What To Know About Massachusetts’ First-In-Nation Health Cost Law

(jimmywayne/flickr)

Massachusetts Governor Deval Patrick, a Democrat and pal of President Obama, hasn’t signed the sweeping, 350-page health care cost-cutting bill yet — but he says he will soon. (Expect a celebratory, bells-and-whistles bash, a la Mitt Romney at Fanueil Hall in 2006, signing health insurance reform legislation that would become a model for Obama’s national health overhaul.)

When the new bill does become law, the Bay state will be the first in the country to attempt to slow rising health care costs through numerous strategies including tethering the growth in health care spending to the state’s overall economy, moving away from fee-for-service payments to doctors and more heavily managing and coordinating medical care.

After the bill passed earlier this week, Representative Steven M. Walsh, a Democrat and House Chair of the Joint Committee on Health Care Financing, who has shepherded the legislation, underscored the consumer’s perspective. “The passage of today’s bill is all about seeing our health care system through the eyes of the patient. We have the highest quality medical system in the nation and the highest percentage of health care coverage, yet it is a struggle for families to afford their health insurance premiums. This legislation focuses on increasing efficiency and cutting costs within our system, while enhancing the quality of care that our patients receive and empowering them to make the best personal health decisions.”

Even if you don’t live in Massachusetts, many of these changes — in some form or another — will likely be coming to your state or doctor’s office too. We’re still digesting all the details and implications. But here’s an early snapshot of five things you might like to know:

1. Try Not To Get Sick In The First Place

Prevention and wellness are a priority in the new Massachusetts cost-cutting plan. If you lead a healthy lifestyle and try to care for your body through diet, exercise, not smoking, good attitude (when possible) etc. you can spend more time away from the doctor and out of the hospital thus saving the system money and just generally making life better. Under the Mass. plan, there’s $60 million for a prevention and wellness trust fund to boost such efforts. There are also tax credits for small businesses that run wellness programs.

2. The Cost Of Care

Speaking of budgeting, there will now be even greater pressure on your doctor, hospital or hospital system to save money. That means you will have to start thinking much more about how much your health care costs. Under the Mass. plan, hospitals and doctors will have to cut their rate of growth by about half. You, as the patient, may experience this in various ways, for instance, fewer non-critical tests, procedures and imaging (though what is considered “non-critical” remains highly debatable).

Drafters of the new Mass. reform plan are estimating about $200 billion in savings over 15 years (our estimate, based on analyses from folks at the Harvard School of Public Health, is closer to $197 billion by 2022) and some of that will come from changes in how care is delivered. The president of the Massachusetts Medical Society, Richard Aghababian, worries this may mean more headaches for patients, who, he says should prepare for the changes.

“I think it may affect accessibility to physicians,” he told WBUR. “It may mean that some patients can’t get in to a procedure because there’s no one to staff the machine or to do the procedure, at least as quickly as they have been up to this time.”

3. Acronyms Await You

Warning: There will be new acronyms in your life, chief among them, the ACO, or accountable care organization. (If you crave more on this, see our cartoon, “What The Heck Is An ACO.“) In Mass. at least, it’s mostly the public insurance programs that will be mandated to join such ACO’s — clusters of providers that will manage care (theoretically) in a more efficient, coordinated way.

Currently in Mass., about 1 in 4 residents with private insurance are already under another new model in which doctors and hospitals are paid through a global budget per patient. (Some of these arrangements are called AQC’s or alternative quality contracts. If you’re already confused, see our Glossary for Reform 2012 here.) The new bill requires the state’s Medicaid program, the state’s employee health care program and all other state-funded health care programs to transition to new health care payment methodologies. These payment models will seek to “incentivize the delivery of high-quality, coordinated, efficient and effective health care over quantity of services to reduce waste, fraud and abuse.”

4. “Noctor” Alert

Nurse Practitioners and Physician’s Assistants may play a bigger role in your care. Under the state plan, these practitioners can act as primary care providers in order to expand access to cost-effective care, particularly for more routine medical matters. Doctors will still supervise nurses and PAs, but the major doctors groups, not surprisingly, remain wary.

5. You May Someday Hear Your Doctor Say, “I’m Sorry.”

If your doc, or another provider, makes a mistake, you may get an apology. To reduce the costs of unnecessary litigation and malpractice claims, the bill creates a “182-day cooling off period while both sides try to negotiate a settlement, and it allows for providers to offer an apology to the patient.” This isn’t always easy for highly trained medical experts to manage, as studies have shown. Also, we’ll see if the risk managers comply.

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  • DocB

    The title for a PA is Physician Assistant, not physician’s. This is a subtle yet important distinction. Please fix the article.

  • Isobel

    What a snotty little article!  Thin on information, thick with unexplained venom and uncalled for insults to nurse practitioners, RNs and all the other people who actually take the trouble to find out what’s wrong with us.  If this woman hasn’t had the good fortune to be treated by a nurse practitioner yet, she shouldn’t indulge in cheap sarcasm at their expense.  (If she had, she simply wouldn’t.)

    Is there something corrupt about Governor Patrick being a Democrat, and a friend of the President’s?  What’s her opening line supposed to imply, if not that?  Puzzling.  I’m not a friend of the president’s myself, but I’m still in favor of whatever limited improvements to the justice and reduced cost of our health care system are possible in this dessicated society.  As I’ve spent a lot of time living in Europe, I’m aware how pitiful these changes are compared to what most of the rest of the developed world can take for granted (at so much lower cost, with greater longevity and lower infant mortality), but they’re not nothing, and it wasn’t corruption or cronyism that effected them.  Indeed, should Ms. Zimmerman prefer Republicans whose “pals” are CEOs, it was Mitt Romney–under pressure from the people of Massachusetts and their advocates.

  • DSM

    I am an attorney, and am put off by the sarcasm of the article as a whole.  The new program (and there’s nothing in the article to suggest why iwe should think it won’t succeed) represents a strong effort to change our present system of dispensing medical care, which is susceptible to duplications and delays.   If the author doesn’t like it, he should come out directly and say so and why.  and suggest an alternative.   Simply belittling the process by his tone does no service to anyone.

  • Alan Wilensky

    Mass Health, the commercial healthcare connector, and the whole state insurance machine have screwed me from the day I had my accident. Open Enrollment? My ass! effective disclosure of coverage? It’s criminal how they obfuscate  what plan covers what. pre-existing condition? They say it is covered, and then nail you to the wall/ Where the IG in all of this? Oh, yes, in the pocket of the insurers. The connector should be closed and its managers jailed.

  • Unamused NP

    I am a licensed nurse practitioner in Massachusettes, nationally board-certified and currently pursuing a Doctor of Nursing Practice. I am offended by your disrespectful use of the term “noctor”, which I have never heard before. I expect better from an NPR syndicated blog. Nurse practitioners and other advanced practice nurses are highly educated and skilled, offering excellent quality, unique and comprehensive client-centered care in a multitude of specialties and settings. We excel at health promotion, preventive care and chronic disease management. An ever-growing body of literature exists that demonstrates the value of such care at achieving the same or better health outcomes than care offered by physicians alone. The art and profession of nursing offers embodies an irreplaceable knowledge base. For all of these reasons, the care that you receive from an advanced practice nurse is not simply a lesser substitute or alternative for physician care, as the term “noctor” implies. At the expense of cutesy slogans for your blog, please think carefully before you disrespect an multiple professions and stick to the facts.

    • http://www.wbur.org/people/rzimmerman Rachel Zimmerman

      Oh dear, no disrespect was intended in using the term. It was simply meant to convey the idea that highly skilled nurses, nurse practitioners and PAs will, under the new law, be able to provide care that has traditionally been left mainly to doctors. I often see NPs for primary care as well as for urgent medical matters and have always received fine care. RZ

    • DJ

      If it’s any consolation, I’d like to say that the best experience I’ve ever had with a medical practioner was with a nurse practioner.  Why should doctors be ‘wary’?  NP’s are more responsive to patients than many doctors who are either too arrogant or busy to listen.

  • Notesdev

    So government will wave its wand and health care will magically be cheaper without loss of quality…

     

    • Imustbeinwonderland

      B***
      S***!  Health in America, at present, is
      just a business, nothing more.  It is not
      “health care”—there is no care, as in, “I/We don’t care.”  At best, we have health services that
      we can purchase—no more caring than Wal-Mart, definitely not the model of a
      caring social institution.  Such words
      as, “We have the best health care in the World!” are irrelevant to most Americans’
      experience and resides in the imaginations of those who make such
      assertions.  If you’ve got the money, you’ve
      got the services with grudging exceptions required by law (the
      government).  Otherwise, nobody really
      cares.  In fact, many are antagonistic to
      caring.  Witness the Republican debate
      where the question about letting a sick person die for want of adequate health
      insurance.  The audience did not recoil
      from the shouted, “Yes!” in fact, responding favorably.  Don’t talk to me about the slipping of the
      quality of care in America.  Private
      health insurance companies have long required such a decline, again with grudging
      exceptions required by law (there’s that damned “government” again).  I’m glad some among us have what we call
      health care.  I’m glad they appear to
      have the personal resources to make that happen for themselves.  However, on average, the quality of health in
      America is heading for third world status unless we (yes, “We, the People”) can
      manage to compel the other “People” (“corporations are people, my friend”)  to rethink the notion of quality health care
      for real living human beings. 

    • CarolynPrescott

      It’s no magic. The savings will come about partly through the transparency, which will help to cut the huge amount of fraud that is found in the current system. As I understand it, there will also be a shift to treating the whole person–more will be paid to cover the needs of the chronically ill, etc.– rather than simple fee-for-service charges. In quite a few initiatives around the country, this has also led to better health for patients:  fewer emergency hospitalizations and re-hospitalizations, less redundancy in tests and treatment and more cooperation among doctors, leading to a better understanding of what is really going on with a given patient. There is also evidence that people who are now gaining access to health care services are taking more responsibility for their own health. The very superficial and skeptical article above doesn’t convey the many good things that are likely to come out of both “Romneycare” and the national Affordable Care Act.