global payment


Patrick At Health Cost Trend Hearing: 7 Points, New Subtleties

Rachel Zimmerman reports:

Gov. Deval Patrick, speaking today at the 2011 Massachusetts Health Care Cost Trends Public Hearing, pretty much stuck to his theme that the second phase of health reform is coming, like it or not, and without effective solutions for containing medical costs, no economic recovery will stick.

There were a few new subtleties in Patrick’s testimony, however. First, he didn’t mention the term “global payment” in his remarks. (He told reporters later that accountable care organizations and global payments were basically interchangeable concepts, so his not mentioning global payments was not significant.) Still, his non-mention comes less than a week after Attorney General Martha Coakley issued a report saying that so far, global payment agreements have not brought costs down and are not likely to do so any time soon.

Also, Patrick said that he wants to highlight the fact that the insurance commissioner should have “explicit” authority to deny premium increases if they are based on inequitable reimbursement rates to providers. He also reiterated that he wants a bill passed this fall.

Here, edited and condensed, are seven points the governor made:

1.The cost of health care is going up at an unsustainable rate. Fixing it is “an urgent challenge… failing to do so will threaten our economic recovery.”

2. We’ve already made progress: 99.8 percent of children in Massachusetts are insured and 98 percent of adults now have health insurance following the 2006 reform law. Patrick said that more private companies are offering insurance, and insurance can’t be pulled when a person gets sick. “It’s affordable,” he said. And “it stands as a value statement: health is a public good, everyone deserves access.”

3. There’s an emerging consensus on solutions on how to contain costs. “Whole-person care” works, and moving away from fragmented, fee-for-service care is imminent. Continue reading

Massachusetts Attorney General Drops Health Reform Bombshell

By Carey Goldberg and Rachel Zimmerman

“Our examination found that paying providers on a global basis has not resulted in lower total medical expenses.”

It’s just a short, no-frills sentence, but it amounts to a bombshell dropped on a central tenet of the Massachusetts governor’s plan for the next phase of health reform.

That finding anchors a report issued this morning by state Attorney General Martha Coakley. And it appears to contradict Gov. Deval Patrick’s argument that shifting to global payments is a key to “cracking the code” of ever-spiraling medical costs.

The attorney general also found that wide price disparities unrelated to the quality of care still persist from one Massachusetts hospital to another, largely dependent on the providers’ clout in the marketplace. And the report unearthed a counterintuitive trend: residents from the richest zip codes in the state are spending on average far more on health care than people living in poorer neighborhoods. Yet premiums vary little, so in effect, it appears that lower-income people are subsidizing the care of the wealthy.

Global payments are supposed to re-align doctors’ incentives and put a stop to the rise in costs. Under such a global system, instead of being paid for each specific treatment, health care providers are put on an overarching budget for every patient. At the end of a year, if they’re within the budget and meet quality standards, they can win bonuses; if not, they risk penalties. The Patrick administration and private insurers have been pushing doctors toward this model, saying it leads to better, thriftier practices.

But Martha Coakley says: “Our investigation shows that a move to global payments is not the panacea to controlling costs.” The attorney general’s report suggests that in fact, thus far, care has tended to end up costing more under global budgets rather than less. Continue reading

How Exactly Did The Mass. Medical Society Vote On Payment Reform?

If you read just the Boston Herald headline this morning — “State docs’ group gives the nod to new health care payment plan” — you might get the impression that the 23,000-member-strong Massachusetts Medical Society had just resoundingly approved a radical payment reform plan for the state.

Wrong impression, says MMS spokesman Richard P. Gulla. He sent along this clarification:

Waltham, Mass. – Dec. 6 – Press reports in today’s [Monday, December 6] media that have incorrectly indicated that the Massachusetts Medical Society has endorsed the state’s proposed global payments system of health care provider reimbursements require clarification.

The policy adopted by the MMS House of Delegates at its Interim Meeting December 3-4 was not an endorsement by the Society. The resolution adopted by delegates said that accountable care organizations (ACOs) should merely be one option along with other approaches to health care financing.

The Massachusetts Medical Society still has deep concerns about the viability of ACOs. While we recognize that some ACOs have already been established and are proving successful, MMS believes it remains an untested means of health care financing and can pose unintended consequences that can impair the physician-patient relationship and affect the viability of physician practices. Additionally, many legal issues exist for those physicians considering moving into ACOs.

The current policy of the Society states that the Massachusetts Medical Society encourages a pluralistic compensation system to include fee-for-service, salary, and limited pilot studies that utilize global payment system.

Not to Herald-bash, it was mainly the headline that might mislead; the text of today’s story did seem to get the facts from the meeting basically right: Continue reading