Too often, debates over public policy reduce complex issues into polarizing political slogans. This is happening in health care, both here in Massachusetts and on the federal level.

Earlier this month, the Boston Globe ran a story on the state Payment Reform Commission’s recommendation that we begin to move away from our fee-for-service payment system to one that rewards quality and efficiency through “global payments” for providers. By the end of the day, there were more than 150 comments posted online; most criticized the Commission’s recommendations, some asserting that it would lead to “Soviet-style” health care.

Similarly, when a proposal was made to include $1.1 billion in comparative effectiveness research (CER) in the federal stimulus bill, some groups in Washington quickly derided it as an unwarranted infringement of the doctor-patient relationship and the beginning of the rationing of health care. These criticisms continue and are intensifying. A recent New York Times article referred to CER as a “medical minefield.”

What these two proposals have in common is the speed and intensity in which critics reduced them into simple and incendiary arguments. Another common element? Both have the potential to improve the quality of care and slow the growth of health care costs: CER by telling us which treatments will help people the most and global payments by providing incentives for using those treatments that will result in better outcomes. Read more…

In Massachusetts, you can’t just have any old health insurance plan if you want to avoid the penalty for failure to have health coverage. The Connector board adopted a standard for “minimum creditable coverage” (mcc) that has been in effect since January 1st. The Connector staff expected to get a lot of questions from employers (and individuals) about whether their policies fit the standard. Turns out there may be a deluge.

The Connector’s general counsel, Jamie Katz gave board members an update this week with these numbers:

1) 262 plans approved so far, 11 denied
2) 78 plans under active review
3) 183 more applications awaiting review and 132 plans from one carrier to be reviewed
4) One consulting firm says it will be submitting 1,000-2,000 plans

Katz says this process consumes the time of 2.5 staff positions.

He asked the board to consider whether a cap on prescription drugs (of between $5,000 and $25,000) a year should be allowed. The MCC standard requires a prescription drug benefit. Board members were divided on this item so it will be discussed in more detail at a later meeting.

Martha Bebinger

(This is an update on our report yesterday that 28,000 legal residents would become ineligible for Commonwealth Care under the Senate’s proposed FY10 budget.)

Health Care advocates say the Senate is proposing a dangerous step backwards in the state’s bid to cover nearly all the uninsured in Massachusetts. But they aren’t hearing reassurances from the Senate, House or Governor’s office.

The advocates are angry about the Senate’s plan to save roughly $130 million next year by dropping 28,000 legal immigrants from Commonwealth Care, the state’s subsidized health coverage plan. Greater Boston Interfaith Organization president, Reverend Hurmon Hamilton, says these residents pay taxes, are on the path to becoming citizens, but have just not completed the 5 year waiting period.

“So now we’re picking on categories of people, I think that’s just the completely wrong thing to do at the time the nation is looking at us as a rational to try to drive health care reform by the end of this year.”

But as state tax revenues plunge, neither the House nor the Patrick administration are pledging to find money to keep these adults enrolled. Read more…

Massachusetts hospitals can no receive payment for preventable mistakes such as wrong-site surgeries, major medication errors, and hospital-associated infections. The regulation approved yesterday by the state Department of Public Health prohibits hospitals from charging or being reimbursed for certain services and procedures that cause death or serious injury in patients. Paul Dreyer, director of the state’s division of health care quality, says the new rule makes official what was already happening informally.

“Many hospitals didn’t charge people for charges associated with these events; it’s just not the right thing to do,” Dreyer says. “But the regulation makes it explicit: that hospitals may not charge for care associated with the occurrence of these events.”

The nonpayment rule is part of an effort to improve patient safety at Massachusetts hospitals. It does not apply to Medicare patients, however, since federal rules override state laws.

Sacha Pfeiffer

There are at least a dozen major cuts that would affect patients and providers. Health Care for All summarizes some of them here. There are several others to watch:

1) The Essential Community Provider Trust Fund – which distributed $32.6 million to 69 hospitals and community health centers earlier this year. You can see the full list of who got how much here. There are a few examples of grants that seemed essential to the well-being of these facilities (Caritas Carney and Quincy Medical Center to name two).

2) The Senate proposes to save $10 million next year by ending payments to treat hospital acquired infections. Senate aides say this is separate from the regs adopted by the Public Health Council today that end Medicaid payments for so-called “serious reportable events.”
Read more…

D’Angelo’s tuna sub or D’Angelo’s cheeseburger sub? Which one is the better choice if you’re watching your weight? Would you have guessed the cheeseburger sub has almost 200 fewer calories?

State public health officials want to end those surprises by requiring chain restaurants to prominently display the calorie content of their food offerings on their menus or menu boards. The rule, expected to be approved today, is meant to fight obesity.

(SOUND OF EXERCISE CLASS)
JUDITH FORMAN: “Lunge, lunge — good. Abs tight. Lunge. This is a big open lunge.”

About a dozen women in tennis shoes and t-shirts are at Danehy Park in Cambridge for Ultimate Bootcamp. It’s an outdoor fitness class led by personal trainer Judith Forman. She makes the group run, stretch, do jumping jacks and do other exercises to help them get in shape.

JUDITH FORMAN: “Tight abs — go. One, two, three, four…”

Besides counting lunges, kicks and squats, Forman also wants these women to count calories. But she worries that’s hard to do for on-the-go people who frequently eat take-out. Read more…

A colleague recently attended a conference for clinical and non-clinical health care managers on the topic of “high performing” medical groups. Because of our history with and belief in high performing provider networks, I was intrigued. When I heard more, I was stunned.

To us, the definition of a high performing medical group is one that delivers high quality, coordinated care in a cost efficient manner. When done right, a limited network comprised of high performing provider groups and hospitals provides significant value to patients and meets our policy goal in Massachusetts of holding down medical cost trends. It’s a model that makes sense — in any economy.

Interestingly, this conference had a very different definition of high performance. Some highlights:

- Speakers defined high performance as “maximizing revenue” and placed significant emphasis on the value of billing ancillary services, especially lab and radiology. Read more…

As President Obama embarks on his second 100 days in office, our nation continues to slog through an extraordinary economic downturn that now has Massachusetts lawmakers struggling to create a viable state budget in the face of rising unemployment and continuously plummeting revenues. April receipts were nearly 35 percent below the same month last year– down almost $1 billion from last April’s collections – and $456 million under already lowered projections for the month. The Commonwealth’s lawmakers are starting to use words like “catastrophic” and plain old “awful” to describe next year’s budget.

Both nationally and at the state level, healthcare reform is correctly being linked to economic recovery. In the face of such severe deficits, the temptation will be to make even more widespread cutbacks. But we must pursue our goals of economic recovery through investments in healthcare, or risk doing irreparable damage not only to our healthcare infrastructure but to the broader economy.

There are three powerful reasons for investing in Massachusetts healthcare:

• Keeping the state population healthy is invaluable as a humanitarian goal, but it also helps keep our workforce productive; Read more…

At both the state and national level, sustainable, long-term health-care reform has three goals: extending health insurance to the currently uninsured, improving the quality of care, and ensuring that costs reflect the value of the care that patients receive. Massachusetts has lead the nation on the first goal but will have to now wrestle with the other two challenges. Bringing quality up and costs down in hospitals whose performance lags has emerged as a key component of long-term health-care reform. Achieving this goal on a national scale, however, may by stymied by both logistical and political resistance. Looking instead to improve hospital performance to the levels achieved by their better-performing peers within their own local area – rather than asking them to attain national benchmarks that may seem quite removed from local resources, practice styles, and capabilities – may be a more viable alternative, particularly because there is suggestive evidence that hospitals are able to “learn” practices from other nearby hospitals.

Using measures of quality and low-value spending that are relatively robust to differences in patient mix and illness burden, we show that achieving local benchmark performance would raise quality by almost as much as achieving national benchmarks. Read more…

Policymakers in Washington seem enamored of the idea of a public plan that would compete with private plans. There are a few problems with this idea however, beginning with the definition of “public”. Do we mean government designed, government funded, government administered, government regulated? No one knows. In fact, the real attraction of the public plan idea seems to be the prospect of lowering the cost of the product by paying health care providers Medicare rates, which are significantly lower on average than rates paid by private health plans.

What would happen if the federal government introduced a product that had benefits comparable to private plans and paid providers Medicare rates? Read more…