Mario Motta, M.D., President, Massachusetts Medical Society, suggests that payment reform, evidence-based health insurance, early disclosure of medical errors coupled with non-judicial resolutions, and other measures will be more effective in reigning in health care spending than a plan backed by the current administration:

Governor Patrick’s small business legislation is a well-intentioned attempt to encourage business growth in the Commonwealth and provide relief for small businesses from rising health care costs. But one of his prescriptions for relief, cost control, is not a wise course of action.

We recognize how the recession has battered small business. Rising health insurance premiums are a significant part of this. But we believe that simply regulating rates would trigger a wide range of unintended consequences and would not solve the underlying problem.

A better approach for cost containment comes from the Massachusetts Health Care Quality and Cost Council. Its final recommendations would allow the state to meet its goal of containing cost growth in health care because it employs a comprehensive approach to a very complex problem.

The Council’s recommendations include comprehensive payment reform, support of system-wide redesign efforts, widespread adoption and use of health information technology, implementation of evidenced-based health insurance coverage informed by comparative effectiveness research, development of health resource planning capabilities, enactment of malpractice reforms and peer review statutes, implementation of administrative simplification measures, consumer engagement efforts, emphasis on the prevention of illness and the promotion of good health, and increased transparency. Read more…

Check out The New England Journal of Medicine’s excellent interactive timeline charting the history of health care reform in the U.S.

Beginning in 1912, when the Progressive Party of Theodore Roosevelt endorses health reform, through 1935 when the first compulsory health insurance bill failed to pass Congress, to 1971 when Richard Nixon backs a plan to require employers to pay for health insurance (Ted Kennedy counters with a single-payer proposal; both plans fail), to the present state of limbo, the graphic offers snapshots of important milestones and NEJM articles that span the years.

For another thoughtful perspective, read Rick Hertzberg in The New Yorker this week on President Obama’s health care summit and why the current bill under consideration, for better or worse, is already bipartisan.

Mario Motta, M.D., a Salem cardiologist and president of the Massachusetts Medical Society, argues in favor of legislation that would prevent cuts of about $13,000 to each physician in the state next year:

The U.S. House of Representatives took a giant step toward health care reform on November 7 with its passage of H.R. 3962, the Affordable Health Care for America Act. But achieving meaningful health care reform still has a long way to go, and a critical part of that journey includes passing the complimentary bill H.R. 3961, The Medicare Physician Payment Reform Act of 2009. A vote on H.R. 3961 is scheduled this week.

H.R. 3962 contains many provisions that will improve patient access to quality health care. It will cover 96 percent of Americans, invest in public health and quality improvement programs, reduce administrative waste, expand Medicare coverage of prescriptions drugs, create pilot programs for malpractice reform, and underwrite improvements in the primary care workforce. These are goals at the core of health care reform, and physicians vigorously support them.

However, if H.R. 3961 falls by the wayside, or some other payment reform for Medicare doesn’t come about, much of what H.R. 3962 seeks to accomplish will be greatly diminished.

H.R. 3961 will repeal a seriously flawed formula used to set Medicare physician reimbursement rates. The culprit is something called the “sustainable growth rate” formula, introduced in a budget bill passed by Congress in 1997. While it’s a complex formula, the basic idea is that the amount Medicare pays to provide care for an average Medicare patient can’t grow faster than the economy as a whole. When the economy is good, there’s no problem.

But since 2002, the formula has called for cuts in reimbursements to physicians, and for seven years in a row, Congress has stepped in at the last minute to reverse the cuts. Read more…

Mario Motta, M.D. a Salem cardiologist and president of the Massachusetts Medical Society says a new proposal that aims to make health insurance more affordable for small businesses could bankrupt physicians and is merely a cynical attempt by insurers to avoid reigning in premiums and profits:

The latest proposal to improve our state’s health care reform effort offers no improvement at all. In fact, it’s detrimental to physicians and hospitals – and thus to patients.

This week I testified at a hastily scheduled hearing for Senate Bill 2170, filed on behalf of the Massachusetts Association of Health Plans, which would create a new kind of a health insurance plan, ostensibly to make health insurance more affordable for small business owners.

But it’s actually a cynical attempt by the health insurance industry to focus cost-cutting efforts on the state’s health care providers and away from insurance premiums. Providers who have participated willingly and enthusiastically in all of the state’s health care reform efforts to date deserve better.

Insurers now want to force physicians to participate in a health insurance product totally of their own design and whose reimbursement levels could bankrupt many physician practices.

If we don’t want to participate in these private plans but still want to serve our patients with other insurance, we should be able to do so. This bill would prohibit that. Read more…

Mario Motta, M.D., a Salem cardiologist and president of the Massachusetts Medical Society offers a reminder that universal coverage doesn’t always translate into universal access:

Massachusetts continues to attract attention as a model for the nation in health care reform, and the analysis and commentary, both good and bad, on our experience keeps flowing from a variety of sources.

In a September 30 commentary in The Christian Science Monitor, entitled “Health care in Massachusetts: A warning for America,” Denver physician Paul Hsieh provides a litany of negatives about health reform in the Commonwealth and seeks to dissuade the nation from copying our model in any way, shape or form. Some excerpts:

“Rather that creating a utopia of high-quality affordable healthcare, the result has been the exact opposite – skyrocketing costs, worsened access, and lower quality care…..The Massachusetts plan thus violates the individual’s right to spend his own money according to his best judgment for his own benefit….The Massachusetts plan is also breaking the state budget.”

A study in Health Affairs published October 1, “Employer Coverage from Employees’ Perspective,” provides some good news. It found that “employer-sponsored health insurance coverage has remained strong under health reform in Massachusetts.” The survey found more workers reporting an insurance offer from their employer and more workers taking up that offer in the fall of 2008 that before health reform. “Overall,” the study concluded, “these findings provide evidence of Massachusetts employers’ commitment to providing access to high-quality employer coverage under health reform, despite the beginning of the economic downturn.”

Readers can judge for themselves about the intent and accuracy of those analyses and others on the Massachusetts experience. The fact is we’ve made progress with our health care reform: more residents than ever before are now insured, and many of those are now able to see physicians and get care they’ve been without for far too long. And that is very good news.

Huge issues remain, of course, with cost and quality among those at the top of the list, and we have been forced to deal with those in an unusually tough economic environment. Read more…

The state payment reform commission has a vision of a new payment system for Massachusetts – a global payments system. The commission’s report is an important contribution to the debate over health care reform for Massachusetts, and for the country, as we strive to provide affordable care with reliably high quality. However, our state’s movement to such a model should be careful, deliberate and mindful of the errors of the past.

This new payment model would mean a dramatic change in how practices and hospitals organize themselves around patient care. Any business leader who has attempted a change of a similar scope will tell you that the process is slower, more difficult and more costly than initially expected. When you consider that we would be attempting payment reform at the same time that people are still becoming sick or injured, this task becomes even more daunting. It’s like trying to fix an airplane while it’s flying. You have to do this carefully – very carefully.

If physicians sound cautious about proceeding with this transition, it’s with good reason. Like everyone else, we have long memories. We remember past failed experiments, like capitation in the 1990s, which was rushed into implementation without proper safeguards, checks and balances. Read more…

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…

Health care reform for the nation is coming. And certainly there are unanswered questions. When will it happen? Who will lead the efforts? Will it be good enough to address health care’s real problems of cost, quality, access, and equity?

This presents physicians with a challenge – and opportunity. Physicians are the one key link between patients and a system that currently is in chaos. I believe that physicians can work to ensure a workable health care delivery system for our future.

Physicians have two key imperatives in my view. The first and most obvious is clinical. This is our prime directive, and we must never deviate from the pursuit of the safest and highest quality clinical care.

The second is less obvious, but now especially, no less important. It is, to participate in the efforts — without ever sacrificing our primary clinical role or the pursuit of excellence in quality — to ensure that we have a health care system that is affordable, sustainable and accessible by all.

We’ve seen in Massachusetts that providing universal coverage, while an admirable goal, does not ensure patient access or an adequate work force. Read more…

A recent meeting of representatives from the Special Commission on the Health Care Payment System hosted by the Massachusetts Medical Society allowed physicians the opportunity to share their ideas on the topic of payment reform. As one of those in attendance, I was impressed by the time and energy the commission has devoted to gathering input from all stakeholders as part of this challenging process.

While unanimous consent about payment reform – even among physicians — is unlikely, I think we can agree on certain key principles.

First, all stakeholders should practice “principled negotiation.” Dr. Elliott Fisher, Director of The Center for Health Policy Research and Professor of Medicine and Community and Family Medicine at Dartmouth Medical School, defines that as a willingness to collaborate and to frame issues in a way that everyone will interpret as valid rather than self-seeking.

I think all participants in the dialogue would also agree that a redesigned payment system could promote better coordination of care, preventive care, and chronic disease management. Shortcomings in these crucial areas adversely affect patient health and drive up costs.

However, those reforms could take several years to show a return on investment. Read more…

Add another “first in the nation” to the long list of accomplishments for health care in the Commonwealth.

The American College of Emergency Physicians (ACEP) last week issued its National Report Card on the State of Emergency Medicine, and listed Massachusetts as ‘first in the nation for its support of emergency patients.”

The report, a comprehensive analysis of the support that states provide for patients needing emergency care, which also includes recommendations to overcome weaknesses, was the second issued by ACEP. Massachusetts ranked second in the organization’s first analysis in 2006.

The move from second place to first is significant, because the 2008 report contained more than twice the measures of the previous report, analyzing 116 measures in five categories. Besides the overall number one ranking with a grade of B, the state also ranked first in the individual category of Public Health and Injury Prevention, with a grade of A. Read more…