting firm in Boston. In his thirty years in the business, he’s never seen anything like this:

STEVE TRINGALE: The factors which are driving the overall economic downturn have conspired in some ways to almost set up a perfect storm for hospitals.

NICKISCH: There are four main factors contributing to this storm. First, the state budget is tightening. So far the Commonweatlh has cut up to two hundred fifty million dollars in reimbursements to hospitals. The second factor is more of a surprise. People are foregoing medical care just to save money. Read more…

Capitalist. Socialist. Impatient. Curious. Dissatisfied. Forward-thinking. Compassionate. Innovative. Competitive. Extremist. Centrist. Risk tolerant. Risk adverse. Does one or some of these terms describe an aspect of your central core? For many of us in the Massachusetts health care system — whether it be care delivery, financing or policy — these personal and professional attributes may serve as the fuel driving change; and in many cases change for the better.

The Massachusetts health care system, which has undergone and continues to experience change, is admired by the country and the world. Of course, here at home, it’s easy to find blogs, essays, conferences, editorials, and other sources that focus on what’s broken instead of what’s working. And, yes, I’ve been a contributor to that debate. Part of it may be that we’re cranky New Englanders. But I also think we have an intolerance of mediocrity and a passion for pushing the policy envelope — attributes that have propelled our health care system forward.

For many of us, this is the time of year to look back at our achievements over the prior 12 months and assess our performance relative to the plans we made when the year was young. It’s an important exercise for many reasons, the most important of which may be that we get to take time out from fixing, creating and improving to celebrate our successes. It’s something that we don’t do often enough in this competitive culture. Read more…

The year 2008 was a watershed in the decades-long debate over health insurance parity for mental health conditions. Health insurers in the United States have historically required greater copayments or instituted special restrictions for the use of mental health services.

In October, Congress included a mental health parity provision as part of the $700 billion plan to rescue the nation’s troubled financial industry. The provision requires group health plans with more than 50 employees choosing to offer mental health coverage to cover mental illnesses on par with other physical illnesses. A similar measure in July established parity in insurance coverage for mental health services in Medicare Part B. These laws will impact insurance benefits for mental health for a substantial portion of Americans with employer-based or Medicare insurance by guaranteeing equal copayments and coverage restrictions for mental health and other medical services.

Will parity in insurance coverage lead to improved quality and access for mental health care? In a recently published study of nearly 44,000 Medicare managed care enrollees in over 300 Medicare health plans who were hospitalized for a mental illness from 2002 to 2006, we found that enrollees in health plans with equal copayments for mental health care and primary care were more likely to receive appropriate follow-up care within 30 days after discharge compared to plans where copayment were higher for mental health than other medical care. Read more…

The Department of Revenue sent out this notice about how it will calculate tax penalties for failure to have health insurance next year. I’ve added a few links. DOR’s penalty information for this tax year (‘08) is here.

Penalties for 2009 will continue to apply only to adults ages 18 and over who can afford health insurance, based on separate standards adopted by the Board of the Commonwealth Health Insurance Connector Authority on an annual basis. By statute, the penalties must not exceed one-half of the monthly cost of the least expensive health insurance plan available to an individual through the Health Connector.

In 2009, individuals must be enrolled in health insurance policies that meet minimum creditable coverage standards defined in regulations adopted by the Commonwealth Connector. The penalties in 2009 will accrue for each month of non-compliance with the individual mandate. However, there is a grace period permitting lapses in coverage of no more than 63 consecutive days.

The maximum penalty for tax year 2009 will be $89 a month ($1,068 for an entire year of non-compliance) for a person 27 or older with income over 300 percent of the federal poverty level ($31,212 or more for singles). The 2008 penalty for this same individual was $76 per month or $912 per year. The maximum penalty increased slightly compared to 2008 due to slight increases in health plan prices and the requirement that individuals have prescription drug coverage as of Jan. 1, 2009. Read more…

The Patrick administration says the number of uninsured in Massachusetts has dropped to about 167,000 residents. The findings are based on surveys of almost 5,000 households last summer…before the economy took a serious turn for the worse. Nevertheless there is a lot of excitement about these numbers among those working to expand coverage for the uninsured. Health and Human Service Secretary JudyAnn Bigby says Massachusetts has succeeded in covering the uninsured at an amazing rate.

“Massachusetts now has both the lowest rate of uninsurance in the country and a rate that is less than half that of the next lowest state. The results also show that we have covered nearly every child in the Commonwealth. This is a remarkable achievement, and Massachusetts has already begun to see the benefits.”

Senator Ted Kennedy says these results are another endorsement of the state’s health coverage law. Read more…

250 staff members at Boston Medical Center are losing their jobs or losing hours. The hospital is also putting a hold on 35% of planned capital projects and spending 14-million dollars less in departments throughout the hospital. In total, BMC is cutting $61.5 million in response to state budget cuts. Hospital President Elaine Ullian says patients will feel the effects.

“They’ll be longer waits for appointments. They’ll be fewer phones answered. We have the largest interpreter service in New England; we’re reducing that considerably. Every element of our institution will diminish the service and access it provides to patients at a time when our hospital has never been busier.”

“Now is the time when that safety net is needed more than ever.”

Mike Fadel with SEIU, 1999, is frustrated with the Patrick administration.

“We know that the state is under tremendous fiscal constraints, but there are hundreds and thousands of residents who are unemployed or underemployed and in need of the very services that Boston Medical Center provides.” Read more…

A flurry of legislative and regulatory activity surrounding health care reform during the summer and fall prompted Associated Industries of Massachusetts (AIM) to conduct a series of updates for employers throughout Massachusetts. AIM did more than half of these sessions in partnership with the Commonwealth Health Insurance Connector Authority (Connector).

Common threads, some unexpected, ran through all of the sessions. Here are a few impressions from employers representing companies of diverse size, industry, and geographic location:

• Participants are impressed by how much has been accomplished in a year and a half of health care reform. The reaction was apparent when Connector officials shared news about the 439,000 previously uninsured people who now have coverage. The nodding heads of employers conveyed pride in learning that they live and/or work in the state with the lowest uninsured rate in the country.

• Employers were also impressed to learn that, of the 191,000 newly-insured people who have private insurance, 159,000 have obtained that coverage through their employers. Many of the employers have seen increased enrollments and resulting cost increases in their own businesses, but were unaware of the statewide numbers.

• Employers remain frustrated about rhetoric suggesting that they are not doing their share. Read more…

Add another “first in the nation” to the long list of accomplishments for health care in the Commonwealth.

The American College of Emergency Physicians (ACEP) last week issued its National Report Card on the State of Emergency Medicine, and listed Massachusetts as ‘first in the nation for its support of emergency patients.”

The report, a comprehensive analysis of the support that states provide for patients needing emergency care, which also includes recommendations to overcome weaknesses, was the second issued by ACEP. Massachusetts ranked second in the organization’s first analysis in 2006.

The move from second place to first is significant, because the 2008 report contained more than twice the measures of the previous report, analyzing 116 measures in five categories. Besides the overall number one ranking with a grade of B, the state also ranked first in the individual category of Public Health and Injury Prevention, with a grade of A. Read more…