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In Mass., You Can Now Get Prices For Health Care In Advance (But It’s No T.J. Maxx)

The form Blue Cross patients fill out if they want an estimated price for health care.

The form Blue Cross patients fill out if they want an estimated price for health care.

“How much will my MRI cost?” It sounds like a simple question. But before Oct. 1, it was very difficult to get an answer.

Now, Massachusetts is pulling back the curtain on what has been a largely secret world of health care prices. A new state law says health insurers must be able to tell members, in advance, how much a test, treatment or surgery will cost. The idea is to help patients become health care shoppers — especially patients who have to pay a lot out of pocket before their insurance kicks in.

Phone Calls And Forms

I threw out my back last week and went to the doctor. She sent me down the hall for X-rays. I may need more. So, I was curious: How much does an X-ray cost? I called my insurer, Blue Cross.

The recorded message didn’t mention health care prices, so I went with, “For all other inquires, press 0.”

On came Jamie D. (customer service reps don’t give out their last names) and I explained that I wanted to compare the price of lower back X-rays at a few different facilities.

“Absolutely,” Jamie said. “Do you know the name of the provider you’re going to be working with?”

I had the doctor’s name, but I didn’t have most of the other information Jamie wanted. Blue Cross, Harvard Pilgrim and Tufts Health Plan will ask you for lots of details before giving you an estimate.

Blue Cross, for instance, wants the procedure and/or diagnostic codes (CPT or ICD-9) for each X-ray I may need, my doctor’s National Provider Identifier (NPI) and the name, address and NPI for my hospital or lab, so it can consolidate all the charges into one estimate.

“Typically with the X-rays there’s going to be a charge for the provider who renders the X-ray and then who’s reading it,” Jamie explained, “so it’s like a professional and a facility charge.”

Jamie directed me to an online form. I called my doctor and got the information. Twenty minutes later I clicked submit, and that was for just one lab. If I wanted to compare prices, I’d have to fill out separate forms for each one. Once I’d submitted all the correct information, Blue Cross had 48 hours to get me an estimate. I guess it goes without saying I’d never do this in an emergency.

So far, it didn’t feel like shopping. The main point of this new requirement is to help patients make smarter choices. We’re supposed to start behaving more like consumers of health care. So where’s the instant gratification I get from finding a designer sweater for $16.99 at T.J. Maxx?

Continue reading

As Nation Braces For Obamacare, Mass. Tackles Health Costs

If for some reason you’re not already drowning in the rough waters of U.S. health policy — what with the Affordable Care Act’s health exchanges launching today and Congress and President Obama still duking it out over the four-year-old law upheld by the U.S. Supreme Court — well, you’re in luck. Because in the midst of all this Obamacare angst and government shutdown, our fair state this week kicks off the Oscars of health wonkdom, aka, the Massachusetts Health Policy Commission’s Annual Health Care Cost Trends Hearing.

It’s a time for state health care officials and bureaucrats to conduct a little reality check with insurers, hospitals, businesses and consumers to ensure that everyone’s making a good-faith effort to hold down medical costs.

Stuart Altman, economist and professor of National Health Policy at Brandeis University and chair of the board of the Massachusetts Health Policy Commission, says the role of the commission is to keep all of the players involved in the health system accountable and sharply focused on driving down costs while improving quality. “We’re like a big searchlight on the system to say ‘Hey this is good’ or Hey, this is not good,” and then follow up, Altman said on WBUR’s Radio Boston Monday.

Gov. Deval Patrick

Gov. Deval Patrick

Here’s a little background on the hearings, to be held at the University of Massachusetts, Boston, from the state:

The cost containment law, signed by Governor Patrick in August 2012, empowered the Health Policy Commission with monitoring health care delivery and payment system reform and developing policies to reduce overall cost growth while improving the quality of patient care. The Commission is governed by an independent board of health care experts who will use the two-day hearing to examine hospitals, insurers and provider organizations about their work to meet the new cost growth benchmark (3.6% for 2013 and 2014), improve care coordination and provide consumers with price transparency tools. Market consolidation’s impact on the Massachusetts health care system will also be a hearing focus.

If you want to get a jump on the hearings, go wild and check out the pre-filed testimony here. Continue reading

Boston’s Mostly Good Results In Health Savings Experiment

Boston is a major player in a critical national health care test: Can focusing on prevention, and paying doctors based on the quality of their care, actually save money?

After the first year of this experiment, the answer is: Maybe.

Nationally, 32 large hospitals and physician groups signed on as Pioneer ACOs (Accountable Care Organizations). 

They agreed to try to save money on Medicare patients while still making sure patients received regular check-ups, cancer screenings and kept problems such as high blood pressure under control. Results out today show that 18 of the 32 groups spent less on Medicare patients than doctors and hospitals outside this pilot project. Most of those who saved money got to keep half the savings.

All 32 groups met the program’s quality goals.  There was a disagreement about how tough the federal Center for Medicare and Medicaid Services should be in setting those 30-plus goals.  The issue may come to a head again this year when quality scores won’t just be reported, they will count towards or against what providers are paid.

Images_of_Money/flickr

Images_of_Money/flickr

In Boston, four of the five Pioneer ACOs spent less money on Medicare patients in the first year of the contract than the federal government projected they would spend if not operating as an ACO:

–Beth Israel Deaconess Care Organization (BIDCO) says it saved 4.2%.

–Mount Auburn Cambridge Independent Physicians Association (MACIPA) says it saved 3.4%.

–Partners HealthCare says it saved 2.4%.

–Steward Health Care says it saved money, but declined to say how much.

–Atrius Health, the state’s largest physicians group lost money.
Update: Atrius Health says a final tally, that includes the first quarter of this year, reduced its loss from 2.1% to .98%. Since this falls within the margin of error, Atrius will not have to return any money to CMS for the first year of the Pioneer ACO program.

Specifically $220 on each of its Medicare patients.  Atrius offered more specific numbers than any of the other Boston Pioneers (as a sort of challenge that the other organizations did not take up). Transparency anyone?

Atrius spent $10,665 on its Medicare patients before becoming a Pioneer ACO, and $10,885 after the first year.

“We thought we’d be at an initial disadvantage,” says Atrius CEO Gene Lindsey, “because we had already harvested much of the low hanging fruit, that some of the organizations might be able to harvest in the first year to show good results.  But the difficult work that would be necessary for sustained results…would really be a long-haul effort.”

At Partners, Vice President for Population Health Management at Partners HealthCare, Dr. Tim Ferris, says he “didn’t expect to be this successful in the first year of the program.”  Ferris echoes Lindsey’s long view. The changes needed to make an ACO work are “a long term effort that will pay off much more in five years than in the first year.” Continue reading

Mass. Hospitals Balk At Fees To Access Trove Of Medical Claims Data

The state’s painfully wonky sounding All-Payer Claims Database (APCD) — a catalog of medical, dental and pharmacy claims, as well as other patient-related information — is truly tantalizing in its potential.

For researchers, tapping into this recently released data — a centerpiece of the newly created Center for Health Information and Analysis and part of the state’s overall plan for health care reform and cost control — can offer “a deep understanding of the Massachusetts health care system by providing access to timely, comprehensive, and detailed data,” according to the APCD website. It promises to “be an essential tool to improve quality, reducing costs, and promote transparency.” (Though not necessarily for the average patient: basically, you need an analyst by your side to really comprehend the trove of complex information.)

(401(K) 2012/flickr)

(401(K) 2012/flickr)

But wait a minute. To access this important data for one year will cost a mid-size organization, like a community hospital, about $40,000, according to the Massachusetts Hospital Association, which argues that the fees are too high. “We’re very disappointed,” says the MHA’s Senior Director of Managed Care, Karen Granoff. “I think [the pricing] is going to discourage many providers from trying to access it.”

The Center For Health Information and Analysis says the proposed fee schedule is based on four factors:

(1) the type applicant requesting the data; (2) the type and number of data files requested; (3)the data elements requested; and (4) the number of years of data requested. The Center may reduce or waive the applicable fees for qualified applicants.

(Also, the final fee schedule is still being determined. It’s slated for release around June 1.)

Still, in written testimony to CHIA earlier this month, the hospital association argued that the proposed fee structure is simply unmanageable, particularly when the state is pressuring hospitals and providers to re-invent themselves as Accountable Care Organizations and to provide less costly and higher quality care and patient management.

“It would be an unintended consequence if the Commonwealth’s multi-year, ambitious effort to control healthcare costs were to fail due to barriers to data access set up by the agency itself,” Granoff wrote.

But hospitals already have all the claims data on their own patients, right? So why the brouhaha over the more comprehensive claims data? Here’s why the information is important, says Granoff:

The purpose of APCDs is to support health care transparency, health care reform initiatives, and improve care for patients. Access to data from all payers (commercial and government) will be vital to the successful development of ACOs and other integrated models of care. While it is true that providers may currently have access to data from one payer at a time, the timeframes, content, frequency, and ability to mesh data from different sources does not exist outside of the APCD.

The legislature recognized the importance of the APCD to providers when it included language specifying that:

“CHIA shall, to the extent feasible, make data in the APCD available to payers and providers in real time. Providers and provider organizations, among others, be permitted to have access to de-identified data for the purposes of lowering costs, coordinating care, performing quality analyses, and for administrative or planning purposes, etc.
Providers and provider organizations be given access to data with patient identifiers for the purpose of carrying out treatment and coordinating care.”

Regarding the APCD and its use by providers, it will allow performance analysis based upon previously unavailable data from private and public health insurance plans, including

*Follow-up after medical or surgical hospitalization
*Readmission rates Continue reading

New Board Begins Work To Control Health Care Costs

Monday, August 6, 2012 – Governor Patrick joins legislators, advocates and stakeholders in Nurses Hall at the State House to sign S. 2400, launching the next phase of health care reform that builds on the Commonwealth’s nation-leading access to care through landmark measures that will lower costs and make quality, affordable care a reality for all Massachusetts residents (Photo: Office Of Gov. Patrick/flickr)

A new 11-member board began work today on what Governor Deval Patrick calls an historic effort to control the interminable problem of rising health care costs.  WBUR’s Martha Bebinger offers this initial report:

The main goal of this board, including consumers, employers, providers and health care experts, will be to make sure Massachusetts meets the new goal of keeping health care spending in line with the state’s overall economic growth.  Governor Patrick swore in commission members this morning.

“It’s important for them to realize that they’ve been called to this moment by history. We a model for national health care reform in terms of access. And in terms of cost control, we’re going to be a model for the country on how to crack that code,” he said.

The board’s chairman, Prof. Stuart Altman, a Brandeis economist, asked members to make sure they represent the interests of the state as a whole, not their special interests on health care spending.

Boros Named Director Of New Center To Implement Cost-Control Law

This just in from the Patrick administration:

Governor Deval Patrick, Attorney General Martha Coakley and Auditor Suzanne Bump today selected Áron Boros to serve as the first Executive Director of the Center for Health Information and Analysis (CHIA), furthering the Commonwealth’s efforts to lower health care costs and make quality, affordable care a reality for all Massachusetts residents. Currently the Commissioner of the Division of Health Care Finance and Policy (HCFP), Boros has helped shape the development of the Commonwealth’s landmark cost containment law.

Aron Boros is named the first Executive Director of the Center for Health Information and Analysis

“Áron brings valuable experience and a proven commitment to this critical role,” said Governor Patrick. “This is another important step forward in the Commonwealth’s efforts to create a health care system that is as affordable as it is accessible.”

“The Center for Health Information and Analysis will play a vital role in continuing to increase transparency and understanding of the health care market,” said Attorney General Coakley. “We are pleased that Áron Boros will lead CHIA as we begin the next stage of health care reform in Massachusetts, with a strong focus containing costs.”

“Áron Boros is the right choice, given the leadership role he has played at the HCFP and his understanding that good data and analytics are the foundation upon which good public policy must be built,” said Auditor Bump. Continue reading

Gov. Touts Health Reform: Prevention Up, Smoking & Cervical Cancer Down

(Photo by Dominick Reuter for WBUR/flickr)

In a speech to the Massachusetts Medical Society today, Gov. Deval Patrick took the opportunity to crow about health improvements linked to reforms that started in 2006. There were the usual statistics about coverage: 98.2 percent of the total population and 99.8 percent of children in the state have health insurance. But the governor also cited some other, less familiar numbers. Here are a few (all quotes from Patrick’s prepared remarks):

– More businesses offer health insurance to their employees today than before our 2006 reforms took effect, some 78 percent of Massachusetts businesses as compared to the national average of about 69 percent

— Preventive care is up: more people are receiving cancer screenings, more women are getting pre-natal care and visits to emergency rooms have decreased. 150,000 people have stopped smoking because we expanded coverage for smoking cessation programs. A recent study by the National Bureau of Economic Research documents improvements in physical health, mental health, functional limitations, and joint disorders as a result of increased access to care in Massachusetts. Women, minorities and low-income people have experienced the biggest health improvements.

— Among Hispanic males, a notably underinsured population in Massachusetts before health care reform, the detection of testicular cancer has more than doubled and the majority of cases are now detected at an early stage.

— And with wider access to screenings, we’ve seen a 36 percent decrease in cervical cancer in women.

— Over 90 percent of our residents have a primary care physician, and 4 out of 5 have seen their doctor in the last 12 months.

Continue reading

A New Approach To Cutting MA’s Health Costs: Throw Spaghetti

(401k/flickr)

By Rachel Zimmerman and Carey Goldberg

When Massachusetts passed sweeping health insurance reform in 2006, a crucial piece was missing from the landmark legislation: how to control rising medical costs.

Today, state lawmakers unveiled an ambitious new proposal to do just that, including new ways to pay doctors and hospitals, a specific cap on health-care spending tethered to economic growth and a tax on the state’s most expensive hospitals if they can’t justify their prices.

MIT economics professor Jonathan Gruber, an architect of the state’s 2006 health law and an advisor to President Barack Obama on the national Affordable Care Act calls the new House proposal “aggressive, broad and visionary.”

“This is an incredibly hard problem,” said Gruber, speaking on WBUR’s Radio Boston today. “What I like about this…is that it’s really taking the spaghetti approach to cost control; let’s throw a bunch of things against the wall and see what sticks. They’re doing a bunch of different things all of which might work.”

So, what does it mean for patients?

Rep. Steve Walsh, the House chair of the joint Committee on Health Care Financing, said the plan would save $160 billion over 15 years. As far as savings for patients, Walsh said: “The first thing I’d tell [a patient] is five years from now, her family plan is going to be $2,000 cheaper than it is today.” Walsh said businesses would also find their health costs cut significantly.

House Speaker Robert DeLeo added: “With this bill, I think everyone’s gotten a little something they want and everyone’s gotten a little something they don’t want. So that’s what this legislation is all about, but at the end of the day, most importantly what it’s going to provide is some real health care cost containment. That’s what the bill is all about.”

One of the greatest challenges, he said, was to contain costs while not undermining a key industry in the state, with 1 in 7 jobs here linked to health care. Clearly some folks will be disappointed that the plan didn’t go far enough. Gov. Deval Patrick introduced legislation in February 2011 that would have allowed greater government oversight of contracts between insurers and health care providers and moved more medical groups into global payment systems that put doctors and medical groups on a budget.

But DeLeo also made the point that once again, the state is in the forefront of health reform. “I look at this as Massachusetts being a leader once again in terms of what’s going on in the health care field in the country.”

Here are some details of the House bill, officially the Health Care Quality Improvement and Cost Reduction Act of 2012, presented today by lawmakers. The state Senate is expected to introduce its own version of the plan next week.

1. Oversight: A new, quasi-governmental agency called the Division of Health Care Cost and Quality would oversee the transition to the new payment and delivery system with a board including consumer, government and industry representatives.

2. Cost-Cutting: To curb the increase in medical spending, the plan establishes a cap for health-care spending linked to the local economy, the Gross State Product, minus one-half a percent.

3. Leveling The Field: The state could impose a 10 percent “luxury tax” on pricey hospitals that charge more than 20 percent of the state median price for a given service without being able to justify that higher price. (Two earlier reports by Attorney General Martha Coakley found that certain hospitals exploited their market clout and charged higher prices without offering better quality care.) Hospitals would pay this penalty into a “distressed hospital” fund for institutions that serve a high proportion of poor and vulnerable patients. Continue reading

Breaking Report: House To Release Health Payment Reform Bill Friday

This just in from Michael Norton at State House News Service:

Stepping in front of a planned announcement from state senators, House leaders late Thursday said they’ll unveil a long-awaited health care payment reform and cost control bill on Friday.

According to House Speaker Robert DeLeo’s office, the bill will be unveiled during a 2:30 p.m. press conference in Nurses Hall with Health Care Financing Committee Co-chairman Rep. Steven Walsh (D-Lynn) and other members of the committee.

Senate President Therese Murray said last week the Senate planned to debate its version of Gov. Deval Patrick’s payment reform bill, filed in February 2011, in mid- May, after the bill emerged from the Senate Ways and Means Committee. This week, Murray said the Senate bill would be released next week.

Rumors began circulating on Beacon Hill Wednesday that a House health care bill might emerge on Friday, before the Senate bill. Until Thursday afternoon, House aides either declined to respond or declined comment when asked to confirm those plans or whether committee members were voting on bill. Continue reading

The Wonk Olympics: Sweeping New Health Cost-Cutting Plan Coming

In this April 12, 2006, file photo, then-Gov. Mitt Romney is seen with lawmakers and staffers after signing the state's universal health law at Faneuil Hall in Boston. (AP File)

In health policy circles, it’s as big as the Olympics, with major players, major maneuvering and all eyes watching. It’s a sweeping new plan to control health care costs through radical changes in how doctors are paid and other measures that will be soon be unveiled by state lawmakers in the next chapter of health reform, reports WBUR’s Martha Bebinger. Here’s a bit of her preview:

The House and Senate are expected to build on movements that are already under way: global payments, electronic health records and the increased focus on primary care. The House point person on health care, Steven Walsh, has outlined his proposals in meetings with dozens of groups.

Legislators are considering some controversial moves.

The Senate has talked about taxing insurance company profits. One House leader has a proposal to close the gap in payments to rich and poor hospitals. There’s a vigorous debate about how aggressive the state should be in trying to hold down health care costs. Continue reading