Major teaching and research hospitals in Massachusetts are worried about two elements in the national health reform debate. One…how the federal government will continue funding for medical education. Two…the suggestion that higher Medicare payments to hospitals with higher health care costs (such as Massachusetts) aren’t justified.
Those who favor reducing Medicare payments to help reign in health care spending routinely cite this research from the Dartmouth Atlas Project. The Massachusetts Hospital Association says the Darthmouth analysis ignores “underlying demographic and cost-of-living” differences and does not recognize “added costs of educating the next generation of physicians.” The Massachusetts delegation relayed these concerns to the House chair of Energy and Commerce in this letter.
Amid the talk about high health care costs in Massachusetts, this chart is interesting:
Click to enlarge.
This is from the state’s Division of Health Care Finance and Policy (DHCFP). It’s based on data from the Centers for Medicare and Medicaid Services (Office of the Actuary, National Health Statistics Group, 2007). The $63 billion estimate for health care spending this year is 16.3% of the state’s GDP (based on the predicted national GDP growth rate from Bureau of Economic Analysis, US Department of Commerce, also calculated by the DHCFP). Health Care spending is expected to be nearly 18% of the national GDP this year.
Martha Bebinger
I see this a framing problem rather than an economic one.
Teaching hospitals do likely cost more than others due to myriad of factors.
As a product of the Boston teaching hospitals, I think these organizations should frame their position as an opportunity.
Teaching hospitals have a excellent opportunity to lead innovation in health care. They have a surplus of young innovative minds and willing workers. Right now, and even more so outside of the fee for service framework, teaching hospitals can be factories for scalable innovation.
In my opinion the true problem is a hidden one. Too much health care research is focused on determining causality rather than improving outcomes. Knowing why does not necessary translate to how. If teaching hospitals reframe their innovation and research directions toward outcome improvement they can bring out innovation that can benefit them and the rest of the society.
Evan Pankey
twitter @epiStoic
The ‘innovative’ idea of a ‘pay for value / outcome’ pack came after the CBO had previously pointed out this health care reform wouldn’t work without ‘fundamental’ change in the out of date system. It is said that as much as 30 percent of all health-care spending in the U.S. -some $700 billion a year- may be wasted on tests and treatments that do not improve the health of the recipients, and this 700 billion dollars a year can cover a lot of uninsured people.
The expected Benefits of this ‘innovative idea’ are as follows ;
1. Meet the objective of revenue-neutral.
Supporters of the agreement say it could save the Medicare System more than $100 billion a year and ‘improve’
care, that means more than $1trillian over next decade, and virtually needs no other resources including tax on the
wealthiest. Supposedly even the ‘conservative’ number of such savings might be able to meet the objective of
revenue-neutral.
2. Quality and affordability.
If you are a physician, and your pay is dependant upon your patient’s outcome, you will most likely strive to
prescribe the best medicine earlier in the process, let alone skipping the wasteful, unnecessary treatments.
3. No intervention in decision-making.
The innovative idea of ‘a pay for outcome’ will more likely prompt team approach and decision, as at Myo clinic.
Under the ‘pay for outcome’ pack, for good reason, best practices as ‘recommendations’ would simply help them
make a better decision, and the government won’t still have to meddle in the final, actual decision-making
process as a non-expert.
4. Speed up the introduction of IT SYSTEM.
The pay for ‘Outcome’ pack is most likely to expedite the introduction of Health Care IT SYSTEM.
The synergy effect of the combined Health Care IT & a pay for ‘outcome’ system may allow the clinicians to
‘correctly’ diagnose and effectively treat a patient earlier in the process so that it can measurably scale back the
crushing lawsuits and deter the excuse for unnecessary cares to make fortunes.
5. Accelerate the progress in medical science, in return, it saves more cash.
6. Settle the regional disparity.
7. Reduce the emergency room visits & save immense costs.
Public health insurance plans such as Medicare and Medicaid paid for more than 40 percent of U.S. emergency
room visits in 2006, according to government figures released recently. Many experts say reducing these hospital
visits would be an important way to lower the enormous, and growing, expense of U.S. health care.
I share the opinion that unlike the insurer-friendly senate plan by ’some’ members, only a strong public option will be capable of getting the premium inflation under control and saving the U.S in turbulence.
To my knowledge, a dual system tends to deliver better results than a pure single payer system. Supposedly, to be or not to be might be up to the innovations like a pay for value program, otherwise, the forthcoming start-ups may fill the void with competitive deals. The competition based on ‘fair’ market value would be a beauty of true capitalism, not monopoly, an objective for anti-trust.
Thank You !
[...] our Congressional delegation for championing this important effort on behalf of all Americans. (See Martha Bebinger’s Aug. 4 post on why some hospitals are worried about two particular elements of the national health care reform [...]