Last week in this forum Dr. David Torchiana of the Massachusetts General Physicians Organization offered both support and caution regarding some of the elements of Senate President Therese Murray’s proposed health care legislation. As the discussion begins this week at the State House on S.B. 2526, I join Dr. Torchiana in applauding the Senate President and the legislature for their leadership in helping address the complexity of reining in health care costs. But it isn’t only about reining in costs; the other equally important component is maintaining the attributes that contribute to the Commonwealth’s well-deserved reputation for excellence in its providers and health plans. To my thinking, it comes down to this fundamental question, “How do we improve access to high-quality health care while keeping health care costs as affordable as possible?”
As we are all aware, the Health Reform Law has been extremely effective in expanding access to insurance coverage to more residents of the Commonwealth. That’s laudable. However, the soaring costs of health care threaten its long-term success and viability. As president and CEO of Tufts Health Plan and chairman of the board of directors of the Massachusetts Association of Health Plans, I have reviewed the proposals closely and can say with great enthusiasm that we fully support H.B. 4587 and support many of the principles and provisions of S.B. 2526, though we believe that some sections may require modification in order to achieve the goal of maximum cost savings.
As a quick overview, the following outlines our position:
· We believe that health plans and providers should both appear before the Health Care Quality and Cost Council rather than different hearing bodies. This would add to a better understanding of the correlation between increases in premium and medical costs—the largest contributor to premiums.
· We also support the provisions in both bills that require public reporting of hospital acquired infections and so-called “Never Events.” This would not only provide an important check on the payment process, but also may provide health plans with an opportunity to strengthen and better direct quality improvement programs.
· While we value the contributions of nurse practitioners and see their role as vital to the health care community, we are concerned as the proposal now stands that there is not sufficient quality control in regards to credentialing standards. Furthermore, a blanket requirement for health plans to contract with nurse practitioners is unduly prescriptive and could actually result in unnecessary, increased costs as this requirement could affect a health plan’s ability to evaluate quality and access.
In the final analysis, this is a welcome debate. We all share the same goals. It is my great hope that the outcome of this hearing will help us answer the question, “How do we improve access to high-quality health care while keeping health care costs as affordable as possible?”
James Roosevelt Jr.
President and CEO
Tufts Health Plan and
Board Chairman
Massachusetts Association of Health Plans
Mr. Roosevelt: Could you point to any provisions of the Senate bill that you think would actually have any real impact on moderating the growth of health insurance premiums? Sounds like we’ll just get more transparency on why our rates are going up…good to know but doesn’t do anything about the problem…. “As affordable as possible” isn’t a very helpful goal if the answer is “not affordable,” which is the current situation for so many people.
Peter
On behalf of the Mass Coalition of Nurse Practitioners, we are grateful that Tufts and MAHP, through Mr. Roosevelt, recognize the important role of the Nurse Practitioner. More than 30 years experience and scientific studies attest to the quality of care and patient satisfaction they
provide. Health Plans have been required to reimburse for Nurse
Practitioner services for more than fourteen years and do so . Although
an NP may be on the provider network providing primary care to insureds, not all plans recognize or list them in their directory. This legislation simply allows the public to have a choice through the directories, of
selecting an NP as a primary care provider. Nothing in the text requires a
plan to include an NP on their network or to contract with them independently. Further, nothing prohibits a plan from requiring any provider to follow the currently utilized processes for ensuring licensees meet quality measures. This language should be embraced as it will create more transparency in the delivery model, so that outcomes and quality can truly be measured, a goal that is central to the Senate President’s efforts.
Respectfully,
Massachusetts Coalition of Nurse Practitioners Executive Board
Peter,
Thank you for reading my blog entry and for taking the time to ask a question. Your question is a legitimate one. We support the principles of the Senate President’s bill because there is opportunity for change and cost savings. While there are others, let me give you two examples that warrant discussion and have the potential to save money and align interests among providers and health insurers.
· Entity to Convene Carrier and Provider Hearings.
Before we can do anything else, we must identify the drivers responsible for increasing health care costs in order to reduce costs. This includes having providers and health insurers working together with shared information and common expectations. Having one agency convene hearings creates a much greater likelihood of a productive process that will allow us to connect the dots and identify solutions and cost savings–much more so than if there are separate agencies reviewing data. It is my view that these hearings should be convened by the Health Care Quality and Cost Council.
· Strengthening the Determination of Need Process.
Several decades ago the DON was created to determine the necessity of significant expenditures, such as major construction or equipment purchases for use in improving the health of the community. Over time, in addition to cost increases due to inflation, there has been a weakening of standards. Reinvigorating this process can directly reduce health care costs. There should be greater consideration on the types of services that are needed within the state and where those services should be located.
But first we must begin the dialogue in a manner that is public and has legislative consequences. We must move toward a cultural shift that includes adherence to evidence-based medicine as a guideline to good medical practice. Moreover, health insurers and providers need to find additional common ground in order to help identify those areas where there is opportunity for cost containment, for the elimination of perverse incentives, for the alignment of goals, and for the elimination of duplication of unnecessary services, all of which are drivers for increasing costs.
Information will lead to action and hopefully influence behavior so that the public will be making informed choices. I could go on, but I think you see my point. We are at the very beginning of a public dialogue, the outcome of which is yet to be played out. I am, however, optimistic. I would encourage you to be optimistic, too.
Dear Mr. Roosevelt,
I am a Floridian and when you guys said our votes for the nominee would not be counted you made it very clear that you would not change your minds”in November” or any other time. I trusted you, I read all the newspapers carefully and saw that there was absolutely no way you would consider changing this, before my husband and I and our first-time-voter daughter, aged 20, agreed not to spend gas money we did not have to go vote. If there was ANY chance the punishment would be retracted, we were going to vote to ensure that our choice–Sen. Obama –got our votes. Every single word any of you party leaders said assured us there was NO way you would pay any attention to our votes.
Now you are going to go back on your word and let the votes count. Don’t you realize that a lot of us didn’t vote? I mean, why would we? It cost gas and took time and effort, here in Florida it is very hot and long car rides are insufferable so if voting was useless, we assumed no one was going to the polls that day.
It turns out that Sen Clinton told her Florida fans to go vote that day and she’d do everything she could to fight for their right to be counted. Well, guess who won Florida? Because Sen Obama did not promise us that he was going to work around your absolute word on this, he lost.
Now Sen Clinton says the hard-working Floridians deserve to have their vote counted. I’m a hard-working Floridian and if they are going to count our votes I deserve to have mine counted, too!
Now Sen. Clinton says if she was a Florida Democrat and saw that her party did not want her vote, why, she’d see if the Republicans would want it. But she certainly doesn’t want my vote counted–notice how she’s not pushing to redo it so every Florida Democrat’s vote can count–she only wants the ones already cast, where she won, counted. I hear she even threatens to take this to court, to sue you or the party or whoever she can sue to get all our delegates seated if you only seat half. Wow. What if I took the party to court for my right to vote in the primary? You can’t say I had one.