Money

All news about the cost of care and the business of medicine from hospitals,' doctors' and patients' perspectives.

RECENT POSTS

House Passes Bill To Fix Medicare's Doctor Payments. What's In It?

House Speaker John Boehner speaks to members of the media during his weekly news conference on Capitol Hill Thursday. (Andrew Harnik/AP)

House Speaker John Boehner speaks to members of the media during his weekly news conference on Capitol Hill Thursday. (Andrew Harnik/AP)

The troubled payment formula for Medicare physicians is one step closer to repeal.

The House Thursday overwhelmingly passed legislation to scrap Medicare’s troubled physician payment formula, just days before a March 31 deadline when doctors who treat Medicare patients will see a 21 percent payment cut. Senate action could come this week as well, but probably not until the chamber completes a lengthy series of votes on the GOP’s fiscal 2016 budget package.

According to a summary of the bill, unveiled by Republican and Democratic committee leaders earlier this week, the current system would be scrapped and replaced with payment increases for doctors for the next five years as Medicare transitions to a new system focused “on quality, value and accountability.”

Hundreds of state and national physician groups are urging Senate passage.

“It will relieve many years of frustration and uncertainty for all physicians by eliminating that sword of Damocles, that’s been hanging over our heads with regards to cuts and replacing it with a predictable albeit small increase in fees over the next four to five years,” said the Massachusetts Medical Society’s president-elect, Dr. Dennis Dimitri.

There’s enough in the wide-ranging deal for both sides to love or hate.

Senate Democrats have pressed to add to the proposal four years of funding for an unrelated program, the Children’s Health Insurance Program, or CHIP. The House package extends CHIP for two years. In a statement Saturday, Senate Finance Democrats said they were “united by the necessity of extending CHIP funding for another four years” but others have suggested they may support the package.

Some Democratic allies said the CHIP disagreement should not undermine the proposal. After the House approved the package by a vote of 392-37, Ron Pollack, executive director of the consumers group Families USA, urged the Senate to “adopt a CHIP funding bill as soon as possible. Families USA believes that a four-year extension is preferable to two years. We also know that time is of the essence, and it is crucial that the Senate act quickly.”

Some senators have also raised concerns about asking Medicare beneficiaries to pay for more of their medical care, the impact of the package on women’s health services and cuts to Medicare providers.

In a letter to House members before Thursday’s vote, the seniors group AARP said the legislation places “unfair burdens on beneficiaries. AARP and other consumer and aging organizations remain concerned that beneficiaries account for the largest portion of budget offsets (roughly $35 billion) through greater out-of-pocket expenses” on top of higher Part B premiums that beneficiaries will pay to prevent the scheduled cut in Medicare physician payments.

Hospitals, nursing homes and rehabilitation centers would see lower rates of increase, but are largely backing the legislation.

“Although nothing’s perfect, at a time when it’s so difficult to reach accord on really complicated issues, broad support for this solution is really impressive,” said Tim Gens, executive vice president at the Massachusetts Hospital Association. “And if it fails, we go back to these temporary patches that only solve the problem in a very expensive way for months at a time.”

Some GOP conservatives and Democrats are unhappy that the package isn’t fully paid for, with policy changes governing Medicare beneficiaries and providers paying for only about $70 billion of the approximately $200 billion package. The Congressional Budget Office Wednesday said the bill would add $141 billion to the federal deficit.

For doctors, the package offers an end to a familiar but frustrating rite. Lawmakers have invariably deferred the cuts prescribed by a 1997 reimbursement formula, which everyone agrees is broken beyond repair. But the deferrals have always been temporary because Congress has not agreed to offsetting cuts to pay for a permanent fix. In 2010, Congress delayed scheduled cuts five times. In a statement Sunday, the American Medical Association urged Congress “to seize the moment” to enact the changes.

Here are some answers to frequently asked questions about the proposal and the congressional ritual known as the doc fix. Continue reading

Partners HealthCare Drops Bid To Acquire South Shore Hospital

Partners HealthCare is withdrawing its bid to acquire South Shore Hospital, state Attorney General Maura Healey’s office announced Tuesday.

The move comes less than a month after a judge rejected a deal Partners had struck with former Attorney General Martha Coakley’s office that would have allowed Partners to acquire South Shore and two other local hospitals in exchange for some limits on price and staff increases.

In a statement Healey’s office said the state would continue to evaluate Partners’ bid to acquire Hallmark Health Corp.’s Lawrence Memorial and Melrose-Wakefield hospitals “if and when Partners and Hallmark complete pending federal regulatory obligations.”

“We appreciate the thoughtful process that Partners engaged in while making this important decision, and believe it is the right choice for Partners and the Commonwealth,” Healey, who opposed the deal Partners had reached with Coakley, said in the statement. “We are thankful for the valuable input that was provided by the health care community throughout this process to help reach this result.”

Continue reading

Related:

New Partners CEO Says He Will Explore Expanding Outside Of Mass.

The incoming CEO at Partners HealthCare says the network will continue to expand, but not necessarily in Massachusetts.

Dr. David Torchiana said a judge’s rejection of Partners’ plan to acquire three more hospitals in the state was clear.

“We’re obviously chastened by the verdict,” Torchiana said. “There wasn’t any ambiguity to the message that we got back.”

Continue reading

Related:

Judge Rejects Partners Deal To Acquire 3 Hospitals

Updated 6:30 a.m.

BOSTON — The state health care market is reverberating with the aftershocks of a major court decision Thursday which rejected a deal that would have let Partners HealthCare, the state’s largest hospital network, acquire at least three more hospitals.

Suffolk Superior Court Judge Janet Sanders gave two reasons for rejecting the deal former Attorney General Martha Coakley’s top staff spent months thrashing out with Partners. First, she says, it is not in the public interest.

Allowing the network to expand “would cement Partners’ already strong position in the health care market and give it the ability, because of this market muscle, to exact higher prices,” Sanders said.

For proof, she cited the work of the state’s Health Policy Commission. It concluded, in separate studies, that adding both South Shore Hospital and two Hallmark Health hospitals to the Partners system would increase health care spending by $39 million to $49 million a year in Massachusetts.

“If we’re going to have the cost of health care grow at a more normal rate, we need to have enough competition in the marketplace so that no part of the system can dictate prices,” said Stuart Altman, chair of the Health Policy Commission. “If you get too big, as Partners has become, it sort of destroys the concept of a competitive marketplace.”

Sanders’ second reason for blocking the deal: it would just be too difficult to enforce. Her opinion offered a few examples.

Continue reading

Related:

Welcome, Attorney General Healey. What Are You Going To Do About Partners?

It’s swearing in day for Maura Healey, Attorney General. (Steven Senne/AP)

It’s swearing in day for Maura Healey, Attorney General. (Steven Senne/AP)

Maura Healey will inherit several thorny issues Wednesday as she becomes the next state attorney general. Near the top of her list: the agreement that would let Partners HealthCare acquire at least three more hospitals in exchange for some limits on price and staff increases.

During the campaign, Healey raised questions about whether the deal was enough, both in scope and in duration.

So now that she’s in charge, will she urge Judge Janet Sanders to approve the agreement, suggest changes, or start over? In an interview before her swearing-in, WBUR’s Bob Oakes put these questions to Healey. Here’s the sum total of her response:

This is a matter that I’m reviewing and being briefed on now. The perspective I come from, as attorney general, is to drive down health care costs. So I’m considering my options. Right now, the matter is before the court, as you say. There was a proposed consent judgement filed, and we’ll just have to see on that.

In short, stay tuned.

Sanders suggested back in November, at the last hearing on the Partners deal, that she’d like to speak to Healey before issuing a ruling. She may also be waiting for Partners to name a new CEO, a decision some sources expect in the next four or five weeks. Sanders could call the parties in for a status conference at any time. Healey and Partners have that option as well.

Who will make the next move? Any bets?

You can hear all of Bob’s conversation with the new AG here.

Related:

Trying To Turn Up Heat On Health Cost Control In Mass.

Updated Jan. 17, 2015, 4:15 p.m.

BOSTON — In 2012, Massachusetts became the first state in the country to set a goal to cut health care spending.

In 2013, the state beat the goal. Spending grew 2.3 percent, well below the gross state product (GSP), 3.6 percent.

Now, at the start of 2015, the state’s largest employer group says good, time to set a more aggressive goal.

We should “congratulate ourselves for being successful in year one,” says Rick Lord, president and CEO at Associated Industries of Massachusetts (AIM), and “set a target that’s more aggressive.”

AIM is backing legislation filed by House Minority Leader Brad Jones that would lower the benchmark from straight GSP to GSP minus 2 points starting next year and continuing through 2022. After that, the cap would go back to even with GSP.

Continue reading

Inspired By Family Illness, Philanthropist Gives $650 Million For Psychiatric Research

The Broad Institute of Harvard and MIT  summer student Lydia Emerson and aesearch associate Aldo Amaya. (Courtesy/Kelly Davidson Photography)

Researchers at the Broad Institute plan to use Ted Stanley’s money to catalog all the genetic variations that contribute to severe psychiatric disorders. (Courtesy/Kelly Davidson Photography)

In the largest-ever donation to psychiatric research, Connecticut businessman Ted Stanley is giving $650 million to the Eli and Edythe Broad Institute of MIT and Harvard. The goal — to find and treat the genetic underpinnings of mental illnesses — was inspired by a family experience.

Ted Stanley made his fortune in the collectibles business. He founded The Danbury Mint, a company (later MBI, Inc.) whose first product was a series of medals commemorating the biggest scientific achievement of its time: the moon landing in 1969. While his business grew, his son Jonathan Stanley grew up as a normal Connecticut kid. Until, at age 19, Jonathan came down with bipolar disorder with psychosis, which got worse over the next three years.

“We’ll call it the epiphany from my dad’s standpoint at least,” Jonathan Stanley remembered of the turning point in his illness. “I went three days straight running through the streets of New York, no food, no water, no money, running from secret agents. And not surprisingly, after I stripped naked in a deli, ended up in a psychiatric facility.”

Jonathan was a college junior at the time.

“My dad came to visit, and he got to see his beloved son in a straitjacket,” Jonathan Stanley said.

The Stanleys were lucky. Jonathan responded well to the lithium, then a newly-approved drug. He went on to graduate from college and law school, too. Yet along the way, his father had met other fathers whose sons did not respond to treatment. He met other families who had to keep living with uncontrolled mental illness.

Ted Stanley said that gave him a focus for his philanthropy.

There was something out there that our son could take, and it made the problem go away,” he said. “And I’d like to see that happen for a lot of other people. And that’s why I’m doing what I’m doing.”

Continue reading

Judge Delays Review Of Partners HealthCare Deal

Update 6:35 p.m.: A judge has granted Attorney General Martha Coakley’s request for an extension. The comment period will now close Sept. 15, and Coakley will have until Sept. 25 to file comments from her office after seeing the full Health Policy Commission report. A new hearing has been set for Sept. 29.

Our original post continues:

BOSTON — Massachusetts Attorney General Martha Coakley is asking a judge to postpone reviewing a settlement between her office and Partners HealthCare that would allow the hospital network to acquire three new hospitals.

Massachusetts Attorney General Martha Coakley (Steven Senne/AP/File)

Massachusetts Attorney General Martha Coakley (Steven Senne/AP/File)

Coakley’s motion asks a judge to wait until September to hold a hearing on the deal, which aims to limit the market clout of the state’s largest hospital network in exchange for allowing it to acquire South Shore Hospital and Hallmark Health.

A spokesman for the attorney general says Coakley has seen findings from a preliminary review of the deal from the state’s Health Policy Commission, and she believes the court should consider the full report.

The statement reads in full:

Our office always retained the option to seek to renegotiate portions of this agreement as it relates to Hallmark following a Final Report by the Health Policy Commission.  After reviewing the preliminary findings by the HPC, we believe it is in the interest of the public and the parties involved to wait for the final report before any final consent judgment is considered by the court.

Continue reading

Can Brain Science Help Lift People Out Of Poverty?

Five years ago Lauretta Brennan was a single mom on welfare with a pack-a-day smoking habit, stuck in a “bad” relationship and living in the South Boston projects where she grew up.

Now, she’s still living in the projects with her young son, but the bad boyfriend is gone and Brennan’s got a job as an administrative assistant after receiving a business management degree. And she quit smoking.

Her childhood in the projects was marked by alcoholism and violence all around, Brennan said; “having no adult role model was the norm, being with a man who’s ignorant, that was the norm.”

Lauretta Brennan graduated from Bunker Hill Community College with an Associates Degree in Business Management in June 2013 (Courtesy)

Lauretta Brennan graduated from Bunker Hill Community College with an Associates Degree in Business Management in June 2013 (Courtesy)

But now, thanks to a novel program that uses the latest neuroscience research to help women dig themselves out of poverty, Brennan says: “I don’t want to live off welfare. I want to make money and be around people who work and go to school. In five years, the program got me to think more like an executive — I have goals, I’m an organizer managing my family well. I’m not scared anymore.”

This shift in thinking — from chaotic, stressed-out, oppressed and overwhelmed to purposeful and goal-oriented — may not sound like brain science. But it fits into an emerging body of research that suggests that the stress of living in poverty can profoundly change the brain: it can undermine development and erode important mental processes including executive function, working memory, impulse-control and other cognitive skills.

To fix that damage, the new thinking goes, people must engage in activities and practices that strengthen this diminished functionality and, exploiting the brain’s ability to change (plasticity in neuroscience lingo) re-train themselves to think more critically and strategically.

“Poverty whacks executive function and executive function is precisely what’s needed to move people out of poverty,” says Elisabeth Babcock, chief executive of the nonprofit Crittenton Women’s Union, a Boston-based group that draws on the latest brain research to help families achieve economic success. “What the new brain science says is that the stresses created by living in poverty often work against us, make it harder for our brains to find the best solutions to our problems. This is a part of the reason why poverty is so ‘sticky.'”

In a recent paper, “Using Brain Science To Design New Pathways Out Of Poverty,” Babcock makes the case that living in an impoverished environment “has the capacity to negatively impact the decision-making processes involved in problem-solving, goal-setting and goal attainment.” In other words, this type of stress can “hijack” the brain.

As other researchers, including Jack Shonkoff, director of the Center on the Developing Child at Harvard, have noted, this chronic vise of pressure — to pay the bills, function at work, raise the kids, and simply survive in an atmosphere rife with social bias and harsh living conditions — “places extraordinary demands on cognitive bandwidth.” Babcock writes:

“The prefrontal cortex of the brain — the area of the brain that is associated with any of the analytic processes necessary to solve problems, set goals and optimally execute chosen strategies — works in tandem with the limbic system, which processes and triggers emotional reactions to environmental stimuli…When the limbic brain is overactive and sending out too many powerful signals of desire, stress, or fear, the prefrontal brain can get swamped and the wave of emotion can drown out clear focus and judgement…”

How does this play out in real life? Chuck Carter, senior VP of research at Crittenton Women’s Union, explains:

“One of the things the brain science brings is something of an ‘aha’ in terms of why things are sometimes harder than we expect them to be. When you’re looking at a family that is struggling and making decisions that you don’t really understand, having that research helps you reassess…it adds another perspective. A lot of nonprofit organizations look at the social determinants [of poverty] but not a lot look at the science that says, ‘What else is at play?’

“I think that, on the ground, it gives us creative ways to think about the work and how we might approach it…Often families are in a lot of crises…and they feel they need to do things ‘right now.’ So, for instance, we’ve got a family, and they’re in a hallway and they’ll have to talk to the case manager ‘right now.’ And we ask whether it’s a true emergency, and if not, can we talk about this the next morning, and not in the hallway. It’s a problem with executive function and poor impulse control, but we can help them slow down and figure out the right time to figure this out and what information do they need. It’s about not responding so impulsively in other parts of their lives. So, in thinking about what to do with money, it can be a question of, ‘Do I buy cigarettes now or save the money for some new furniture when I move?'”

So how do you begin to fix all of this?

I asked Babcock a bit about the science behind her organization’s Mobility Mentoring program, in which low-income — mostly single — mothers apply to get training, professional mentoring, financial and other support for three to five years, in hopes of attaining economic independence.

Here, edited, is our discussion:

RZ: What does the research say about how poverty changes the brain? And how does a “hijacked” brain function compared to a brain not experiencing intense, chronic stress?

EB: Poverty hits what scientists call our executive functioning skills: our ability to problem-solve, set priorities and goals, juggle and multi-task, focus and stick to things. And it does this in at least two very important ways. First, the stress of dealing with new problems every day and never having enough to make ends meet overwhelms our heads and swamps us. It overloads the circuits in our brains and compromises our decision-making in the moment. Continue reading

Pregnancy Woes: Why Did The Price Of My Progesterone Skyrocket?

(Photo: Rekha Murthy)

(Photo: Rekha Murthy)

By Rekha Murthy
Guest Contributor

Update: KV Pharmaceutical changed its name to Lumara Health, two days after this post was published.

I’m 34 weeks pregnant and working hard to keep this baby inside me for as long as possible. As with my last pregnancy, there’s a real risk that the baby could come too early. But we’re both holding on so far, thanks to a combination of luck, modified bed rest and medical science.

The science is my biggest concern right now. I will spare you much of it because, man or woman, you will instinctively cringe and close your legs. However, one critical medical intervention that has been proven to work for countless women and babies is again under threat, and I must speak up.

Every week, my husband injects me with 250 mg (1 ml) of 17 alpha-hydroxyprogesterone caproate (“progesterone” for short). Leaving aside what this does to an otherwise tender and loving marriage, these injections have been found to significantly lower the risk of preterm birth.

Two weeks ago, my insurance co-pay for progesterone went from $5.50 per dose to $70 per dose. Just like that. For those without insurance (or with a deductible), the medication went from $32.50 per dose, according to my local compounding pharmacy, to…wait for it…$833 per dose, according to the new pharmacy my insurer is now requiring me to use.

$833. Per. Dose.

Pricing varies somewhat across pharmacies and insurers, but not enough to make this price change any less breathtaking. In fact, the drug’s list price is $690 per dose.

The 12-fold leap in my co-pay sent an epic shock through my (natural and synthetic) hormone-laden system. I immediately called both pharmacies, my insurer, and my doctor, and started digging around online. I soon learned that the price increase came from a new requirement to buy expensive brand-name progesterone, instead of the affordable compounded version I had been getting. A disturbing picture came into focus. Continue reading