Soon the Special Commission on Payment Reform (set up by the legislature as part of healthcare reform) will be proposing changes to how Massachusetts pays for healthcare services. Currently Massachusetts’ payment system is no different from any other state, and the entire US is having problems controlling health care costs. Our payment system pays for illness and volume, and it needs to change.

Right now, we pay doctors, providers, and pharmacies predominantly on a fee-for-service basis. That is, if they see you, they get paid. If they see you a lot, they get paid a lot. If you are in the hospital, get sent home, and then have to return for the same problem, the hospital gets paid again. We pay for volume (the more a provider sees patients, the more they get paid), and we pay when you get sick. This is the problem that needs solving. To move from paying by volume for illness, to paying fairly for prevention and wellness.

We don’t now pay well for prevention. We don’t pay doctors anything special for keeping you well, and we often don’t pay for them to check up on you at all! We don’t pay for them calling you, or talking to another doctor about you. We pay providers only when you go in to see them. Read more…

The World Health Organization is increasing the alert level for swine flu to “5″…just one step below a full pandemic. The Centers for Disease Control and Prevention has the latest tally of cases (and deaths) as well as general information and prevention measures here.

While swine flu may seem like the biggest threat to public health right now, the bigger danger may be deep cuts to public health budgets.

The proposed House Ways and Means budget would gut MA Department of Public Health (DPH) non-hospital programs by almost one–quarter, and the Governor’s budget also disproportionately cut public health. At the same time, the state has been holding strong on its commitment to sustain full funding for health reform and critical access to health care – but at what cost?

Protecting health reform might be possible today, because of additional FMAP support and other state programs bearing more of the share of cuts. But this won’t be sustainable in the long-run without success in slowing the growth of medical costs – exactly what public health can do.

For example, in the current House Ways and Means version of the state budget, the line item that funds Health Promotion and Disease Prevention is cut by half. Read more…

The Division of Health Care Finance and Policy (DHCFP) has proposed regulations which would require schools to report more comprehensive information on their health plans’ benefits and performance. The ACT!! Coalition will voice our perspective on these regulations at DHCFP’s public hearing tomorrow. The ACT!! Coalition strongly supports the proposed regulations increasing disclosure and reporting requirements. We appreciate the DHCFP’s commitment to analyzing student health insurance plans and requiring that students are provided with transparent information about their plans. As Massachusetts leads the nation in guaranteeing that our residents have access to quality health insurance coverage, we commend DHFCP for ensuring that students do not fall through the cracks.

ACT!! has significant concerns with student health plans, particularly the lack of comprehensive coverage and unaffordable cost-sharing. The skinniest of the skinny, student health plans often do not cover basic services such as prescription drugs and surgery. Read more…

Tomorrow morning, WBUR begins a five part series on end of life care. You can hear the stories at 6.40am and 8.40am…and all the sections together in a one hour documentary on Sunday 3 May at 8pm and Thursday 7 May at 9pm.

We’ll post the links to the audio and special web features here.

Please let us know what you think.

Here’s a summary of the project:

In this new documentary about end of life care in America special correspondent Rachel Gotbaum investigates what prevents many patients from having a dignified death. From well-intentioned but maybe unwarranted medical interventions, to the pressure from family members, to the difficult decisions doctors – who are trained to extend survival – have to make when treating elderly patients, this program delves into the challenges in America to proper end of life planning and a “respectful death.” Read more…

While many of us in the health care “space”, as some like to call it, are waiting for Congress and its five committees that are involved in health care legislation to come up with something we can respond to, we, in the Commonwealth are plowing along, trying to come to grips with our own great piece of unfinished health care reform business, namely cost control and its first cousin, payment reform. Proceedings of the Cost Containment committee have been concentrating on the many options that have been espoused over the years to contain costs, and the committee is now poised to begin making some choices among them. At the same time, the Payment Reform Commission, moving with admirable speed, has already selected one path, from among four or five possibilities, and is beginning to tackle the issues of how to get from here to there. The road taken is global payments as the preferred substitute for fee for service. So now begins the hard part — definitions of what level of aggregation is intended for those global payments, who will get them, who will distribute them, and how will they be allocated. We also have to figure out how to include self insured purchasers in the new system, and how long a transition can be tolerated, given the economic circumstances of 2009, 2010, and who knows how much longer. Read more…

I am a young and relatively healthy person (except for the occasional cold) in my late twenties. I exercise five to six times a week and try to keep a healthy diet. I don’t binge drink and I don’t smoke. No respiratory issues, no allergies. Pretty typical picture, right?

Yet, I cannot get comprehensive health care insurance in any state but Massachusetts.

It’s not even about the money. My healthcare history includes a major open heart surgery performed at 8 months. I had what you call a pulmonary stenosis, something that is routinely corrected without a major incision in today’s operating rooms. I had a fantastic surgeon and cardiologist back in my hometown of Houston; luckily I’ve had no incidents and problems since that fateful day.

When filling out insurance forms for other states, I obviously have to disclose my history.

Yes, I was born with it. No, I do not feel palpitations. Read more…

Dear Senator Kennedy – The crisis being induced by high and rapidly rising health care costs in the United States is well known. It has become the #1 issue for workers, most businesses, and almost all municipalities; it is the largest and fastest growing item on every state budget, as well as a very large portion of the federal budget; and its spill-over effects – particularly the impact on the affordability of adequate health coverage for patients – have made it of central concern to health care providers. We know also that we aren’t getting anything for our high costs, that countries spending half or even one-third what we do have better health outcomes (longer lives, lower morbidity rates), receive more care along a broad range of services, and even have better clinical outcomes – calling into question the notion that our quality of care is better than nations with universal health care.

There have been no significant attempts to control health care costs through legislation since the failure of Bill Clinton’s 1994 Health Security Act. Read more…

April is National Minority Health Month, a time to examine the health of communities of color both nationally and in Massachusetts. While there is great excitement for national healthcare reform and pride in the state’s coverage accomplishments, not enough attention is paid to the pervasive racial and ethnic health disparities that persist across the country and the state.

People of color continue to live shorter and sicker lives in Massachusetts and the United States. Even when insurance status is equal … access, treatment, and outcomes are not. As we work to ensure the success of healthcare reform in the Commonwealth and vision a nation with universal coverage, we must also increase our focus on eliminating these inequalities. These differences, inequalities and disparities in outcomes become inequities because they are “avoidable, unnecessary and unfair.”

There is some good news for Massachusetts. Several efforts are in progress to achieve health equity and improve community health for everyone. Read more…

An annual report that measures how welcoming the state is for doctors finds that Massachusetts is not an easy place to practice medicine.

The report says more than half of medical school residents and fellows who train here will leave Massachusetts to pursue their careers, and nearly a third of the state’s practicing physicians want a career change. That’s due partly to the cost of living, the expense of maintaining a practice, and the burden of malpractice insurance. Bruce Auerbach is president of the Massachusetts Medical Society, which released the report.

“The major headline,” said Auerbach, “is that from a physician perspective, the ability to maintain a viable practice and the attraction of practicing in this state is continuing to deteriorate.”

Auerbach says Massachusetts could face a worsening doctor shortage if this climate doesn’t change.

Sacha Pfeiffer