Outgoing Tufts Medical Center CEO Ellen Zane
Last week at the state cost-trend hearings, outgoing Tufts Medical Center CEO Ellen Zane proposed a radical idea: a “common fee schedule across all health plans.” We asked her to expand on it, and she does so below, clearly and with some deliciously frank turns of phrase, such as: “There should be no more special deals outside of the base fee schedule, which I have always described as ‘bags of cash’ funneled through to hand-picked providers through various schemes.”
The hearings on providers, payers and costs last week were enlightening for what they showed about the attitudes of different participants in the market. Overall, I think providers showed they are willing to lead major changes in how they provide care and how they are paid for it.
I would like to see a similar willingness to change on the part of insurers, and in my testimony at the hearing I briefly touched on what I think some of those changes should be. I believe these changes could eliminate millions of dollars in administrative costs. If all insurers could agree to – or were required to – apply one set of rules to the way they pay providers, we would have millions more available for patient care or reducing premiums.
Let’s start by examining the premise that insurance companies always put forward: that only 10 percent of the health care dollar goes to administrative costs. That only looks at insurers’ administrative costs – it ignores the millions upon millions that providers pay to interpret the myriad insurance rules that determine how much we are paid for each service.
Imagine a sport in which players were expected to adapt to a totally different rulebook every time they played in a different stadium – and that over the course of a season they played in tens, if not hundreds, of different stadiums. On top of that, imagine the referees are entitled to change the rules in the middle of a game. That’s what it’s like for providers trying to interpret how to bill insurers. To keep up with all this takes football fields of billing folks (just to extend the sports analogy) at my hospital, and at every other hospital in the state.
So how do we create a more level playing field? First of all, I proposed the establishment of a base fee schedule for all of the many services provided by doctors and hospitals. Continue reading
Outgoing Tufts Medical Center chief Ellen Zane proposed this intriguing idea yesterday for a potential fix to the huge variation in prices between hospitals, one of the drivers of ever-rising health costs:
“I fundamentally beieve a real fix in this market is to have a common fee schedule across all health plans. Not that we’re all rate- setting. We’re not talking about intense rate-setting. But that fee schedule should be moderated with inflators in private negotiations, not state-run negotiations, private negotiations.
So perhaps the hand of the state could come in and develop a foundation that’s transparent, that we all know the basis of, that isn’t different from health plan to health plan. And then in our private negotiations [we talk about reasons to raise prices from baseline] — whether it’s the fact hat we have a high Medicaid population or a high case mix or a teaching mission — all of which are legitimate variations in price.
So rather than talking about what’s fair and not fair, we ought to do it more scientifically, and we ought to do it more transparently, so that we have a common understanding that’s irrefutable and then we inflate it based on who we are, what our quality is, what our mission is and so forth. And there’s been a resistance to even thinking about that and I frankly don’t know why.”
Readers, why do you think? And how do you like this idea?
Ellen Zane, the president and CEO of Tufts Medical Center, is mobilizing hundreds of replacement nurses and is prepared to put them to work if Tufts nurses authorize a strike later this week, The Boston Herald reports.
Zane is taking a page from President Reagan’s anti-union battle book, lining up hundreds of out-of-state replacements for anyone who might dare to go on strike in an increasingly bitter union-management fight.
On Thursday, Tufts’ 1,110 nurses will vote on whether to authorize a strike. Their contract expired in December.
Zane yesterday called the Massachusetts Nurses Association’s threat of a hospital strike “reprehensible.” MNA spokesman David Schildmeier shot back that Zane’s threat to use replacements is “obscene.”
Zane told the Herald she’s contacted out-of-state nurses and is prepared to spend up to $4 million hiring at least 200 to keep Tufts open during what she’s classifying as a “very, very likely” work stoppage over a dispute about how many patients each nurse serves. The union wants a limit of four per shift — a demand Zane said could cost another $33 million a year.
Outgoing Tufts Medical Center CEO Ellen Zane
This just in from Tufts Medical Center:
Tufts Medical Center CEO Ellen Zane to retire in September; Search for New CEO Planned
Zane and team credited with transforming the academic medical center
Zane will serve as a Vice Chairman of institution’s Board of Trustees
BOSTON (Feb. 17) – Ellen Zane, president and CEO of Tufts Medical Center and Floating Hospital for Children for more than seven transformative years, announced today that she will retire from her current role in the fall. Zane will continue to consult with the hospital for a year after her retirement and will serve as a Vice Chairman of its Board of Trustees. The Board of Trustees will begin a comprehensive search for a new CEO to lead the organization into a new era.
“While I look forward to enjoying retirement, this decision is a bittersweet one for me,” Zane said. “I am so proud of what my team and I have accomplished at Tufts Medical Center. I have loved leading the Medical Center and working with the incredible doctors, nurses, administrators, researchers and staff members here. I have never worked with a more dedicated group of people in my career. This decision is far easier because I know we have excellent staff and leadership who will continue to provide a strong direction for this indispensible institution. I look forward to the remaining months of my tenure as CEO and to continuing to provide advice and guidance to the leadership here.”
Over the course of her tenure, Zane pulled Tufts Medical Center back from fiscal crisis and returned it to financial stability. She strengthened its relationship with Tufts University, established its community physician network which now includes 1,500 doctors, and launched its Distributed Academic Medical Center™ model which partners with community hospitals to keep more care locally in the community. Under Zane’s leadership, the hallmark of Tufts Medical Center has been the high-quality care it provides to its patients, the most medically complex patient population of any full service acute-care hospital in the Commonwealth. The Medical Center does so at a lower cost than its academic medical center competitors, providing immense value to patients, employers and the health system as a whole. Zane is the first woman to serve as CEO in the 215-year history of the hospital, which was founded by Paul Revere and Samuel Adams, and is one of the oldest medical institutions in the nation.
The full announcement is here, but here are a couple of particularly interesting chunks: Continue reading