health reform 2012


Is This Chelmsford Doctor A Model For The Nation?

Dr. Damian Folch runs his first half-marathon.

Dr. Damian Folch runs his first half-marathon.

Do you think Dr. Damian Folch, a primary care doctor in Chelmsford, is a model for the nation? You can vote on that here at The Los Angeles Times.

Oh, wait, you want to know how he might be a model? Well, he definitely has my vote when it comes to practicing “Lifestyle Medicine,” tackling his patients’ unhealthy lifestyles and getting them to exercise more. (Check out that story from earlier this year here.) But now The Los Angeles Times features Dr. Folch in “A shift in how care is paid for.” It’s an excellent explanatory piece about the shift away from “fee for service” medicine — paying doctors for each bit of care — and toward “global payments” that pay doctors for a patient’s overall care — and rewards them for keeping the patient healthier and costs lower. That shift is happening more systematically here in Massachusetts than anywhere else, the piece says.

It begins:

CHELMSFORD, Mass. — It’s hard work being one of Dr. Damian Folch’s diabetic patients.

If a lab test shows high cholesterol, Folch is quick to call or email. No patient can leave the office without scheduling an annual eye exam, a key preventive test. A missed exam or an appointment leads to another call.

“We are a real pain in their necks,” joked Folch, a primary care physician in suburban Boston. “We track them down.”

That kind of attention has always been good medicine. For Folch, 59, it’s now good business. He is among thousands of physicians in Massachusetts whose pay depends on how their patients fare, not just on how many times they see them. If patients stay healthy and avoid costly medical care, he gets more money. Continue reading

Are We Lowering Health Costs Or Just Shifting Them To Consumers?

“You guys on Beacon Hill back off, the market is working.” That’s the message, more or less, from most hospitals and some business leaders to the House and Senate — particularly to the House, which takes up its health care cost bill tomorrow.

The evidence of market success? Hospitals are agreeing to contracts with lower rates of increase and insurance premiums are rising at their lowest rate in five years. A few employers are actually reporting a cut in premiums.

Why are premiums down and why are hospitals able to take a lower increase than in recent years? I haven’t seen much firm evidence that answers this question. But the latest report from the state’s Division of Health Care Finance and Policy has some important analysis on the premiums question.

"Massachusetts Health Care Cost Trends: Premiums and Expenditures" Division of Health Care Finance and Policy

Take a look at the far right column on this chart and note the premium increase in 2010 when “adjusted for benefits.” If you put back all the costs that have shifted to members (higher co-pays, deductibles, co-insurance, etc.), premiums in 2010 would be rising at almost the same rate they have for the last decade or so. In healthcare-speak, this is called “benefit buydown.” The market is producing lower premiums, but it is because patients are paying more health care costs on their own.

When I contacted the Division to see if I was reading the chart correctly, they sent a statement with a more nuanced view:

The data that the Division has collected indicates that benefit buydown is a likely contributor to the recent decrease in premiums. Other contributors include a decreasing trend in medical claims expenditures, reflecting lower utilization (likely related to the recent recession).

I called a few people to get their reaction. Continue reading

Revised House Health Costs Bill Is Out

This is an updated version of the story. For more on the latest House bill and comparisons with the Senate version, click on the audio bar on the right.

On Beacon Hill, the House has made few changes to a health care cost control bill despite intense pressure from hospitals and some business leaders.

When the House released a draft of the bill earlier this month, critics said it would put the state’s golden goose — its health care system — at risk. They objected to the health care spending target and to a penalty that expensive hospitals would have to pay if they can’t prove they have higher quality. Rep. Steve Walsh said the spending target and that penalty are still in the bill.

“It’s a disingenuous comment to suggest that asking people to show their quality will kill the golden goose,” said Walsh, the House point-person on the health costs bill. “We have the best systems in the world, I think they’ll continue to be the best but as President Reagan said, ‘Trust but verify.'”

The House makes one significant revision in the bill. The new entity that would set guidelines and monitor compliance with required changes would be within the Executive Office of Health and Human Services. But it would still be independent, as is the Group Insurance Commission.

Walsh won praise for his efforts to craft reasonable solutions from the Greater Boston Interfaith Organization and the state’s largest physician group, Atrius Health. Continue reading

Breaking: Mass. Senate Passes Historic Health Care Cost-Cutting Bill

5/18 Update: WBUR’s Martha Bebinger has a feature report on the bill’s passage.

Original post: Here’s the full, unedited press release:

Senate Approves First-In-Nation Payment Reform Bill

BOSTON – Crunching through 265 amendments during two full days of public debate, the Senate on Thursday capped a framework of nation-leading health care reforms with landmark cost-control legislation that will save the Commonwealth $150 billion in the next 15 years while improving the quality of care and increasing the transparency and accountability of the state’s entire health care system. The bill passed 35-2.

Health spending is projected to double from 2009 to 2020, outpacing both inflation and growth in the overall economy. Massachusetts residents, businesses, and state and local government continue to struggle with increasing premiums and other health care cost sharing.

“The most important goal of this legislation is to reduce the cost of health care while providing access and quality outcomes,” Senate President Therese Murray (D-Plymouth) said. “Massachusetts spends 15 percent more per person on health care than the rest of the nation and 40 percent of our state budget is spent on health care. This bill will reel in health care costs, without harming our number one industry or patient care, and remove a major roadblock to long-term job growth and essential investments in education and transportation.”

“The Senate today took bold action to address one of the most serious threats to our economic recovery and strength, and did so in a thoughtful and deliberate manner,” said Sen. Richard T. Moore (D-Uxbridge), lead sponsor of the bill. “This proposal will result in billions of dollars in savings for consumers and small businesses across the Commonwealth, and it will ensure that patients receive the highest quality of care which they expect and deserve. The Senate recognizes the importance of our innovation economy, and sought to pursue reforms in a collaborative manner with those stakeholders responsible for implementation. This legislation completely alters the landscape of our deliver system, and does so with a desire to seek the greatest value at the most reasonable cost for the residents of the Commonwealth.” Continue reading

Patrick: Use Anti-Trust Laws To Fix High Hospital Prices

WBUR’s Martha Bebinger reports:

I’ve been waiting to hear from Governor Patrick on one of the most controversial health care cost control issues on Beacon Hill: what to do about hospitals that charge three, four or five times more for an MRI (and hundreds of other services) with little or no difference in quality.

Two reports from Attorney General Martha Coakley and at least two from the Governor’s administration (the latest here) say that inflated prices based on the market clout of major teaching hospitals are a major factor driving health care costs in Massachusetts.

Governor Deval Patrick addresses members of the Greater Boston Chamber of Commerce Photo courtesy of the Chamber

Now we have some insight into the Governor’s position on this dicey problem. During a Greater Boston Chamber of Commerce breakfast Tuesday, the Governor was asked whether he wants a provision in the final health care costs bills from the House and Senate that would deal with what’s often called “price disparities” among hospitals? The Governor framed the problem as one of “market clout” and said dealing with the market clout of top Boston hospitals is in the hands of AG Coakley.

The AG, said Patrick, “has tools today to address these imbalances and we have to look to her office to use those tools.”

I called Patrick’s office to clarify. What “tools?” An aide says the Governor was referring, loosely, to the AG’s ability to file anti-trust charges against hospitals. Continue reading

The Ancient Rome Angle On Mass. Health Reform, Circa 2012


The emperor Diocletian (

Boston Globe columnist Jeff Jacoby is often too caveman-ish for my taste, but he certainly gets erudition points today for comparing Gov. Deval Patrick to the third-century Roman emperor Diocletian.

In a column headlined “On health care, state doesn’t know best,” he describes Diocletian’s “famous” (I guess to everyone but me) “Edict on Prices.” It “established price ceilings for a wide range of goods and services,” and it totally backfired, leading to hoarding, black-marketeering, speculation and a general economic worsening. Now to the proposals afoot to contain rising health costs in Massachusetts:

These bills aren’t written in Latin and they don’t impose the death penalty, but their core principle is not much different from Diocletian’s: The state knows best. What fraction of the local economy should health care consume? How fast should medical spending rise? On what business model should provider networks be organized? How should hospital and doctors fees be calculated? Where should consumers get information on quality and cost of care? When are a provider’s high rates justified? What penalty should it bear when they aren’t? In the world these plans envision, decision after decision comes not through the voluntary interplay of doctors, patients, hospitals, and insurers, but from government agents who impose them from above.

And his conclusion: “Price controls invariably make economic problems worse. It was true in Diocletian’s Rome. It’s no less true in Deval Patrick’s Massachusetts.”

There are already some thoughtful comments, both agreeing and disagreeing, below the column on the Globe’s site here. Including: Continue reading

Berwick On Mass. Health Reform: More Pain, More Gain

Dr. Donald Berwick, former Medicare chief

I don’t know about you, but when my dentist says that I’m about to experience some “temporary discomfort,” I know what that really means is, “Hang in there, this is going to hurt like heck.”

In the Boston Globe, Dr. Donald Berwick, the widely admired former chief of Medicare and one of the nation’s leading health policy mavens, has just weighed in on the competing proposals for cost-cutting reform in Massachusetts. He argues in favor of aiming for more ambitious cost-cutting targets: The House’s tougher goal rather than the Senate’s less ambitious one, or even the still-tougher target put forth by business and religious groups.

I must say that what struck me most in his essay were the repeated references to pain for a good cause. Massachusetts needs “large-scale changes in delivery that will be temporarily uncomfortable for most providers.” Government must step in because “The changes are just too hard for most to face.” And “Undoubtedly, this transition will be wrenching.” I’m left wondering: Is there a political equivalent to Novocaine?

The whole piece is an important read but here’s an excerpt: Continue reading

Health Reform 2012: Hello, How Much Will My Care Cost?


“Hello, is this the state medical care price line? My doctor says I need to get a mammogram, and suggested I go to XYZ imaging center. I have ABC insurance. Could you please tell me how much that will cost me? $200? Okay, thanks very much.”

Not exactly how things work now, is it? But as the Massachusetts legislature works toward the next, cost-cutting phase of health reform, both the House and the Senate proposals envision a toll-free number and online information for patients who want a sense in advance of how much their care is about to cost.

Costs of Care founder Dr. Neel Shah

Costs of Care founder Dr. Neel Shah

I asked Dr. Neel Shah, founder and executive director of the Boston nonprofit Costs of Care, what he thought of the legislative proposals. He was just coming off a night shift for his day job, as a senior resident and soon-to-be chief resident in Obstetrics and Gynecology at Brigham and Women’s Hospital, but he kindly shared some thoughts, reacting in part to chunks of the draft bills that talk about price disclosure (see the bottom of this post.) Our conversation, edited:

Judging by the draft bills released in the last few days by the House and Senate, you’re about to get your wish: Medical costs in Massachusetts are likely to become much more transparent to patients. Is that true?

A; Well, I’m cautiously optimistic. I think it’s important to keep our eye on the overall goal of the legislation, which is to improve the value of the care we’re delivering and help us get more bang for the buck.

There are a lot of different parts of the bills. None of them is a silver bullet solution but they’re all important steps. The cost transparency part of the bill gets us part of the way there.

What do you mean?

First, a disclaimer: I’m not pessimistic about this. But to speak more broadly for a minute: Every year, in our essay contest we get dozens of anecdotes from all over the country that illustrate how difficult it is for patients to find out what their care will cost. It’s really hard on patients, and for physicians it’s not any easier. Continue reading

House Vs. Senate Health Reform Plans: Let The Comparison Shopping Begin

shopping carts

The Massachusetts House released its plan for cutting health costs on Friday. The Senate is releasing its own plan today. And now begins the public “compare and contrast” period, the ingathering of input that could influence the final bill that the legislature is expected to pass this summer.

Let us commence. This just came in from the Greater Boston Interfaith Organization, which has been campaigning for lower health costs:

GBIO is grateful to the Senate for their inclusion of the public health prevention trust with much needed funding. We all know that prevention saves lives and dollars.

With respect to the the TME spending target, GBIO supports the House version of the legislation. We estimate that the House target saves employees and employers an additional $11-12 billion over ten years, compared to the Senate version. We will be urging the legislature to adopt the House’s version of a TME spending target.

Translation: The House plan proposes a somewhat tighter cap on overall health spending, saying it should grow at a slightly slower rate than the state economy. The Senate version allows health spending to grow at a rate equal to or slightly above the state economy’s.

In contrast, Liz Kowalczyk’s extremely excellent Boston Globe story on the Senate plan includes this reaction:

Michael Widmer, president of the Massachusetts Taxpayers Foundation, said the House bill goes too far. The Senate’s spending benchmark “strikes a better balance than the House between the need to squeeze cost out of the health care system without damaging the state’s world renowned health care sector,’’ he said. Continue reading

Mass. Senate Health Cost Bill: Mostly ‘Darn Similar’ To House Plan

By Rachel Zimmerman and Carey Goldberg

The Massachusetts Senate today released its version of a sweeping plan to control health care costs. And guess what? It’s pretty close to the sweeping plan the House released last week. Both emphasize preventive care and wellness. Both place a specific cap on the growth of health spending linked to the growth of the state economy. And both envision shifting more care into systems that put doctors on a budget instead of paying per procedure.

In the details, the Senate plan may be slightly more business-friendly: There’s no “luxury tax” on pricey hospitals that fail to justify their high costs, and there are more references to “market-based” solutions as opposed to government interventions.

The Senate’s cap on health spending is also slightly less restrictive. (Until 2015 it’s set to be equal to the projected growth of the gross state product plus 0.5%. From 2016 to 2026 it’s equal to the projected growth in the state’s GSP and from 2027 and beyond, it’s the GSP plus 1.0%. The house plan proposes GSP minus 0.5% beginning in three years.)

The House and Senate health cost plans ‘look pretty darn similar to me.’  — MIT economist Jonathan Gruber

Other new elements: The Senate bill‘s prevention and wellness provision is backed by $100 million in funding over five years. And it establishes a new certification process for “Beacon ACOs,” the most effective accountable care organizations. These “beacons” would get preference in state health-care contracting.

The Boston Globe’s Liz Kowalczyk sums up the House-Senate difference in flavor: “The Senate bill appears to allow doctors and hospitals more leeway to find their own solutions, while the House appears to want more oversight.”

Still, the degree of common ground is notable. Electronic health records become inescapable in a few years. The price of specific medical tests and treatments should soon be transparent to any consumer who checks a Website or makes a phone call. If your doctor makes an error, you may well receive a direct and prompt apology under new medical malpractice provisions in both bills. State agencies overseeing health care are reorganized.

We asked a few local experts for their first impressions.

Jonathan Gruber, the MIT economist who served as an advisor on the state’s 2006 health insurance reform law as well as the national Affordable Care Act, emailed that the two bills “look pretty darn similar to me.” Continue reading