Money

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

RECENT POSTS

MassHealth Squandered More Than $500 Million, Audit Finds

The state Medicaid program squandered more than $500 million through unnecessary payments or missed savings opportunities in its managed care program, according to an audit released Tuesday.

The review by State Auditor Suzanne Bump found MassHealth, the state Medicaid program, made $233 million in unnecessary payments for medical services that should have been covered by managed care organizations between October 2009 and September 2014. The audit also says the state could have saved $288 million more through more detailed structuring of managed care contracts.

Bump said that during the five years covered by the audit, MassHealth paid managed care organizations about $12 billion to provide health services to 1.6 million members. Managed care organizations are private health care insurers that agree to fixed, per-member rates to administer and pay for specific categories of health care claims on behalf of MassHealth.

Continue reading

Financial Relief Finally On Its Way For Meningitis Outbreak Victims

A vial of injectable steroids from the New England Compounding Center is displayed in the Tennessee Department of Health back in 2012. (Kristin M. Hall/AP)

A vial of injectable steroids from the New England Compounding Center is displayed in the Tennessee Department of Health back in 2012. (Kristin M. Hall/AP)

Lyn Laperriere, a retired automobile industry worker living in Michigan, was having back pain in the fall of 2012 when he received a dose of steroids produced at the former New England Compounding Center in Framingham.

Lapperiere was a drag racer and was looking forward to the winter bowling season. But a week after receiving the shot he checked into a hospital. Forty-two days later, his wife Penny Laperriere agreed to take him off life support. He was 61.

“We did everything together,” Penny Laperriere recalled. “So when he passed away, life for me came to a screeching halt too.”

Lyn Laperriere was one of 64 people who died after receiving a dose of steroids produced at the former New England Compounding Center in Framingham. (Courtesy Penny Laperriere)

Lyn Laperriere was one of 64 people who died after receiving a dose of steroids produced at the former New England Compounding Center in Framingham. (Courtesy Penny Laperriere)

More than two and a half years after NECC recalled all of its products after steroids the compounding pharmacy produced were linked to a nationwide meningitis outbreak, some financial relief may finally be on its way for the relatives of the 64 who died and the 750 who were sickened as a result of receiving injections of the tainted drugs.

A federal bankruptcy judge on Tuesday indicated he would approve a $200 million settlement to compensate NECC’s creditors, including victims of the outbreak.

‘There’s Been No Financial Help’

Penny Laperriere, who’s now 58, couldn’t afford to keep the house she’d shared with her husband. She had an auction to sell off the couple’s things and moved close to her sister. She’s received lots of bills, but no money to help with what became the deadliest case of contaminated medicine in the country’s history.

“That’s the hard part, there’s been no financial help for me or any of the patients who are still living with this,” she said.

Laperriere started a support group for victims of fungal meningitis who’ve had to cash in retirement funds, file bankruptcy and still face mounting medical bills. Patients and those who lost loved ones will file claims for a share of the $200 million settlement beginning next month.

Laperriere has no idea what to expect. “Anything I get will be a gift,” she said. “I’m not expecting much because there are so many hands in the pot.” Continue reading

Related:

John Hancock Taps Fitness Trackers To Breathe New Life Into Insurance Industry

John Hancock Financial is the first U.S. insurer to offer discounts to policyholders who wear Internet-connected fitness trackers, like the ones pictured here. (Richard Drew/AP)

John Hancock Financial is the first U.S. insurer to offer discounts to policyholders who wear Internet-connected fitness trackers, like the ones pictured here. (Richard Drew/AP)

Could 15 minutes of exercise could save you 15 percent on your life insurance?

John Hancock Financial on Wednesday became the first U.S. insurer to offer discounts to policyholders who wear Internet-connected fitness trackers. Sign up for a new life policy today, and the company will send you a Fitbit, one of those bracelets that tracks your steps.

The more you exercise, the bigger discount you get on your insurance premium, up to 15 percent.

Company President Craig Bromley says the policy will also incentivize healthy behavior with “fun sort of rewards” to get policyholders to the gym, like gift cards, discounted hotel stays and leisure travel.

Delaying a death benefit “would obviously be good for us, but also good for them,”  TWEET Bromley said. “You know, other companies are not really helping people to live longer.”

It’s not just about customers living longer. By leveraging wearable devices and promoting wellness, the 153-year-old company is also trying to bestow a youthful glow on the aging life insurance industry.

“It’s great to be at sort of the forefront of all this technological change, which hasn’t always been the case for the life insurance industry,” Bromley said.

Continue reading

Bill Would Toughen Oversight Of Planned Hospital Mergers

Attorney General Maura Healey is pushing legislation designed to give her office stronger oversight of hospital mergers.

The bill would toughen the authority of the Health Policy Commission when considering mergers of health care providers.

The bill would allow a report issued by the commission to be considered strong enough evidence that the Healey’s office could use it to seek a temporary block of a proposed deal between health care organizations if the deal would force up health care costs.

Continue reading

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