Politics

What are the lawmakers, and other state and federal officials, up to when it comes to health reform laws?

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6 Mass. Hospitals Collaborate On Ebola Response Plan

An entrance to Beth Israel Deaconess Medical Center in Boston. The hospital is one of six in the state that have formed a collaborative system to handle Ebola patients. (Steven Senne/AP)

An entrance to Beth Israel Deaconess Medical Center in Boston. The hospital is one of six in the state that have formed a collaborative system to handle Ebola patients. (Steven Senne/AP)

Six Massachusetts hospitals have formed a collaborative system to handle Ebola patients, even though there have been no Ebola cases in the state and public health officials say the risk is “extremely low.”

The Department of Public Health announced Friday that Baystate Medical Center in Springfield as well Beth Israel Deaconess Medical Center, Boston Medical Center, Brigham and Women’s Hospital, Massachusetts General Hospital and Tufts Medical Center in Boston would accept transfers from other hospitals in Massachusetts based on existing referral relationships and capacity.

Commissioner Cheryl Bartlett says the collaboration “shows that Massachusetts health care providers are well prepared” and that the plan will help ease pressure on the few hospitals nationwide that have already treated Ebola patients.

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Against Odds, Menino Fought Successfully To Merge 2 City Hospitals

At rear left is Boston Mayor Thomas Menino, pictured standing near, Sen. Edward M. Kennedy, D-Mass., shakes hands with nurse Janet Killarney while visiting the Boston Medical Center in 2004. (Charles Krupa/AP)

At rear left is Boston Mayor Thomas Menino, pictured standing near, Sen. Edward M. Kennedy, D-Mass., shakes hands with nurse Janet Killarney while visiting the Boston Medical Center in 2004. (Charles Krupa/AP)

In 1996, it took all of Boston Mayor Thomas Menino’s political muscle to pull off what some consider a managerial miracle. Despite intense union opposition, a reluctant city council and concerns about health care costs, Menino fought successfully for the merger of two city hospitals that had been founded in the mid-19th century.

Today, Boston Medical Center stands as an enduring legacy to Menino’s efforts to serve the health needs of the city’s neediest citizens.

On Thursday a steady stream of ambulances, people in wheelchairs and children pushed in strollers entered and left the Menino Pavillion on the Boston Medical Center campus.

“Me and all my children go here. It’s a great hospital,” said Jasmine Vigo, who was leaving the Menino Center with her infant son.

“He was wheezing. I wanted to make sure it wasn’t like a viral infection or something like that. He didn’t,” she said.

Vigo said she had all four of her children in the Menino building.

The eight-story brick building, bearing the former mayor’s name, contains clinics for adults and obstetrics. Its emergency room is the busiest in the Northeast. Meanwhile, its pediatric clinic provides health care to 30,000 kids a year — and that’s just at this one building on the sprawling Boston Medical Center campus.

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Where Baker, Coakley Stand On Health Care

Democrat Martha Coakley and Republican Charlie Baker, before a televised debate Tuesday in Boston (Barry Chin/Boston Globe/Pool/AP)

Democrat Martha Coakley and Republican Charlie Baker, before a televised debate Tuesday in Boston (Barry Chin/Boston Globe/Pool/AP)

It’s nearly half the state budget, almost 20 percent of the state’s economy and a perennial top concern for voters. The issue is health care, and so far, neither Democrat Martha Coakley nor Republican Charlie Baker has taken the lead on this topic with voters in the gubernatorial race.

“Coakley has perhaps a slight edge on the general health care issue, as well as the affordability issue, but neither campaign has really broken away” on health care, said Steve Koczela, president of the MassINC Polling Group. “It’s not like taxes, which go big for Baker. It’s not like education, which tends to go a bit bigger Coakley. It’s an issue that is still very closely fought.”

So where do the gubernatorial candidates stand on some of the key concerns in health care? Below is a summary of the candidates’ proposals for how to treat the health of the state.

On Making Health Care More Affordable:

BAKER: He argues that giving patients information about how much tests and procedures cost, in advance, will help us become informed consumers of care. We’ll spend less money, because we’ll choose to have a baby, for example, at the hospital with the lowest cost and best quality scores. As of Oct. 1, health plans in Massachusetts are required to post what they pay each hospital and doctor.

Baker would take a next step. “I’d like to get to the point where hospitals just post prices and people can see them plain as day,” Baker said. “As governor, I’m going to lean really hard on this.”

Some health care analysts say Baker’s strategy for reducing health care costs could backfire. Patients may assume that the most expensive hospital is the best even though that’s generally not true. And letting Brockton Hospital, for example, know that it is paid about half of what Massachusetts General Hospital receives for a C-section may mean Brockton Hospital demands more money, instead of MGH saying, “OK, I’m going to lower my prices to compete.” In addition, some of the expensive hospitals say their higher prices subsidize teaching and research.

COAKLEY: She argues she is uniquely positioned to tackle health care spending. She created a health care division in the attorney general’s office, issued the first detailed reports on health care costs and used her leverage to negotiate a deal that would limit the price increases Partners HealthCare could demand in the near future.

“The agreement that we have reached, to be approved by the court, caps costs and lowers costs as opposed to maintaining the status quo, which we all agree is too expensive,” Coakley said during a campaign debate on WBZ-TV. Continue reading

Surgeon General Nominee Murthy Loses Support Of Key Backers

Dr. Vivek Murthy (Charles Dharapak/AP/File)

Dr. Vivek Murthy (Charles Dharapak/AP/File)

One of the country’s leading medical journals is withdrawing support for a Brigham and Women’s Hospital physician nominated by President Obama to become the next surgeon general.

The New England Journal of Medicine (NEJM) endorsed Vivek Murthy in May, but an editorial published Wednesday withdraws that support.

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Mass. Lawmakers Hear Calls For Ebola Training

As nurses raised alarms that they are untrained and ill equipped to handle cases of Ebola virus, Massachusetts hospital officials said Thursday that the health crisis emerging from West Africa demands a unique response.

A licensed clinician participates in a CDC training course in Alabama earlier this month for treating Ebola patients. (Brynn Anderson/AP)

A licensed clinician participates in a CDC training course in Alabama earlier this month for treating Ebola patients. (Brynn Anderson/AP)

At a Public Health Committee hearing, Massachusetts General Hospital Emergency Preparedness Chief Dr. Paul Biddinger said handling cases of Ebola is “fundamentally different” than regular medical care, and suggested hospitals should create a “highly trained expert cadre” to handle Ebola rather than attempting to train all staff equally.

Massachusetts has not had a confirmed case of the deadly disease, though there have been suspect cases and two nurses at a Texas hospital have been infected with the disease. Ebola is spread from the fluids of a person who is infected and symptomatic.

Massachusetts Nurses Association President Donna Kelly Williams said the training and equipment at Massachusetts hospitals is “inconsistent,” and nurses have said they have been provided with “flimsy” garments that Williams said would not adequately protect them against infection.

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Judge Wrestles With Partners Deal

Suffolk Superior Court Judge Janet Sanders is wrestling with a decision that will shape the health care industry in Massachusetts for at least a decade.

On the face of it, Sanders is reviewing a customary settlement in an anti-trust case. Partners HealthCare and Attorney General Martha Coakley reached an agreement to avoid a lengthy court fight. The agreement would allow Partners to acquire at least three hospitals and hire more physicians in exchange for limits on price increases and unchecked expansion through the next decade.

“[Sanders] has two choices: either enter it or not enter it,” says Partners attorney Bruce Sokler of Mintz Levin. “It’s not like she can rewrite the decree or decide what the right answer is for health care. There are other forums for that in the commonwealth.”

But this case, Commonwealth of Massachusetts v. Partners HealthCare et al, is not proceeding like any routine anti-trust matter.

For one thing:

“This is the first time I’ve ever had this kind of opposition to a consent decree,” Sanders said during a hearing Monday.

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A First-Year Victory In The Mass. Fight To Control Health Costs

(Source: Center for Health Information and Analysis)

(Source: Center for Health Information and Analysis)

Two years ago, Massachusetts set what was considered an ambitious goal: The state would not let that persistent monster, rising health care costs, increase faster than the economy as a whole. Today, the results of the first full year are out and there’s reason to celebrate.

The number that will go down in the history books is 2.3 percent. It’s well below a state-imposed benchmark for health care cost growth of 3.6 percent, and well below the increases seen for at least a decade.

“So all of that’s really good news,” says Aron Boros, executive director at the Center for Health Information and Analysis (CHIA), which is releasing the first calculation of state health care expenditures. “It really seems like…the growth in health care spending is slowing.”

Why? It could be the pressure of the new law.

“We have to believe that’s the year,” Boros says, “that insurers and providers are trying their hardest to keep cost increases down.”

But then, health care spending was down across the U.S., not just in Massachusetts, last year.

“There’s not strong evidence that it’s different in Massachusetts; we really seem to be in line with those national trends,” Boros adds. “People are either going to doctors and hospitals a little less frequently, or they’re going to lower-cost settings a little more frequently.”

The result: Health insurance premiums were flat overall in 2013.

2013 average premiums:

Individual: $461 PMPM (1.8% increase 2012-2013)

Small group (1-50 enrollees): $421 PMPM (0.4% increase)

Mid-size group (51-100 enrollees): $444 PMPM (0.5% increase)

Large group (101-499 enrollees): $433 PMPM (-0.2% decrease)

Jumbo group (500+ enrollees): $423 PMPM (-0.8% decrease)

“2013 was a year in which we were able to exhale,” says Jon Hurst, president of the Retailers Association of Massachusetts. But he’s worried the break on rates was short-lived. This year, Hurst’s members are reporting premium increases that average 12 percent.

“If we’re going back to these double-digit increases that so many small businesses suffered through for most of the last decade, we have very large concerns,” Hurst says. “What’s going to happen to the small business marketplace in Massachusetts?” Continue reading

Mass. Seeks $80M More From Feds For Health Website

Massachusetts will ask the federal government for another $80 million to build a new health insurance shopping website tied to the Affordable Care Act.

Massachusetts received $174 million for multi-state planning and a website that never worked.
The state has about $65 million left, but says it will need the additional money to build a new site.

So the total cost of the site — which is expected to be ready for the next open enrollment period that begins Nov. 15 — will be roughly $254 million. If the federal government agrees to the additional expense, it would end up spending about $224 million for the insurance exchange. The balance, about $30 million, would come out of the state’s capital budget.*

Project directors from hCentive, the company building out the new site, walked the Health Connector board through a demo Thursday morning. There were a few glitches, but a sample user was able to compare plans and enroll. The site has not been tested yet with the hundreds of users who are expected to log in when the next open enrollment period begins on Nov. 15. Continue reading

Medical Marijuana 101: Doctors, Regulators Brace For ‘Big Marijuana’

The argument that marijuana is poised to become Big — as in Big Tobacco — begins more than a hundred years ago, argues Dr. Sharon Levy, a pediatrician at Boston Children’s Hospital.

Changes in curing made tobacco easier to inhale, additives made it more addictive, and machines began to churn out inexpensive, readily available cigarettes, she says. With these “innovations” and lots of market savvy ads, tobacco use and addiction rose dramatically.

“Is there anything to prevent innovative products with marijuana that will do the exact same thing?” asked Levy, who runs the adolescent substance abuse program at Children’s.

Levy described her concerns about Big Marijuana in the New England Journal of Medicine last month. She acknowledges that marijuana is nowhere near as harmful as is tobacco, and that marijuana has some health benefits. But Levy worries that marijuana addiction rates, now around 9 percent of users, could climb to those seen among tobacco users (32 percent) without strict controls on growers and manufacturers. Growers are already producing strains of marijuana with stronger and stronger concentrations of THC, the ingredient that makes people high. It’s also the ingredient that seems to trigger depression, anxiety and sometimes psychosis in Levy’s adolescent patients.

“At the heart of it,” Levy said, “the drive to make a profitable market out of marijuana is at odds with protecting the public health because the way to make marijuana profitable is to sell more and more of it.” Continue reading