250 staff members at Boston Medical Center are losing their jobs or losing hours. The hospital is also putting a hold on 35% of planned capital projects and spending 14-million dollars less in departments throughout the hospital. In total, BMC is cutting $61.5 million in response to state budget cuts. Hospital President Elaine Ullian says patients will feel the effects.

“They’ll be longer waits for appointments. They’ll be fewer phones answered. We have the largest interpreter service in New England; we’re reducing that considerably. Every element of our institution will diminish the service and access it provides to patients at a time when our hospital has never been busier.”

“Now is the time when that safety net is needed more than ever.”

Mike Fadel with SEIU, 1999, is frustrated with the Patrick administration.

“We know that the state is under tremendous fiscal constraints, but there are hundreds and thousands of residents who are unemployed or underemployed and in need of the very services that Boston Medical Center provides.” Read more…

A flurry of legislative and regulatory activity surrounding health care reform during the summer and fall prompted Associated Industries of Massachusetts (AIM) to conduct a series of updates for employers throughout Massachusetts. AIM did more than half of these sessions in partnership with the Commonwealth Health Insurance Connector Authority (Connector).

Common threads, some unexpected, ran through all of the sessions. Here are a few impressions from employers representing companies of diverse size, industry, and geographic location:

• Participants are impressed by how much has been accomplished in a year and a half of health care reform. The reaction was apparent when Connector officials shared news about the 439,000 previously uninsured people who now have coverage. The nodding heads of employers conveyed pride in learning that they live and/or work in the state with the lowest uninsured rate in the country.

• Employers were also impressed to learn that, of the 191,000 newly-insured people who have private insurance, 159,000 have obtained that coverage through their employers. Many of the employers have seen increased enrollments and resulting cost increases in their own businesses, but were unaware of the statewide numbers.

• Employers remain frustrated about rhetoric suggesting that they are not doing their share. Read more…

Add another “first in the nation” to the long list of accomplishments for health care in the Commonwealth.

The American College of Emergency Physicians (ACEP) last week issued its National Report Card on the State of Emergency Medicine, and listed Massachusetts as ‘first in the nation for its support of emergency patients.”

The report, a comprehensive analysis of the support that states provide for patients needing emergency care, which also includes recommendations to overcome weaknesses, was the second issued by ACEP. Massachusetts ranked second in the organization’s first analysis in 2006.

The move from second place to first is significant, because the 2008 report contained more than twice the measures of the previous report, analyzing 116 measures in five categories. Besides the overall number one ranking with a grade of B, the state also ranked first in the individual category of Public Health and Injury Prevention, with a grade of A. Read more…

Boston Medical Center is preparing for layoffs as early as this week and Cambridge Health Alliance will likely close one of its three hospitals and some health centers early next year. The state’s two largest safety new hospitals claim they are bearing a disproportionate share of state budget cuts…but the Patrick administration say it is time to rebalance the state’s health care spending.

(story transcript)

MARTHA BEBINGER: For decades, Boston Medical Center and Cambridge Health Alliance have made it their mission to care for Massachusetts residents who fall through the cracks of the health care system. They’ve created comprehensive programs of care for the uninsured, immigrants, drug addicts and the mentally ill. Representative Alice Wolf of Cambridge is leading a group of state and local elected officials worried about how her hospital will cope with 55 million dollars in state budget cuts this fiscal year.

ALICE WOLF: If there is a reduction in services, if an emergency room had to close or part of a hospital had to close, that would make a real difference. There isn’t any other place for those visits to be taken care of.

BEBINGER: Cambridge Health Alliance includes hospitals in Cambridge, Somerville and Everett as well as 20 community health centers. Administrators have not announced any changes …but the uncertainty is having an effect. Read more…

In 1993 the large national health insurance carriers contributed to the defeat of national health care reform by their association with the famous “Harry and Louise” advertising, which struck a cord with the entire country. While there are arguably many reasons for the failure of health care reform at that time, the opposition of most of the nation’s health plans helped to doom an idea whose time had not, apparently, come.

I’m pleased to report that times have changed. Last week, I represented the national association of health plans, America’s Health Insurance Plans, in a press conference in Washington to announce its series of proposals designed to support the national adoption of universal coverage.

The announcement said many things, but my quote that found its way to daily newspapers was this one, “The heart of our proposal is a public-private partnership that builds on the employer-based coverage that 170 million Americans rely on today. We have laid out a workable, realistic path to universal coverage and we want to ensure that no one falls through the cracks of our health care system because of age, health status, or income.”

While it is only the beginning of the national health reform discussion, the ideas put forth by AHIP have merit. No less an advocate than Sen. Kennedy has called for serious consideration of the AHIP proposals for a workable, realistic path to universal coverage. Read more…

Massachusetts health care consumers just got a whole lot savvier. As part of its commitment to improving health care quality and containing costs, the Commonwealth launched today an interactive websiteto help residents select high-quality, lower cost care and to encourage providers to improve quality and contain costs.

These efforts are particularly critical as Governor Patrick, his Administration, and our partners in the Legislature continue to move forward with health care reform implementation. Since 2006, more than 442,000 people have enrolled in insurance programs, making Massachusetts first in the nation in the percentage of uninsured. Care for the remaining uninsured, financed by the Health Safety Net, has decreased by more than 36% as enrollment has increased.

These are critical achievements, but the architects of Massachusetts’ historic 2006 health care reform initiative wisely recognized that controlling costs and improving quality are key components to ensuring the long-term sustainability of health care reform. The Health Care Quality and Cost Council has developed a consumer-friendly website that allows a diverse range of stakeholders to compare common health care procedures at different hospitals and outpatient facilities. A patient considering knee replacement surgery, angioplasty or a mammogram can now visit the new site to see how cost and quality measures might differ between various local hospitals for that procedure. Read more…

As the state looks for ways to improve health care and save money, the end of life is getting a lot of attention. 80% of the Medicare budget is spent in the last year of life but more than half of patients do not have the kind of death they’ve said the would prefer. One reason is that don’t explain their wishes to physicians or their loved ones.

(text of story)

BEBINGER: Pam and Steve Rosenberg are in their family room, in Andover, trying to answer a questionnaire about what they want their last weeks or months of life to be like.

STEVE ROSENBERG: No.1 let me die in my own bed without any medical intervention.
PAM ROSENBERG: I agree with that.
STEVE: OK so, what if you can’t express your wishes? Is it up to me, in which case I’m never going to let you go. How do you know that science wont’ catch up to you in 5 years?

BEBINGER: Pam is 40. Steve is 53. Pam is pregnant with her first child. They have two sons from Steve’s first marriage. The Rosenbergs are both healthy. But Steve’s father’s death last year, was traumatic and both Rosenbergs hope that by being clear with each other now, they will avoid confusion and regret.

STEVE: I fall off a ladder and I am unconscious, on a ventilator, what are you going to do? Read more…

The dramatic cuts in funding proposed for Cambridge Health Alliance (CHA) and Boston Medical Center (BMC) are causing an increasing stir among caregivers and the communities these key safety net hospitals serve.

These cuts have local and national implications. With cuts looming, and with no apparent plan in place to ensure access and care, patients and caregivers in the communities where minority and low-income neighbors are served by BMC and CHA are feeling increasingly alarmed by a proposal which would be devastating for their community hospitals. Community, labor, and religious groups are taking measure of the impact the proposed cuts would have to essential care for minority and low-income neighborhoods. And advocates, safety net providers, and policymakers across the country are watching to see if Massachusetts can develop a plan to ensure the continued viability of its safety net system in the face of the dramatic changes wrought by health reform and the current economic and budget crisis.

A plan is essential because Massachusetts cannot afford to lose the vital services provided by BMC and CHA.

Consider:

CHA provides 150,000 visits annually for patients with behavioral or substance abuse problems. CHA provides 10% of all the state’s mental health inpatient stays, and 14% of all Medicaid mental health and substance abuse care. With the cuts proposed to CHA this year alone, it is possible that 10% of all the acute care psychiatric beds in Massachusetts could be closed. Read more…

Writing about what’s next in health care and health insurance during the next five or six months is going to be pretty much of a crap-shoot (If that’s a swear — sorry — I think of it as a gambling term) and most of us would be wise, not to do it. Who knows how bad the economy will get, or what help we will get from the next Congress and the next administration — or what that help will accomplish. And who knows what will come of the various health reform packages — Senator Baucus’s, Senator Kennedy’s or Secretary Daschle’s. And of course, in the great parlor game of musical chairs, we’re all waiting to see who gets on the short lists for CMS, for AHRQ, for CDC, for FDA, for Surgeon General — who from Massachusetts will get the nod — which incumbents get to stay — and who goes — what will it all mean for us in the Commonwealth as we watch the state’s revenues sink, along with those of our sister states. Misery doesn’t particularly enjoy this kind of company.

Although we can see the future only dimly, the one thing we know is that things will be different in Washington — and in Boston. So, with absolutely no inside knowledge to guide me — my predictions are the following:

- There will be a stimulus package, and it will pass quickly.
- There will be a health reform bill and it will pass during the first year of the new Congress. Read more…

Click here to listen to Dr. Atul Gawande talk about a wide range of issues including the Individual Mandate, reducing surgical errors and whether patients will shop for the best values in health care.