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Mass. Health Cost Watchdog Says Partners Merger Raises Red Flags

The Massachusetts Health Policy Commission (Source: HPC on Twitter)

Looks like the health-cost-control rubber is just beginning to hit the road. This just in from the Health Policy Commission, the independent agency created under the 2012 Massachusetts law aimed at containing health costs:

HEALTH POLICY COMMISSION INITIATES FIRST COST & MARKET IMPACT REVIEW

Partners, South Shore Hospital merger to be examined for potential effects on costs and the health care market

BOSTON – Wednesday, May 22, 2013 – The Health Policy Commission (HPC) today initiated its first Cost and Market Impact Review (CMIR) by notifying Partners Healthcare System and South Shore Hospital that it will examine the potential effects of their proposed merger on costs and the health care market.

“CMIRs are an important tool to enhance the transparency of significant changes to our health care system,” said HPC Executive Director David Seltz. “Almost every day we hear about new developments in our health care market. These reviews help us consider the impact of those developments on health care costs and market functioning. We are committed to conducting them on consumers’ behalf in a timely and thorough manner.”

‘Given Partners’ size and high costs, an expansion of that system to include South Shore Hospital, a large, high-cost community hospital, is likely to have a significant impact on the Commonwealth’s ability to meet its health care cost growth goals, and on the competitive market.’

The HPC’s preliminary review of this proposed transaction found that given Partners’ size and high costs, an expansion of that system to include South Shore Hospital, a large, high-cost community hospital, is likely to have a significant impact on the Commonwealth’s ability to meet its health care cost growth goals, and on the competitive market. To enhance public understanding of the potential costs and benefits of this transaction, the HPC is proceeding with a further examination.

“The HPC was set up to be a watchdog to monitor the health care market,” said HPC Chair Dr. Stuart Altman. “CMIRs are one of the ways we will fulfill that important role as we work to build a more affordable, effective, accountable, and transparent system. I look forward to discussing the merits and next steps for this specific review with the commissioners and the public at our June meeting.”

Seltz will report on the CMIR at the Commission’s next public meeting, Wednesday, June 19, 2013, and Commissioners will vote whether to continue with the review. The CMIR will include analyzing information from the parties and other market participants, developing a preliminary report, and issuing a final report. The proposed transaction cannot be completed until 30 days after the HPC issues its final report. The HPC may also refer its findings to the Attorney General for possible further action on behalf of health care consumers.

The response from Partners spokesman Rich Copp: “The proposed affiliation between Partners, Brigham and Women’s Hospital and South Shore Hospital will offer patients in southeastern Massachusetts more coordinated, accessible and affordable health care. We have always anticipated that the Health Policy Commission would review our proposal, and we look forward to taking this next step forward in the process.”

Looking for fine print? The HPC is here and I just signed up to follow them on Twitter at @Mass_HPC. Anybody else feeling extremely intrigued about how this review will play out, and what it will mean for the state’s efforts to contain health costs?

FILED UNDER: Insurance, Medicine/Science, Money, Politics, health policy commission

May 22, 2013 | 3:00 PM | Carey Goldberg

Even At Mass. General, Medical Training On Addiction Deemed Lousy

Massachusetts General Hospital is one of the highest paid in the state. (Steven Senne/AP)

Massachusetts General Hospital. (Steven Senne/AP)

Even at the lofty institution that bears the nickname Man’s Greatest Hospital, most medical residents think they’re not taught well enough about addiction and substance abuse, a 2012 survey found.

The hospital itself, Massachusetts General Hospital, sent over word of the study today, and says it has since increased addiction training for medical residents, who estimate that one-quarter of the inpatients they see have a substance abuse problem. From its press release:

BOSTON – A 2012 survey of internal medicine residents at Massachusetts General Hospital (MGH) – one of the nation’s leading teaching hospitals – found that more than half rated the training they had received in addiction and other substance use disorders as fair or poor.

Significant numbers felt unprepared to diagnose or treat such disorders, results similar to surveys of practicing physicians. In response to the findings, published online in the journal Substance Abuse, the MGH has increased residents’ training in addiction medicine.

“Our residents estimated that one in four hospital inpatients has a substance use disorder, which matches what other studies have found and represents a disease prevalence similar to that of diabetes,” says Sarah Wakeman, MD, chief medical resident at MGH and lead author of the report. “Finding that the majority of residents feel unprepared to treat addiction and rate the quality of their education so low represents a tremendous disparity between the burden of disease and the success of our current model of training.”

The study’s authors note that residents provide most direct medical care in teaching hospitals and often find caring for patients with addictions to be troublesome – possibly due to a lack of training and faculty role models – which can lead to a lack of trust between patients and physicians. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, addiction, medical education, substance abuse

May 22, 2013 | 11:50 AM | Carey Goldberg

Abercrombie: ‘No Uncool.’ Now Victoria’s Secret: No Mastectomy Bras

Abercrombie & Fitch models (Wikimedia Commons)

This is what we call an aggregating post, in which we pull together related news items, and the items I’m aggregating today concern companies that define their brands as “exclusive” — not as in “luxurious” but as in “We choose to exclude certain populations, such as disabled people or women who’ve lost breasts to cancer or are not sylphs.”

First, this just in from CBS News here: Victoria’s Secret Will Not Make Mastectomy Bras, despite the 128,000 signatures on a petition asking for them.

Despite immense public support, Victoria’s Secret will not manufacture a mastectomy bra, the company said Monday.

“Through our research, we have learned that fitting and selling mastectomy bras in the right way…a way that is beneficial to women is complicated and truly a science. As a result, we believe that the best way for us to make an impact for our customers is to continue funding cancer research,” Victoria’s Secret said in a statement.

Allana Maiden had started a petition on Change.org earlier this year, urging the company to create bras for women who had a mastectomy. Maiden’s mother Debbie Barriett underwent a mastectomy over two decades ago when she fought breast cancer.

The Victoria’s Secret decision, of course, says nothing like “We want our brand to be linked to sexy models, not mastectomy patients,” but it immediately made me think of the still-resonating impact of a 2006 Salon interview with Abercrombie and Fitch CEO Mike Jeffries. It was resurrected earlier this month by Business Insider, and includes this much-spread quote: Continue reading →

FILED UNDER: Medicine/Science, Personal Health, breast cancer, disability

May 21, 2013 | 6:53 PM | Martha Bebinger

Mass. Blocks Higher Insurance Charges For Most Smokers

You’ve heard all the campaigns and statistics: Smoking Kills. It’s the leading cause of preventable death in the U.S.

And, it’s expensive.

cigarette

The Centers for Disease Control and Prevention says smoking costs the country $193 billion a year in lost productivity and health care spending. Add another $10 billion for secondhand smoking expenses.

The federal Affordable Care Act says insurers can charge smokers up to 50 percent more for coverage than non-smokers.

So, says Jon Hurst, president of the Retailers Association of Massachusetts, why not ask smokers to pay more for health insurance?

“If we’re ever going to control costs, we’ve got to make sure that we don’t over-socialize the system,” Hurst says. “In other words, we don’t make people pay too much for somebody else’s health care costs.”

Fifty percent more for smokers might be too much, continues Hurst, “but let’s not dismiss outright, the ability for employers to try to incent people to get healthier.”

The debate about whether to make smokers pay more for health insurance has created some unusual alliances. Tobacco companies are working alongside cancer societies and consumer groups to persuade states they should reject higher charges for smokers.

Continue reading →

FILED UNDER: Insurance, Medicine/Science, Personal Health, cost, public health, smoking

May 21, 2013 | 11:36 AM | Rachel Zimmerman

Advocate: Take ‘Times’ Coverage Of Sodium Report With Grain Of Salt

The New York Times‘ coverage of the ‘How much salt is too much salt?’ debate got a thrashing in a Huffington Post column yesterday by the head of a nonprofit health and nutrition advocacy group.

In the column, Michael F. Jacobson, Ph.D., executive director of the Center for Science in the Public Interest, writes that the Times “bungles” the sodium report in an article and editorial and “misrepresented the findings of a new report from the Institute of Medicine (IOM).

salt (/Flickr)

Jacobson writes that the Times “never told readers that the IOM found insufficient evidence that very-low-sodium diets are risky” and it “failed to inform readers that few Americans consume very-low-sodium diets.” Moreover, he writes:

“The Times imperiled its readers’ health by implying that all advice to cut salt is wrong.

“The panel did not conclude that the average intake of 3,400 milligrams a day is necessarily risky,” said the Times editorial. Of course, it didn’t. The IOM wasn’t asked to examine the risks and benefits of our current sodium intakes. Previous IOM committees concluded that they are harmful. The IOM was asked to look at the effects of intakes in the 1,500 mg to 2,300 mg range. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, diet, media, sodium

May 21, 2013 | 10:47 AM | Rachel Zimmerman

Health Of The Nation: Obesity Up, But ‘Notable’ Decline In Physical Inactivity

In our house, when there’s good news and bad news, we usually start with the good. So here goes:

According to a new national health statistics report out today analyzing five key health behaviors among U.S. adults — sufficient sleep, smoking, drinking, obesity, and physical activity — there are several bright spots. For instance, the survey found that fewer young people (18-24) are smoking and the number of adults who report they’re completely aerobically inactive showed ‘notable’ declines in recent years, from 39.7% inactive between 2005-2007 to 33.9% in the years 2008-2010.

O.K., now the bad news: Heavy drinking has increased, except among the senior set over 75, smoking prevalence remains virtually unchanged (beyond the youngsters) and obesity is up.

girlsrunning

My first reaction is: Huh? Is anyone out there listening to Michelle Obama and all those other Get-Out-There-And-Move and Cut-The-Sugar advocates?

But then I talked to Dr. Eddie Phillips, director of the Institute of Lifestyle Medicine and an assistant professor of Physical Medicine and Rehabilitation at Harvard Medical School, who insisted on highlighting the positive.

A little background: Dr. Phillips’ focus is on physical activity, the link between health and exercise and on educating physicians about how to more seamlessly incorporate physical activity into the practice of medicine.

His takeaway from the CDC report is this: “People are starting to move.” Continue reading →

FILED UNDER: Medicine/Science, Personal Health, alcohol, exercise, obesity, public health, sleep, smoking

May 20, 2013 | 5:27 PM | Rachel Zimmerman

Budget Victim: Inspections For Compounding Pharmacies. Really?

Remember all that outrage last year when we learned that a Framingham compounding pharmacy, the New England Compounding Center, was at the heart of national meningitis outbreak? And remember what followed: a flurry of new government oversight measures, tough public health safeguards, pledges of “Never again.”

So what happened?

Kevin Outterson, a professor at the Boston University School of Law and co-director of the Health Law Program, reports today that additional money that was supposed to be used to inspect compounding pharmacies around the state was cut to zero. At least for now.

(WBUR)

Blogging for The Incidental Economist, he reminds us why the inspections are important: “fungal meningitis from improperly compounded products killed 55 people and infected more that 600.” But apparently, in the latest state budget proposal, money for inspections has been cut, Outterson writes:

All of these products originated in Massachusetts, but all of the injuries occurred in other states. But Massachusetts felt some responsibility for the failures at NECC, as acknowledged by both Gov. Patrick and the Interim Commissioner of Public Health. The DPH enacted emergency regulations on Nov. 1, 2012 and the Governor’s special commission delivered a comprehensive set of recommendations. Both efforts informed the Governor’s proposed legislation in January 2013 and several bills pending in the Massachusetts House and Senate. Continue reading →

FILED UNDER: Medicine/Science, Money, Politics, budget, compounding pharmacies, meningitis, public health

May 20, 2013 | 2:19 PM | Rachel Zimmerman

It’s The Carbs: ADHD In Childhood Linked To Adult Obesity, Study Finds

(Tobyotter/flickr)

Ned Hallowell is a Sudbury, Mass. psychiatrist and expert on ADHD who suffers from the condition himself. Today, he spoke with NPR about a new study in the journal Pediatrics that found boys with ADHD are more likely to become obese men compared to children without the condition. Hallowell is quoted saying the results seem reasonable:

“It makes sense, because they’re self-medicating with carbohydrates. Carbs do the same thing that stimulant medications do — promote dopamine,” says Hallowell, who wasn’t involved in the latest study. “So you get the gallon of ice cream at midnight.”

With impulse control often a problem for people suffering from the disorder, Hallowell also says that nutrition should be part of an ADHD treatment plan. Continue reading →

FILED UNDER: Medicine/Science, ADHD, children's health, men's health, obesity

May 20, 2013 | 10:07 AM | Rachel Zimmerman

Mapping The Ever-Shifting Mass. Hospital Landscape

Thanks to health policy guru John McDonough for highlighting the Blue Cross Blue Shield of Massachusetts’ new Health Care Delivery System Map which offers a snapshot of the state’s medical industrial complex as it becomes increasingly concentrated. There’s great data here, and it’s fairly easy to sort, from hospital revenue, ownership and geography to the latest info on mergers, acquisitions and new partnerships.

This online, interactive site won’t tell you where to get the best colonoscopy or most specialized cancer care, for instance, but it does offer insight into the scope and breadth of the marketplace. It essentially provides a baseline view of the state-of-the-industry for all the Mass. hospitals and hospital systems, medical groups, doctor networks and community health centers.

(Blue Cross Blue Shield Foundation of Massachusetts)

As McDonough writes:

For example, if you want to begin to understand why Partners Healthcare is so dominant in the state’s healthcare market, don’t go to this page, Hospital Systems by Size, on which Partners is #2 after Steward Health Care System. Go this this page: Physician Networks and Major Medical Groups, where the size of Partners’ physician network (called Partners Community Healthcare Inc., PCHI, or “peachy”) is larger than #2 (Steward) or #3 (Atrius), combined.

Or look at hospitals by Net Patient Service Revenue, and see that Partners total NPSR in 2010 ($4.2 billion) was the same as #s 2 (UMass Memorial), 3 (Steward), and 4 (Beth Israel Deaconess) combined.

Don’t forget this helpful page of Recent Changes in the Massachusetts health care market.

Readers, please roam around the site and let us know what’s interesting or useful to you.

FILED UNDER: Medicine/Science, Money, Blue Cross Blue Shield of Massachusetts, hospital systems, hospitals, partners healthcare, steward health care system

May 17, 2013 | 9:48 AM | Rachel Zimmerman

Is It ‘Unethical’ To Prescribe Bed Rest For Pregnant Women?

(cscott2006/flickr)

It seems so intuitively right. You’re facing the risk of delivering your baby early and the doctor prescribes bed rest. What could be more cozy and safe? Why wouldn’t you endure a little extra annoyance (you’re pregnant, after all) if it would help keep your tiny, oh-so-vulnerable fetus floating inside the fortress of your womb as long as possible? Even the words “bed” and “rest” feel so inherently soothing and therapeutic.

Think again.

Bed rest, a growing body of research suggests, may be bad for you. And for physicians to blithely prescribe it is, in a word, “unethical,” argue a trio of doctors from the University of North Carolina School of Medicine.

In a paper called “‘Therapeutic’ Bed Rest in Pregnancy: Unethical and Unsupported by Data” recently published in the journal Obstetrics and Gynecology, Dr. Christina A. McCall and her colleagues make a powerful case against the practice many perceive as cuddly and innocuous.

They cite the medical paradox in which bed rest remains widely used despite no evidence of benefits and, on the contrary, “known harms.” They further suggest that in its current form, strict bed rest should either be discontinued or else viewed as a “risky and unproven intervention” requiring rigorous testing through formal clinical trials.

“If we have anything to learn from the history of medicine it is that instincts and good intentions are a highly fallible compass without the check of scientific controls.”

In an email exchange, Dr. McCall clarifies that she is talking about strict bed rest here and adds:

“If a woman feels that increasing her daily rest lessens anxiety or improves symptoms (whatever they may be), then we are not suggesting this should be discontinued. We are merely suggesting that every woman receive INFORMED CONSENT regarding the literature on bed rest and the autonomy to make her own decision.”

Research suggests that the potential harms for women on bed rest (a broad term that can include everything from total inactivity to limits on strenuous endeavors like household chores, exercise and sex) can be significant. They range from potentially dangerous blood clots and bone demineralization to muscle and weight loss, financial harship due to restrictions on working and a range of psychological suffering, notably depression. Continue reading →