health policy commission


Another Historic Health Care Move In Boston: Saying No To Biggest Hospital System

Massachusetts General Hospital , one of the hospitals in the Partners Healthcare system. (Wikimedia Commons, 2006)

Massachusetts General Hospital, one of the hospitals in the Partners HealthCare system (Wikimedia Commons, 2006)

Even if you don’t follow sports, you surely know about the Super Bowl. And even if you don’t follow the health care business, you may want to note a judge’s bombshell decision that has just hit the sector in Massachusetts. It may affect your hospital bill someday.

The news: A superior court judge has rejected a deal that would have let the state’s biggest hospital system — Partners HealthCare, which includes academic giants like Massachusetts General Hospital and Brigham and Women’s Hospital — expand.

Partners had been seeking to acquire at least three more hospitals, and had agreed to price caps and other limits that would hold for six-and-a-half to 10 years. But Suffolk Superior Court Judge Janet Sanders concluded that letting Partners expand would not be in the public interest; it “would cement Partners’ already strong position in the health care market and give it the ability, because of this market muscle, to exact higher prices.”

If you get too big, as Partners has become, it sort of destroys the concept of a competitive marketplace.

– Health Policy Commission Chair Stuart Altman

To sum up the last decade of Massachusetts health care history in one paragraph: First, the state passed groundbreaking health care reform that presaged Obamacare. But though that reform meant that virtually everyone had health insurance, it didn’t “crack the code” of health care costs, which kept rising. The state created a Health Policy Commission, which was meant to keep an eye on costs among other things. When Partners, which the Boston Globe reports already has $11 billion in revenue, sought to expand, the commission concluded that the expansion would increase health care spending in the state by $39 million to $49 million a year. Partners opponents pushed back, and now the judge has sided with them.

Dominant hospital systems exist in areas around the country; the New York Times has written repeatedly about their tendency to lead to higher costs for patients, including here — 2 Hospital Networks Agree To Merge, Raising Specter of Costlier Care — and here: The Risks of Hospital Mergers. The main risk: The market power of big hospital systems means they can negotiate for higher prices from insurers, prices that tend to be passed down to consumers.

It remains to be seen whether this is an important new national precedent. But we cannot help but note that Massachusetts has certainly set important health care precedents in the past. WBUR’s Martha Bebinger offers a rich, full report of the judge’s landmark decision here, including this memorable quote from Stuart Altman, chair of the Health Policy Commission:

“If we’re going to have the cost of health care grow at a more normal rate, we need to have enough competition in the marketplace so that no part of the system can dictate prices,” said Stuart Altman, chair of the Health Policy Commission. “If you get too big, as Partners has become, it sort of destroys the concept of a competitive marketplace.”

Judge Sanders also wrote in her opinion that the deal would be too difficult to enforce, and offered some examples, Martha Bebinger reports: Continue reading

Mass. Health Numbers: Over $14B Wasted, Teaching Hospitals Huge

Source: Health Policy Commission

Source: Health Policy Commission

Health wonk heaven! The state’s new Health Policy Commission has just released its full report on Massachusetts health costs, and it’s full of numbers one can hang one’s analytical hat upon, here in the state with the highest costs in the nation.

You could say, “Well, we already knew that plenty of health care money is wasted,” and “We already knew that some hospitals are more cost-efficient than others,” to which I would reply, “Yes, but did you know how much, in Massachusetts?”

Here are a few data points from the report that struck me:

  • By 2011, Massachusetts Medicare patients used major teaching hospitals for 40 percent of their hospitalizations, compared with a 16 percent rate nationally.
  • Even after adjusting for the varying complexity of needs of patients treated by each hospital and for different regional wage levels, hospitals with higher levels of operating expenses spent 23 percent more to provide the same services than those with lower levels of operating expenses.
    Continue reading

Globe Scoop: Health Commission To Advise Against Partners Expansion

Have we entered a new era of tough hospital oversight?

That’s one possible takeaway from a Boston Globe report today that says the state’s new Health Policy Commission will — in a “a rare rebuke” — advise against an ambitious expansion plan by hospital system Partners Healthcare. The proposed acquisition of South Shore Hospital by Partners would “push up patients’ costs and stifle medical care competition in the region,” the Globe reports.

More from the story, by Rob Weisman:


A report by the year-old Massachusetts Health Policy Commission details what might happen if Partners is allowed to acquire the 378-bed Weymouth hospital and a Partners-owned physicians group absorbs Harbor Medical Associates, which has 65 doctors on the South Shore.

It concludes Partners’ South Shore moves would not only increase premiums for consumers and employers and weaken rival providers, but also threaten the state’s ability to hit its overall target for holding down medical spending, according to several people briefed on the findings. Those people spoke on condition of anonymity because the report is not yet public.

The commission, created under the state’s 2012 cost containment law, lacks the authority to block Partners’ moves, but its findings come at a critical time for other regulators who do have that power.

Partners spokesperson Rich Copp said his organization had not yet seen copy of the Commission report, which he stressed is “preliminary.”

But he said: “This preliminary report creates an opportunity to begin a meaningful dialogue with the Health Policy Commission around our vision to reduce health care costs.” Continue reading

Another Hospital Deal Raises Red Flag Of Rising Costs

(Courtesy of the hospital)

Winchester Hospital (Courtesy)

You may have missed Lahey Health‘s plan to acquire Winchester Hospital in the current swirl of Massachusetts hospital deals. But it caught the attention of the state’s Health Policy Commission, which has the authority to review, but not stop, ownership changes that may increase health care costs. The commission is supposed to make sure health care spending does not grow faster than the cost of other goods and services.

Commission staff told Lahey late Friday that they would conduct a full cost and market impact review of the Winchester deal. Here’s commission Director David Seltz on why:

The health care market in the North Shore has grown more concentrated in recent years. The Winchester Hospital acquisition will continue this trend, and raises the potential for Lahey (in Burlington) to leverage higher prices through joint contracting with Winchester. Additionally, the transaction could affect health care costs and market functioning in other important ways. For example, total medical expenses could increase if Winchester Hospital redirects care from its current clinical affiliate, Tufts Medical Center, to the generally higher-priced Lahey. We also recognize opportunities for cost savings as Lahey’s physician prices are lower than Winchester’s current contracting affiliates.

Lahey responded with this statement:

We respect the process that the Health Policy Commission has in place and we look forward to demonstrating to the Commission how Winchester Hospital’s affiliation with Lahey Health is anticipated to improve care and care coordination while reducing current, overall health care costs by increasing the amount of care delivered in the community and community hospital setting.

The commission has let several mergers and acquisitions continue without worry that they will raise costs, including a Beth Israel Deaconess Medical Center/Jordan Hospital deal. Continue reading

Mass. Health Cost Watchdog Says Partners Merger Raises Red Flags

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

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:


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?