Politics

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

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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.

Continue reading

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.

Continue reading

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

Buffer Zone Ruling Aftermath: Street Scene At Clinic, New Bill Filed

Outside the Planned Parenthood clinic in Boston. (Photo: B.D. Colen)

Outside the Planned Parenthood clinic in Boston on Saturday. (Photo: B.D. Colen)

The 35-foot “buffer zone” outside the Planned Parenthood clinic on Commonwealth Avenue in Boston is gone, struck down by the Supreme Court’s buffer-zone ruling last month. But a bill filed today in the Massachusetts Legislature would restore some added protections to staff and patients at the state’s reproductive health centers.

Among them, Planned Parenthood writes, is police power to issue a “dispersal order” when a group has impeded access to a facility; a prohibition on using “threat or force to intentionally injure or intimidate” someone trying to enter or leave the facility; and a “clear passage” section that bans impeding anyone trying to come or go.

An opinion piece in the Boston Globe today argues that no anti-abortion protester has ever been arrested for committing violence, and that the buffer zone “restricts and punishes not violence but expression.”

The author might want to take a look here on socialdocumentary.net at the evocative photos shot at the clinic on Saturday by B.D. Colen, a former Pulitzer Prize-winning medical reporter who teaches documentary photography at MIT. True, no physical violence. But you can imagine what it’s like to be a desperate young woman who has to navigate through dozens of protesters and “counselors” to get into the clinic.

The photo set’s “Photographer’s Statement” includes a heart-wrenching letter from a former student of Colen’s, who speaks to the emotional effects of laws and rulings that can make an agonizing time even harder. An excerpt:

“No one gives us – young and old women – enough credit about how terrifying that whole process is – with or without protestors. When they changed the laws to force a woman to look at the sonograms before they’d do the procedure, I cried. I remember being asked if I wanted to see the sonograms – I remember saying no and meaning it. I’m glad that at the time my voice was heard and my opinion was respected. What a cruel unnecessary law. What a lack of understanding that law demonstrated…

“I wish I was in Boston right now. I’d sit out there on that street after work or on my weekends.

“People think that women who have unwanted pregnancies are stupid or careless. That’s so far from the truth that I want to laugh instead of cry. I wasn’t stupid or careless – and even if I was, that shouldn’t matter. Women’s bodies are built to get pregnant. No birth control is 100% effective. I always knew my body was a fighter and stubborn as hell. Now I have concrete proof.
Continue reading

Report: Partners Merger Would Increase Costs

A report by the state’s Health Policy Commission finds allowing Partners HealthCare to merge with Hallmark Health Systems would increase health care costs on the North Shore.

The commission also has concerns about Partners’ acquisition of South Shore Hospital. The commission cannot block the merger but is passing along its concerns to Attorney General Martha Coakley, who is defending the deal.

Partners’ competitors oppose the merger.

More from the Associated Press: Continue reading

The Global View: Lessons For Mass. Health Care From Abroad

By Dr. Jonathan D. Quick
Guest contributor

A study released last week found that insurance is saving lives in Massachusetts. Expanded coverage will mean 3,000 fewer deaths over the next 10 years. We have state-of-the-art health facilities and are among the healthiest of Americans. Despite the fiasco of our failed enrollment website, the state maintains near-universal health coverage, and inspired the Affordable Care Act.

Our example is heartening not just for America, but for the many low- and middle-income countries around the world working toward universal health coverage. These countries aren’t just taking a page from our book, though — they have valuable lessons for us, too.

Dr. Jonathan Quick (Courtesy)

Dr. Jonathan Quick (Courtesy)

Here are four things Massachusetts could learn about health from developing countries:

1. Bring health care to the community level

Community health workers (CHWs) have been a staple of health systems in developing countries like Ethiopia for decades. Community members trained in basic prevention and treatment interventions, such as oral rehydration for childhood diarrhea and family planning education, are making a big difference. Although not as specialized as doctors or nurses, they work in places where those professionals either aren’t present or are overburdened. CHWs are not only cheaper to train and deploy, but they are also trusted neighbors, who don’t require the four-hour walk necessary to reach the nearest health facility.

CHWs are now catching on in Massachusetts and other places in the U.S. In NPR’s “A Doctor’s 9 Predictions About The ‘Obamacare Era,’” an American physician predicts “A new category of health worker will flourish: the community health worker.” Few Americans face long walks to health facilities, but many face other challenges, such as mental or physical disabilities, chronic pain, lack of transportation or difficulty navigating the health system. CHWs provide low-cost outreach that helps patients deal more effectively with these barriers.

2. Make it convenient

Another approach used in global health is accredited drug dispensing outlets. When people get sick in Tanzania, their first stop is a local drug shop. Although cheaper and more convenient than seeing a doctor, they often get the wrong drug, of poor quality, and at a high price. Through training and licensing, drug sellers are able to provide live-saving treatment for common problems like malaria and childhood diarrhea at reasonable prices. Not only has this model been successful in improving access to essential medicines, but drug sellers quickly proved they could do more to improve health: advise on HIV/AIDS prevention, check symptoms for tuberculosis, and dispense some forms of contraception.

Similarly, in the U.S. programs like CVS’s MinuteClinic and Walgreens’ Healthcare Clinic are broadening the role of pharmacy services from flu shots to screening, treatment, monitoring and other basic health services. Like the accredited drug dispensing outlets, these services are more affordable and more convenient. They are a shrewd business move by the pharmacies, but also a paradigm shift in how we provide health services.

3. Generate revenue while saving lives

Developing countries have also been figuring out how to make the most of limited resources. In Mexico, a tax on soda is providing new revenue for public health — with the added bonus of reducing consumption and improving health outcomes. Continue reading

Restraining Partners? Rampant Speculation On A Deal In The Works

What’s up with that Partners-South Shore deal?

This question has come up in every conversation about hospitals in Massachusetts for the past three to four months, at least.  It’s important because the final resolution will be a benchmark for future hospital mergers, acquisitions and partnerships in Massachusetts and beyond. And it may finally address complaints that Partners Healthcare hospitals and doctors are paid more, in some cases much more, than most of their competitors.

If you’ve (understandably) lost track, here’s a recap:

partnersPartners announced plans to acquire South Shore Hospitals in June 2012.

The state’s Health Policy Commission concluded the deal would increase costs $23-$26 million a year.

Partners countered, saying that adding South Shore to its network, currently the largest in the state, would save $27 million a year.

The commission stuck to its original findings and sent a report to Attorney General Martha Coakley.  She, along with the U.S. Department of Justice, have been looking at whether Partners exploits its size and market clout to drive up health care prices and all of our premiums.

There are lots of theories about why we haven’t heard anything since Coakley acknowledged in March that she was in talks with Partners and South Shore.  Is there an impasse?  Are federal regulators clogging up the works?  What kind of pressure is Coakley (who is also running for governor) facing? I’ve heard all kinds of theories. Feel free to add yours below.

Coakley told the South Shore Chamber of Commerce last week that she expects to complete her review of the deal in a month or two.

Working with the Department of Justice, Coakley could sue to try and block Partners from bringing South Shore into its system.

But a deal that would limit Partners clout seems more likely. So what should it include?

Here’s where my random conversations with doctors, hospital executives and patients gets really interesting. The virtual water cooler chatter includes these possible scenarios:

1. Partners can add South Shore — and that’s it.  No further expansion for, say, five years or so (the time frame varies from three to 10 years). Keep in mind, Partners has already announced plans to acquire two North Shore hospitals after the South Shore deal is done.

2. Partners can add South Shore, but it must sell off another hospital of equivalent size or scope. Continue reading