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News on the state's largest health insurers; the effects of health care reform on coverage; rising premium costs.

Mass. Health Cost Watchdog Says Partners Merger Raises Red Flags

The Massachusetts Health Policy Commission (Source: HPC on Twitter)

Looks like the health-cost-control rubber is just beginning to hit the road. This just in from the Health Policy Commission, the independent agency created under the 2012 Massachusetts law aimed at containing health costs:

HEALTH POLICY COMMISSION INITIATES FIRST COST & MARKET IMPACT REVIEW

Partners, South Shore Hospital merger to be examined for potential effects on costs and the health care market

BOSTON – Wednesday, May 22, 2013 – The Health Policy Commission (HPC) today initiated its first Cost and Market Impact Review (CMIR) by notifying Partners Healthcare System and South Shore Hospital that it will examine the potential effects of their proposed merger on costs and the health care market.

“CMIRs are an important tool to enhance the transparency of significant changes to our health care system,” said HPC Executive Director David Seltz. “Almost every day we hear about new developments in our health care market. These reviews help us consider the impact of those developments on health care costs and market functioning. We are committed to conducting them on consumers’ behalf in a timely and thorough manner.”

‘Given Partners’ size and high costs, an expansion of that system to include South Shore Hospital, a large, high-cost community hospital, is likely to have a significant impact on the Commonwealth’s ability to meet its health care cost growth goals, and on the competitive market.’

The HPC’s preliminary review of this proposed transaction found that given Partners’ size and high costs, an expansion of that system to include South Shore Hospital, a large, high-cost community hospital, is likely to have a significant impact on the Commonwealth’s ability to meet its health care cost growth goals, and on the competitive market. To enhance public understanding of the potential costs and benefits of this transaction, the HPC is proceeding with a further examination.

“The HPC was set up to be a watchdog to monitor the health care market,” said HPC Chair Dr. Stuart Altman. “CMIRs are one of the ways we will fulfill that important role as we work to build a more affordable, effective, accountable, and transparent system. I look forward to discussing the merits and next steps for this specific review with the commissioners and the public at our June meeting.”

Seltz will report on the CMIR at the Commission’s next public meeting, Wednesday, June 19, 2013, and Commissioners will vote whether to continue with the review. The CMIR will include analyzing information from the parties and other market participants, developing a preliminary report, and issuing a final report. The proposed transaction cannot be completed until 30 days after the HPC issues its final report. The HPC may also refer its findings to the Attorney General for possible further action on behalf of health care consumers.

The response from Partners spokesman Rich Copp: “The proposed affiliation between Partners, Brigham and Women’s Hospital and South Shore Hospital will offer patients in southeastern Massachusetts more coordinated, accessible and affordable health care. We have always anticipated that the Health Policy Commission would review our proposal, and we look forward to taking this next step forward in the process.”

Looking for fine print? The HPC is here and I just signed up to follow them on Twitter at @Mass_HPC. Anybody else feeling extremely intrigued about how this review will play out, and what it will mean for the state’s efforts to contain health costs?

FILED UNDER: Insurance, Medicine/Science, Money, Politics, health policy commission

May 21, 2013 | 6:53 PM | Martha Bebinger

Mass. Blocks Higher Insurance Charges For Most Smokers

You’ve heard all the campaigns and statistics: Smoking Kills. It’s the leading cause of preventable death in the U.S.

And, it’s expensive.

cigarette

The Centers for Disease Control and Prevention says smoking costs the country $193 billion a year in lost productivity and health care spending. Add another $10 billion for secondhand smoking expenses.

The federal Affordable Care Act says insurers can charge smokers up to 50 percent more for coverage than non-smokers.

So, says Jon Hurst, president of the Retailers Association of Massachusetts, why not ask smokers to pay more for health insurance?

“If we’re ever going to control costs, we’ve got to make sure that we don’t over-socialize the system,” Hurst says. “In other words, we don’t make people pay too much for somebody else’s health care costs.”

Fifty percent more for smokers might be too much, continues Hurst, “but let’s not dismiss outright, the ability for employers to try to incent people to get healthier.”

The debate about whether to make smokers pay more for health insurance has created some unusual alliances. Tobacco companies are working alongside cancer societies and consumer groups to persuade states they should reject higher charges for smokers.

Continue reading →

FILED UNDER: Insurance, Medicine/Science, Personal Health, cost, public health, smoking

May 14, 2013 | 8:31 AM | Rachel Zimmerman

Angelina Jolie’s Double Mastectomy: How Times Have Changed

(Alastair Grant/AP)

About five years ago a close friend of mine had a prophylactic double mastectomy to lower her extremely high genetic risk of developing breast cancer, which had killed her mother. She begged me to keep the operations a secret: she didn’t want to worry her two young daughters.

Today, in a New York Times opinion piece that is about as out-there and open as it gets, 37-year-old actress and activist Angelina Jolie, who carries the BRCA1 gene which greatly elevates her risk of breast and ovarian cancer, writes that she recently had her breasts surgically removed to lower that risk.

On April 27, I finished the three months of medical procedures that the mastectomies involved. During that time I have been able to keep this private and to carry on with my work.

But I am writing about it now because I hope that other women can benefit from my experience. Cancer is still a word that strikes fear into people’s hearts, producing a deep sense of powerlessness. But today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.

My own process began on Feb. 2 with a procedure known as a “nipple delay,” which rules out disease in the breast ducts behind the nipple and draws extra blood flow to the area. This causes some pain and a lot of bruising, but it increases the chance of saving the nipple.

Two weeks later I had the major surgery, where the breast tissue is removed and temporary fillers are put in place. The operation can take eight hours. You wake up with drain tubes and expanders in your breasts. It does feel like a scene out of a science-fiction film. But days after surgery you can be back to a normal life.

Nine weeks later, the final surgery is completed with the reconstruction of the breasts with an implant. There have been many advances in this procedure in the last few years, and the results can be beautiful.

I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer.

Jolie’s mother died of cancer at age 56 and Jolie writes that she didn’t want to put her own kids through that kind of pain if possible. That this highly public figure offers such intimate details about her body and her breasts may be a sign that the taboos around cancer are dwindling. (“On a personal note,” Jolie writes, “I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.”)

Sharon Bober, a clinical psychologist and director of the Dana-Farber Cancer Institute’s Sexual Health Program, who counsels many women who have had similar surgeries, said in an email that Jolie’s honesty is truly refreshing:

Wow!

One thing that strikes me is how times have changed – not that many years ago BRCA carriers would be worried about insurance being dropped, stigma, judgement, (“you are removing healthy breasts?? What are you crazy??”) and now this too is out of the closet. Continue reading →

FILED UNDER: Insurance, Medicine/Science, Personal Health, BRCA, breast cancer, genetics, surgery

May 13, 2013 | 11:34 AM | Carey Goldberg

What Mass. Hospitals Charge Vs. What They Get Paid

View map in a larger map

Some people play fantasy football, some knit. We here at CommonHealth sometimes like to play with health care data — most recently, a trove of Medicare numbers released last week on how much hospitals officially charge for common procedures and how much Medicare actually pays for them.

WBUR’s Alex Kingsbury first took a look at the wide range in Massachusetts hospitals’ charges for a single category, treatment of chronic lung disease, here. His map illustrated a strikingly broad range from $8,918 to $52,729. Now, in the map above, he rejiggers his Google Fusion Table to explore a broader question I put to him: How do the hospitals shake out in terms of the percentage of their official charges that they get from Medicare?

And here’s a fun little factoid that emerges from the map: That range goes from procedures for which the Medicare payment amounts to less than 18 percent of the charges billed to well over 100 percent of the charges billed. I’d thought this recalculation of the data might yield some interesting insights — Who most overcharges? Or who might feel most shafted by government payments? — but it runs such a crazy gamut that perhaps it serves mainly as yet another indicator of just how distorted and Byzantine and broken the American health care market is. (Didn’t need any further proof of that? Fine. Just enjoy playing with the map.)

Last week’s release of the Medicare data brought a media splash — particularly among data-visualization fans like the Washington Post — but also a backlash.

Health care economist Uwe Reinhardt pointed out that the official hospital charges are famously irrelevant to the reimbursement that health insurers actually pay, to the point that he called last week’s fuss about the Medicare data laughable. He wrote in The New York Times:

Even funnier are the protestations by hospital executives that hardly anyone ever pays these fictional prices, which prompted me to offer the following technical definition: “ ‘Charges’ are the prices that a totally inebriated foreign billionaire would pay a U.S. hospital if his wife were not around to control the bloke.”

Former Beth Israel Deaconess Medical Center chief Paul Levy also blasted the Medicare data as “useless noise”: Continue reading →

FILED UNDER: Insurance, Money, medicare

May 10, 2013 | 6:34 AM | Martha Bebinger

Small Biz Insurance Rates Hold Steady In Mass, For Now

The latest small business health insurance rates may be the calm before the storm.

Premiums for small firms are set to increase from a base of 2.5%, on average, in July. That’s slightly less than the average increase of 2.7% this quarter. Employers willing to live with limits on where they and employees receive care could see premiums drop (take a look below at Neighborhood Health Plan and Celitcare). And notice that no one filed (or was approved for) rate increases above 3.6%, the current magic number for health care cost caps in Massachusetts.

July 1 insurance rates for small businesses in MA

But things may look quite different as of January 1st. Very small businesses could see modest increases or perhaps lower rates. But insurers are warning that firms with 20-50 workers could see premiums jump 30% when parts of the federal health care law kick in next year.

“We all thought that Mass. was going to be held harmless under the ACA, but that looks like that’s not going to be the case, at least not for small businesses,” says Jon Hurst, President of the Retailers Association of Massachusetts. “We’re going to be looking at a lot of small businesses getting extreme, double digit increases come next year.” Continue reading →

FILED UNDER: Insurance, Money, cost, small business

May 8, 2013 | 12:39 PM | Carey Goldberg

New Fed Data Show Hospital Prices Vary Wildly: The Mass. Version

View map in a larger map

(Data visualization above: Alex Kingsbury, WBUR)

Today is a glorious day for health care wonks who see great founts of Medicare numbers as enticing Big Data playgrounds just begging for the analytical equivalent of gymnastics on the monkey bars.

The federal government has just released hospital prices on 100 common procedures, and though many studies have already documented the dramatic cost variation among hospitals — here’s a recent one — the numbers have never before been this accessible. The Washington Post does a wonderful job of providing context and translating some of the data into visual form here, including a useful feature titled “How much do providers charge in your state?”

Of course I provincially plugged in Massachusetts, and was surprised to see that though we’re reputed to have among the highest costs in the country, we’re below the national average on the 10 categories shown, ranging from pneumonia to heart failure.

WBUR’s Alex Kingsbury puts his data-visualization talents to excellent use on the Medicare data in the map above, showing the variation in costs for treating one condition, Chronic Obstructive Pulmonary Disease, at each of the state’s hospitals. They range from $8,918 to $52,729. [More on these striking gaps from WBUR's Martha Bebinger here: Crazy, irrational hospital billing (with no connection to quality.)]

Above, click on each blue pin to see what each facility charges. Or if you’re not a geographical type, you can check out the raw Medicare numbers here, and here’s a list of the data points Alex used: Continue reading →

FILED UNDER: Insurance, Medicine/Science, Money, costs of care, hospital prices

May 7, 2013 | 7:21 AM | Rachel Zimmerman

Interpreting The Oregon Medicaid Study: Health Is More Than Insurance

Here’s a very clear analysis of a very confusing study that came out last week and was framed in wildly different ways by various media. The Oregon Health Insurance Study was complicated, for sure, but the bottom line, argues physician John Lumpkin, in the current Health Affairs, is fairly simple: “Better health requires health insurance coverage, but it doesn’t end there.”

(stanlyekost/flickr)

Published in The New England Journal of Medicine, the landmark Oregon study by researchers at Harvard and MIT offered a snapshot that compared Oregonians on Medicaid to those not on the public assistance program. (A 2008 lottery among low-income residents established the two groups, which effectively created a treatment and control arm of the experiment.)

The findings were mixed (generally not good for a headline): on the up side, after about two years on the program, patients showed improved mental health with a dramatic drop in depression among the newly insured, and more financial stability. It also found these patients had greater interaction with the health care system, and more preventive care, in general. Continue reading →

FILED UNDER: Insurance, Personal Health

May 6, 2013 | 11:22 AM | Carey Goldberg

Mass. Poll: Health Costs Feel Heavier Than Ever, Yes To Price Tags

Source: Mass Insight / Opinion Dynamics

You may already know all too well that the cost of health care, whether in premiums or co-pays or deductibles, seems to weigh down your budget more heavily with each passing year. But the chart above tells you that if that budgetary load is feeling more burdensome than ever before, you’re not alone.

Every spring, the Boston consulting and research firm Mass Insight runs a health care “affordability” poll, and this year’s is just out today. From the press release:

Since 2004, the Mass Insight / Opinion Dynamics Healthcare Affordability Index has tracked how much of a cost burden residents feel from premiums, co-pays, prescription drugs, and deductibles. Results are calculated into a single Index score, which measures the level of affordability people feel toward their healthcare. Results from the spring 2013 poll show the lowest score ever recorded on the Index, 109, meaning Massachusetts residents feel their healthcare is becoming less affordable and more of a financial burden.

The poll of 450 Massachusetts residents, conducted in late April, found that its “affordability index” dropped 10 points in just the last year.

Might the 2012 Massachusetts health cost-containment law help at all? At the very least, the poll found eagerness among respondents for one aspect of the new law: its promise of greater health care “transparency” to make it easier for consumers to obtain price information. Continue reading →

FILED UNDER: Insurance, Money, Personal Health, costs of care

May 3, 2013 | 5:30 AM |

Caring For Kevin: An Autistic Man, An Exceptional Doctor, A Life Renewed

Kevin Fitzgerald, after surgery, his vision restored (George Hicks/WBUR)

Kevin Fitzgerald, after the second of two eye surgeries, with his vision restored (George Hicks/WBUR)

By Rachel Zimmerman

Kevin Fitzgerald is parked in a wheelchair near a set of elevators at Boston Medical Center, tense with fear.

He’s a big guy, nearly six feet and about 280 pounds. But because of his severe autism, Kevin can’t verbalize his thoughts. He can only moan.

Dressed in her scrubs, Dr. Susannah Rowe, Kevin’s eye surgeon, sits on the floor next to him. While waiting for a heavy dose of anti-anxiety meds to calm her patient, Rowe practices what she calls “verbal anesthesia.” “It’s OK to be afraid,” she tells Kevin. “Want to hold my hand?”

Institutionalized since childhood, Kevin, now 56, has been losing his sight for the past two years to the point that doctors said he can see little more than shadows. He’s here at BMC awaiting cataract surgery, a fairly simple procedure that generally takes about 30 minutes in the operating room. But for Kevin, who has long feared doctors and has a history of aggressive, unpredictable behavior — like hitting himself or inadvertently hurting others or running away when he’s in distress — the procedure isn’t simple at all.

Surgeon Susannah Rowe, anesthesiologist Oleg Gusakov, M.D. and nurse anestheticst Dale Putnam, CRNA, prepare Kevin for surgery. (George Hicks/WBUR)

Dr. Susannah Rowe, anesthesiologist Oleg Gusakov and nurse anestheticst Dale Putnam in the pre-op room with Kevin. (George Hicks/ WBUR)

It’s not simple for the doctors, either. They’re practicing a special art: medical care for the disabled and mentally ill. It often breaks the rules of traditional care, loses money for their practices and can even put them at physical risk if a frightened patient spins out of control.

But there’s a huge need for such specialized care. As many as 50 percent of people with intellectual disability (defined as an individual with an IQ of 70 or less and difficulty functioning in daily life, among other criteria) have vision problems, according to state experts. And a far higher proportion of these disabled patients have severe vision problems compared to the general population.

With delayed or limited access to treatment, these men and women can begin to lose their already-tenuous connection with the physical world; and their behavior, driven by fear and the inability to understand why things are growing darker, can deteriorate further toward what looks like aggression. Rowe, the surgeon, says anyone with a disability or severe mental illness whose mood, anxiety or behavior gets worse should immediately have their vision checked.

Join doctors in the operating room for Kevin’s surgery. Warning: It gets graphic.

Kevin’s situation may seem exceptional but he’s not alone. According to the state Department of Developmental Services, there are about 32,000 adults and children with intellectual disability (what used to be called mental retardation) eligible for services in Massachusetts. About 9,000 of these adults live in group homes.

But not everyone with an intellectual or developmental disability is getting the care they need, experts say. Consider:

A recent Massachusetts study found that people with autism still face significant barriers in accessing medical care, and it’s worse for patients like Kevin, who can’t fully communicate.
A 2009 survey of eye specialists from around the state found that while most providers believe patients with intellectual disabilities require 30-60 minutes longer for a medical appointment, the vast majority of the specialists didn’t allot that extra time.
According to a 2004 Public Health Reports article: “Research indicates that most individuals with developmental disabilities do not receive the services that their health conditions require…[and] individuals with mental retardation face more barriers to health care than the general population.

Research has also demonstrated that many primary care providers are unprepared or otherwise reluctant to provide routine or emergency medical and dental care to people with developmental disabilities.”

Andrew Lenhardt, a primary care doctor in Hamilton, Mass., who treats many disabled patients, including Kevin, says: “The level of dignity and respect and basic medical care that’s given to people with disabilities is often meager…These people can’t advocate for themselves, they’re an easy target to be treated inadequately or poorly.”

Continue reading →

FILED UNDER: Insurance, Medicine/Science, Money, Personal Health, autism, boston medical center, cataracts, cost of care, developmental disability, eye surgery, intellectual disability, special report

May 1, 2013 | 5:52 PM | Carey Goldberg

Medicaid Study: First 2 Years, Mental Health Improves, Not Physical

Prof. Amy Finkelstein of MIT (Courtesy)

Prof. Katherine Baicker of Harvard (Courtesy)

Just out here in the New England Journal of Medicine: The latest, mixed but important findings about how health and life change for uninsured people when they gain Medicaid coverage.

It’s a nuanced look at what most changes — mental health — and what doesn’t — physical health — in the recipients’ first two years on Medicaid, the government health insurance mainly for low-income and disabled people.

That “mixed message,” in fact, is the bottom line, says lead author Katherine Baicker, a health economics professor at the Harvard School of Public Health.

“There are substantial benefits, but they’re not uniform across all outcomes,” she said. “It’s too easy to have a black or white view of the program.”

If you’re a big Medicaid fan, the study’s findings may well disappoint you. Among winners in Oregon’s Medicaid lottery, after about two years with coverage, it found no measurable improvement on several important health measures: high blood pressure, cholesterol, blood sugar control in people with diabetes.

On the other hand, the study did find a dramatic drop in depression among people newly covered by Medicaid, and — not surprisingly — a great easing of the financial strain caused by medical expenses. In the two years it followed the lottery winners, it also found an increase in diagnoses of diabetes and in the use of medication for diabetes.

Prof. Baicker says the findings contradict “two extreme and opposing points of view” about Medicaid. One holds that Medicaid is “a terrible program that has huge costs and does nothing for beneficiaries” — yet the study clearly found improved well-being among recipients, from reduced depression to increased visits to the doctor.

(From “The Oregon Experiment — Effects of Medicaid on Clinical Outcomes,” courtesy of the New England Journal of Medicine.)

The opposite view holds that Medicaid is “a fantastic program” that so improves care for chronic disease that it will quickly save money. In fact, she said, the study found that people tended to incur $1200 in additional health costs once they were covered, and it’s clear that “at least within the first two years, expanding Medicaid does not pay for itself. It costs money.”

Highlights of the paper from Prof. Baicker and Prof. Amy Finkelstein of MIT: Continue reading →