When Somerville residents step over their threshold at the start of the day, they look out upon a landscape designed for active living and healthy eating. They see wide sidewalks, brightly painted crosswalks, bike lanes and bike racks. As they travel through the day, they might find themselves on the Somerville Community Path, the bus, or T. Many residents will enjoy the city’s parks and playgrounds. They might stop to tend their plot at a community garden, or pick up fresh fruit and vegetables at the farmers’ market. Thanks to the city’s intentional design, residents of Somerville enjoy better health and quality of life.

As Congress embarks on national health reform, it is important to acknowledge the critical role community design plays in the health of the nation. Committees in both the House and Senate have wisely included language to fund community-based prevention and wellness initiatives, including those related to city planning, in proposed healthcare legislation. Congress and the Obama Administration should prioritize funds for community-based initiatives. These initiatives, such as Shape Up Somerville, play an important role in preventing and reducing obesity and improving community wellness.

Shape Up Somerville began in 2002, as a collaboration between Tufts University, the City of Somerville and community organizations to increase access to healthy foods and physical activity for first, second and third graders. Since that time, Shape Up Somerville has expanded its focus to include healthy community design. Read more…

Proponents of a “public” plan offering in the commercial marketplace frequently cite competition as the reason that such an option is needed. But would competition in fact be the result, or would reimbursement rates to providers be driven to lowest common denominator levels?

While the language used to sell the public plan references competitive forces, behind the rhetoric is a plan to fix provider reimbursement rates, preferably at Medicare levels. This is viewed by many in Congress as a significant cost savings initiative, and as a way to make private markets more efficient. It isn’t.

Most providers survive by being able to negotiate reasonable levels of reimbursement from private insurers. In Massachusetts Medicare typically pays providers on average 30% less than private insurers do. If the public plan fixes reimbursement rates at Medicare or some percentage of Medicare, the resulting premium will be low enough to induce a large shift of enrollment from private plans to the public plan. Is this competition? If we want government to fix reimbursement rates, let’s just say so.

Even if the public plan paid at fixed rates would its costs be lower in the end? Medicare’s experience would argue no. Read more…

Massachusetts consumers can now view more information about their local hospitals on The Centers for Medicare & Medicaid Services Hospital Compare website CMS has expanded the website to include hospital re-admission rates – the number of times that a person with Medicare is admitted to the hospital in a 30–day period for the same condition.  The readmission rates for each hospital appear, along with a note as to whether the hospital’s rate is “better than the national rate,” no different than the national rate,” or “worse than the national rate.”

Reducing unnecessary hospital readmissions is a key element of the Administration’s health care reform initiative. 

About 1 in 5 Medicare patients who leave the hospital will be re-admitted within 30 days of discharge. The Medicare Payment Advisory Commission estimates that Medicare spends $15 billion on all-cause readmission including $12 billion on potentially preventable readmissions (based on 2005 data). 

Measuring and reporting readmissions information places a spotlight on the entire spectrum of care that hospitals provide, as well as the care that patients receive from other providers after being released from the hospital.  Read more…

Across the US, we are all struggling through a time of transition and uncertainty. Here in the Bay State, even the weather can’t seem to make up its mind where to head next.

In healthcare, cost is the falling barometer that indicates big storms and other inclement conditions. Nationally and in Massachusetts, hospitals are working to find ways to make contributions to cost savings efforts. In addition, I represent the Massachusetts Hospital Association (MHA) on the Special Commission on the Health Care Payment System, which is charged with making policy changes to the payment system to improve the delivery and cost of care at the state level. The Commission is due to issue its final report and recommendations within days.

Massachusetts hospitals have always been willing and committed to doing their fair share as part of healthcare reform and also in terms of helping the state weather this current economic crisis. But many of our providers’ major contributions and sacrifices have gone unrecognized. Hospitals have repeatedly stepped up to the plate: to fund quality and transparency initiatives; to contribute to the Health Care Quality and Cost Council’s web site and other projects; to track and publish data on Serious Reportable Events (SREs) and Healthcare Acquired Infections (HAIs), and voluntarily not charge for care resulting from SREs; to offer hundreds of millions of dollars of community benefits ranging from asthma education to free cancer screenings; and to live up to their missions of providing care regardless of a person’s ability to pay. These contributions are just a few of the many made by hospitals to remove costs from the healthcare system while improving quality of care.

Our hospitals’ participation in these efforts has largely been voluntarily, though some has been due to legislation or other mandates. But none of these efforts has been without cost, and all have been paid for by the hospital and provider community. Read more…

House Speaker Robert DeLeo is laying out the budget items vetoed by Governor Deval Patrick that DeLeo will ask House members to consider overturning next week.

“Money for housing, rental assistance, senior care, substance abuse, nurses for folks who have been molested or raped…”

DeLeo says restoring money for these programs may preclude maintaining health insurance for low income legal immigrants. He says doing either may be difficult as state revenues continue to shrink. The Speaker says he is not ruling out continued health coverage for this group and is waiting to see how the Patrick administration would restructure their health plans with less money, but…

“Let me point out that these folks would never be turned away at hospitals that there always is going to be a safety net for these folks.”

The Massachusetts Hospital Association says providing free care to legal immigrants previously covered by Commonwealth Care could leave hospitals with $87 million in unpaid bills. This would be in addition to a $40 million cut in the safety net fund this year.

Martha Bebinger

In our constant efforts to control costs and improve quality in our delivery of health care, we may have found another area that deserves more attention than it’s getting: home health services. That’s the headline from a recent survey of physicians conducted by the Massachusetts Medical Society.

Conducted in collaboration with the Home Care Alliance of Massachusetts, the survey represents one of the few efforts to learn more about the under-examined area of physician use of home health services such as skilled nursing care, physical and occupational therapy, speech-language therapy, and medical social services provided in the home.

The survey report revealed some startling numbers. More than 89 percent of responding physicians said they believe home health services can reduce inpatient hospital admissions, 67 percent said remote monitoring services can reduce costs, 63 percent said they can reduce emergency room visits, and 41 percent stated they can produce overall costs savings. And a stunning 97 percent said the services help them better manage their patients’ care at home.

These findings can be significant in developing future health policy, as our population ages and as our physician workforce – especially primary care and geriatrics – becomes increasingly strained year after year. The number of adults 65 and older will double in the next 20 years, and life expectancies are increasing. Those factors, along with current and projected shortages of primary care and geriatric physicians, are adding intense pressure on health care access and delivery for seniors – as well as future health care costs.

An additional benefit of home health services may be to provide some relief to primary care physicians – a specialty whose use of such services is very high. Read more…

There has been a lot of discussion recently about whether health care reform needs to include the option of a “public plan”. Our experience in Massachusetts has convinced me that health reform with virtually universal coverage is very achievable without the total disruption to the marketplace and our employer based system that would occur with the creation of a public plan.

The proponents for a public plan have argued that such a plan is necessary to promote competition and to keep the private plans “honest”. They seem to ignore the fact that we already have 1500 private plans being offered in the country – I fail to see how one additional plan will change the competitive landscape. Read more…

My good friend Jim Roosevelt — who also happens to be the CEO of Tufts Health Plan, one of the GIC’s larger plans — in his blog last Friday described a White House Press event on health reform that he had attended and pointed out that the much admired Massachusetts HealthCare reform program does not include a public option. He suggested that perhaps the country doesn’t need one either. Well, maybe. I’m not particularly interested in getting into a debate with Jim or any of his colleagues from the other five health plans we offer and I most definitely do not want to detract from the success of the Mass HealthCare Reform Act, but we don’t necessarily need to clone all of its features at the federal level. I understand that the private health insurance companies’ Trade Associations, the Massachusetts Association of Health Plans and at the national level, America’s Health Insurance Plans are officially opposed to the prospect of competing with a public plan. They say it will be an unfair competition, and they all assert that they can do the job better, especially if the government provides money to subsidize low income citizens who are currently priced out of their market — 47 million of them. I could concede the point that the playing field might not be level if AHIP acknowledged that even with the best of intentions, they have been unable to control the costs of health care. This is not to say that the challenge is an easy one — it isn’t. Read more…