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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