This is the bullet point version of Senate President Therese Murray’s cost containment bill…as she outlined it at a State House committee hearing today. Are there any particular areas you would like to hear more about?
• Across the United States, premium increases have been between six and seven percent on average. Massachusetts, however, has seen double-digit increases for the last eight years. We need to find out why this is happening here and nowhere else.
• This growth in health care costs is out-pacing the increase in workers’ wages (3.7 percent) and the overall inflation rate (2.6 percent).
• That’s why we propose to hold public hearings for any insurance company that submits premium increases above 7 percent.
• These reviews will explore administrative costs, marketing costs, salaries, compensation packages and reserves.
• We also propose public hearings with health care providers to investigate cost-drivers and make cost-reduction recommendations.
• In short, we need more transparency if we expect to maintain the integrity of our health care system.
• This brings me to an issue that has been getting a lot of attention since we announced the second phase of health care reform….
• The proposed gift ban.
• Let me be clear: No one is proposing to ban the efforts of pharmaceutical companies to educate doctors and nurses about new medical drugs.
• What we want to avoid is the perception of any influence that could lead to the unnecessary or improper marketing, prescription or use of a drug. (Oxycontin example)
• Education is important, but if we’re going to call for transparency, then everyone must be accountable.
• In addition to transparency, another major cost hindrance to our health care system is the failure to implement information technology systems.
• The Senate legislation requires statewide adoption of electronic health records by the year 2015, supported by $25 million a year from the proposed cigarette tax increase.
• We also propose a deadline of 2012 for statewide adoption of computerized physician order entry systems (CPOE).
• Updating these systems could save us hundreds of millions of dollars while also reducing the occurrence of medical errors.
• The Massachusetts Technology Collaborative says the statewide adoption of CPOE alone could save us $170 million a year and prevent 55,000 adverse drug events annually that result in patient injury or death.
• Uniform billing and coding – something Senator Spilka has worked very hard on – is another area where technology can save money. The current system for documenting services and processing claims is antiquated.
• Our proposed legislation sets a statewide standard for uniform billing and coding among health care providers and insurance companies to reduce administrative costs and promote significant savings.
• I would also like to bring more attention to the Determination Of Need process, which is addressed in the bill.
• The duplication of services and expensive technologies is a hindrance to the efficient use of health care resources and a major contributor to overall health care costs.
• Finally, we need to improve access to primary care. This is an essential part of the health care equation.
• The initial success of health care reform has brought people into the system much faster than we anticipated.
• There are now 300,000 newly-insured individuals, which means half of the Commonwealth’s uninsured are now in the system since health care reform began just two years ago.
• That’s an amazing accomplishment, but the shortage of primary care providers that existed even before the first phase of health care reform has created a real challenge.
• A recent physician office poll shows it is significantly more difficult to obtain a primary care appointment now than it was a year ago.
• Just half (51%) of all internists are accepting new patients, down from 64% in 2006 and 66% in 2005.
• The average wait time among internal medicine physicians accepting new patients is up to 52 days.
• The longer patients wait and conditions go untreated, the more likely they are to resort to expensive emergency room visits. This shouldn’t be the case.
• Re-establishing access to primary care is essential for managing illnesses efficiently.
• In order to address this problem, we propose to increase primary care access through various measures:
• First, we will establish a new Primary Care Recruitment Center to coordinate statewide primary care workforce activities;
• Second, we will expand enrollment at UMass Medical School for students committed to primary care;
• Third, we will authorize loan forgiveness programs and an Enhanced Learning Contract for UMass medical students who commit to providing primary care in the Commonwealth – Retaining the doctors we train is important since each year slightly more than half of our medical residents pursue the next step of their careers outside of Massachusetts.
• And, fourth, we will expand the role of nurse practitioners as primary care providers, and increase the number of physician assistants per doctor from two to four.
• Furthermore, by expanding the role of primary care providers into the “medical home” model for patients, we will expect to see better management of chronic illnesses, fewer hospitalizations and improved overall health.
I don’t understand the “individual mandate”the state knows people cannot afford the insurance so the answer is to fine them.The law should be recalled and the state must find out how many are uninsured,how many Doctors are available to them,how much it is going to cost,where will the money come from.Everything is backwards and rushed.The Commonwealth Connector is a waste of taxpayers money,you could start there.Why is the state punishing it’s own citizens?We did not create this mess and we should not have to suffer because of it.
Re “Are there any particular areas you would like to hear more about?” Yes, for starters these two things:
- we propose to hold public hearings for any insurance company that submits premium increases above 7 percent.
- These reviews will explore administrative costs, marketing costs, salaries, compensation packages and reserves.
Many MA citizens feel strongly that a Health System Public Hearing and Review process should take place for all the state’s not-for-profit public charity insurers and hospitals, not just ones that propose a future >7% rate increase.
This information is needed to provide a baseline on health system spending and to provide true transparency. Another benefit is that public hearings with detailed information will create a way for citizens to engage in health reform in an informed manner.
Any additional information that Commonhealth can provide on these two issues is of great value to your readers.
Coverage up, cost down? Pie-in-the-sky or down-to-earth? Federal or State?
A few observations on recent pieces of the conversation on health care reform at the state and federal levels: Sen. Ron Wyden continues to push his health reform legislation. He was hawking it last week at the AHIP meeting. (Matt
“the overall inflation rate (2.6 percent)”
If she thinks the overall inflation rate is “only” 2.6% and that income increases have exceeded inflation, she is definitely smoking something funny.
(1) Overall inflation rate basd upon the Federal fiscl year ending Oct.1,2007, was 3.5% as of August 2007/
The inflaion rate calendar year 2007 is looking like it will be around 4.1%.
The inflation rate for ‘core’ necessities (different from the Fed’s ‘core’ inflation) is much higher. This includes the basics such as food, heat, insurance premiums, and gasoline. It is far higher and in the 9-10% range with most of the cost being driven by food, heat andgasoline.
(2) Income gains of 3.7%? Maye for th etop 15%. Between 2003-2005, the top 1% of incomes had their after-tax incomes increase by 43.5% (that is NOT a typo.) During the same time period, the incomes of the botton 80-85% (households below $85,000) has an after-tax income gain of 3%.
All the income date as of Dec. 2007 showed that in the prior fiscal years, the median household incomewent up .1%. (And that is a LOT less than 3.7%!)
I am curious about how non-physicians understand the primary care shortage.
My patients are stilled surprised to learn that I am only paid for office visits. If I call the patient at home, coordinate care with their specialists by email or phone call, discuss difficult diagnostic and treatment decisions with specialists, coordinate the care with VNA after surgery, obtain urgent referrals, oversee medication interactions from a variety of providers, do prior approval forms for medications or radiology testing, and SPEND TIME talking to my patient -I am not reimbursed. My staff, who help communicate with and assist the patient in accessing care, do not get reimbursed. We only get paid to get you in out of the office “efficiently”. We use electronic records. We order on line. We are almost paperless. We monitor our work flow and strive to be as efficient as possible in every aspect of our daily operations. I have a great office but we are all penalized in this reimbursement “system” for being a good provider of care -whether it be in the office or on the phone.
Forgiving loans for medical students going in to primary care is an excellent idea. It will not help when 10 years into practice, they realize that this is the “the trenches” of medicine- what we applaude in this country is technology, procedures, high priced medicine; we do not respect and protect comprehensive, coordinated, continuity of care.
I strongly believe that costs for expensive testing and procedures can be greatly reduced if we increase the primary care and decrease the specialty care. I believe that patients will feel cared for and we can improve outcomes with better coordination and continuity.
But I fear that none will be “recruited” into this field without a comlete overhaul of how we allocate our resources in health care.
I noticed a few questions on earlier posts about the below issue that were never answered. Please provide more info. about this merger and why MA taxpayers are still subsidizing Harvard Pilgram, why it retains a legal status of a nonprofit public charity in MA despite being joined at the hip with the country’s largest for-profit insurer.
Harvard Pilgrim, UnitedHealth to Merge Networks
Aug 9, 2004
Harvard Pilgrim Health Care and UnitedHealth Group said they will combine Harvard’s regional network of doctors and hospitals with UnitedHealth’s national network in a partnership aimed at national, self-insured employers.
Combining Harvard Pilgrim’s network of 22,000 doctors and 130 hospitals in Massachusetts, New Hampshire and Maine with UnitedHealth’s national network will offer “a simplified administration and care management portfolio in a single, integrated package, the health care plans said in a news release.
The combined networks will be available for health services beginning Jan. 1.
“This alliance will provide significant value to people receiving their health benefits from large multi-location employers, as it builds on the strengths of our two organizations for their benefit,” said Charles D. Baker, president and chief executive of Harvard Pilgrim.
Minnetonka, Minn.-based UnitedHealth, the nation’s largest health insurer, is a for-profit company serving more than 55 million people nationwide through six operating businesses.
Welleseley-based Harvard Pilgrim is a nonprofit plan providing coverage in Massachusetts and Maine and is the parent company of Harvard Pilgrim Health Care of New England, which serves Vermont and New Hampshire.
Copyright 2004 Associated Press
http://www.insurancejournal.com/news/east/2004/08/09/44778.htm
Please tell me how the Senate bill provides immediate and necessary relief to all of us who:
a) are paying penalties because we couldn’t afford the insurance and now can’t afford to pay our bills but still have no insurance or
b) are having difficulty finding a PCP or specialist who will see Commonwealth Care members and when we finally do, we must travel long distances to and from our homes using precious gasoline to see a doctor we’ve never heard of.
The Senate bill is merely a bunch of fancy words in an effort to fool the population into thinking that something is actually being done to help people when, in fact, this sham “reform” is hurting, and will continue to hurt, at least one-half the uninsured in MA.
During the statewide NPR call-in on March 13, I asked Deval Patrick how he could call this a success when at least 300,000 are currently paying penalties. He responded by saying that even if ten people are being hurt, it’s not good, but we all have to pay. He wishes he could make it cheaper but can’t wave a magic wand; he doesn’t have a perfect solution. Yet, it’s a success because MA is doing something although it’s not perfect.
(Please note that the above is the Cliff notes version of the question and answer. However, I did jot down some of his reponses so these catchy phrases are accurate.)
So, to sum this up: It hurts some people and that’s not good but it’s a success. We must all pay even if we can’t afford to pay (the 2007 costs). Kind of tricky.
Do you have a plan that will enable us to afford to pay, sir, which you will be announcing publicly in the very near future?
Jane – Your perspective is SO valuable – thanks for contributing here. I’m a community health nurse who worked for 10 yrs with Boston VNA in the inner-city so I understand all too well what you describe. Home care nurses are in close ongoing communication with primary care providers and their staff and work as a team to plan, implement, evaluate, and coordinate ongoing care. Your comment stirred up so many thoughts…
Regarding your statement “what we applaud in this country is technology, procedures, high priced medicine; we do not respect and protect comprehensive, coordinated, continuity of care.”, I feel strongly that this statement doesn’t represent the average person in the US but it does represent what our government has let happen: unbridled corporate greed and profiteering in healthcare. The American people aren’t the cause of this, they’re the unwitting victims in our perverted system where the incentives are all backwards.
The American people are inundated with ads for all the things you describe, plus some of their doctors market these pricey technologies b/c it brings them higher reimbursements. Most people just want competent and caring clinicians with whom they can develop trusting relationships, be treated with respect and care, and can keep over time even if they change jobs, etc.
I think that most of the root causes of the severe health system problems we have are due to government allowing healthcare to be treated as a profit-generating commodity instead setting rules to make sure it is treated as a public good. It’s crazy-making what the people of this country put up with our wasteful mess of a system! It’s the biggest rip-off going in the country, after the Iraq war.
If we had a system of not-for-profit social insurance where the government collected the monies from all of us in an equitable manner and paid the bills promptly (akin to an improved Medicare-For-All program on the state or nat’l level), we could REDUCE health care spending while at the same time guarantee everyone care across their lifetime. We could finally do quality improvement and oversight in a much more effective way, too. Learn more at http://www.house.gov/conyers/news_hr676.htm
We need more and more people to look around and see that in every other industrialized nation – all of them – there is a program for national health care. And that each of these countries spend about half as much per person as we do in the U.S. and get much MORE care for their money and have BETTER HEALTH outcomes. Do people ever wonder “Why is the United States of America the only country whose government denies its people this most essential and fundamental human right, the equal right to good health care?” (While so much of our money goes for “health care spending”.)
It’s so outrageous that it’s pathetic that we put up with the broken wasteful system we have and that we accept as “reform” the tinkering changes such as Chapter 58 that DOES NOTHING to address and remedy the causes of the problems. (I guess Americans just have very very low expectations of our leaders, look what else we’ve put up with – both on Beacon Hill and in Washington…).
Under the healthcare as commodity model almost everyone is forced – not of their free will – to agree to a large portion of their healthcare dollar being skimmed off and diverted away from care by profit-driven middlemen (insurers).
When will we say “No more of this wasteful inhumane mess of a so-called health care system. We deserve better and we demand better.” and will we mean it?
I propose a ban on all drug advertisements (printed, radio or TV – even billboards) in this state.
I also propose a ban on all ads for hospitals, doctors and especially INSURANCE COMPANIES.
These cost money. Lots of money. Do they work? They may work for the business model, but they don’t help the patient. When they are able to be charged off as an operating expense, the cost is simply passed off to the person who ultimately foots the bill – the citizen.
This money is derived from the pockets of patients who need medical care, not the gaggingly enticing public promotions for some product or service.