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

diocletian

The emperor Diocletian (fmschmitt.com)

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?

phone

“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

Reactions To House Health Reform Plan: Confusion, Cheers, Concerns

Times like this separate the true health reform wonks from the wannabes. Did you spend your weekend poring through H.4070, An Act relative to Health Care Quality Improvement and Cost Reduction Act of 2012, which was finally unveiled Friday afternoon? For the hard core, this was a health cost weekend: No time for lilacs or Little League, what the heck does this thing say and what does it mean? (Here’s our initial summary.)

Though many of the bill’s proposals were long expected, reaction tended to be muted on Friday because everyone needed a chance to digest. Now, the considered analyses are beginning to roll in, and we aim to make CommonHealth their home, much as it was during the debate around the state’s 2006 health reform. The Senate is expected to weigh in with its own bill on Wednesday, and then comes the great sorting-out. Here’s a very early sampling of today’s opinion harvest, and we plan to update this post today as others come in.

Forbes:
Massachusetts moves toward health care price controls; Is America next?

Goodness, ‘The Apothecary‘ blogger Avik Roy — a member of Mitt Romney’s health care advisory council, according to his Forbes profile — re-posts a bit more of CommonHealth’s bill summary than is usual blogging practice. But he does make some interesting points, including a prediction that the proposal to impose a surcharge on high-cost hospitals will backfire badly. He writes:

The beauty of government-controlled relative pricing is that it creates an incentive for everyone to raise prices. There are two ways for a high-cost provider (say, Partners HealthCare) to get their prices within the 20-percent band: (1) lower their prices; (2) get everyone else to raise their prices.

Thanks to the transparency provisions of the bill (and transparent prices are, in general, a good thing), low-cost providers will know what their peers are charging. They will therefore have the ability to raise their prices considerably.

For example, let’s say Mass General charges $32,000 for a coronary angioplasty, whereas the state median is $21,000, driven in part by low-cost Tufts, which is charging $16,000. Now that Tufts knows that MGH is charging $32,000, Tufts knows that it can charge, say, $25,000 per procedure, and still gain favorable status from insurers, without incurring the new “luxury tax.” Continue reading

Atrius Chief Calls For Speed On Health Reform

Atrius chief Dr. Gene Lindsey (courtesy of Atrius)

You know how when microwave popcorn begins to reach kernel-blowing heat, first you hear a few isolated pops and then they turn into rapid-fire, machine-gun-speed explosions? That’s the dynamic we can expect for the debate about the next, cost-cutting phase of Massachusetts health reform — and right now we’re in the isolated-pop stage. With the legislature expected to unveil its blueprints for cost-cutting very soon, we’re just starting to hear those first few pops of views, opinions, reactions.

Dr. Gene Lindsey, the chief of Atrius health, the state’s largest physician group, is just out in The Boston Globe (well, okay, yesterday but I somehow missed it at first) with an op-ed piece titled “Payment reform is working in Massachusetts.” It ends:

Governor Patrick wants us to move even faster. He delivered his draft legislation on payment reform in February 2011. Now, the Legislature is about release its proposed bill. What we really need from the Legislature now is the support to move forward with speed to implement changes so that patients and employers can begin to see a difference both in the care that is delivered and in the invoice that follows. Continue reading

Glossary In Progress: Health Reform Terms For Coming 2012 Debate

dictionary

(Fotopedia.com)

Very soon, the topic of health reform is going to get white-hot again in Massachusetts. Legislative leaders will reveal their plans for the next stage, the part left out of the landmark 2006 law: How to cut costs. Gov. Deval Patrick laid out his own blueprint last February, and now, at long last, this next political shoe will drop.

To prepare you and ourselves, we at WBUR are gathering a glossary of terms that it will help to know in the coming debate. We entreat you to improve on our definitions and write in suggestions for more. And most of all, we need a catchy title for what’s coming. Health reform, part two or 2.0? Health reform 2012? There’s Romneycare and Obamacare, but Devalcare or Patrickcare just don’t sound right, especially for the coming legislative initiatives.

One thing we do already know: We’re going to use the Twitter hashtag #mahealthcosts for relevant tweets, and invite you to do the same.

ACO — Accountable Care Organization — An accountable care organization is a collection of hospitals, doctors, and other care providers that coordinate among themselves to provide high-quality, efficient care to a patient within the bounds of a single payment. Consumers, at some point you will likely be asked to sign up for one of these. This is a really important decision because it means you’re making a commitment to get most or all of your care from within this group. Here’s a fuller explanation in cartoon form: “What The Heck Is An ACO?”

AQC — Alternative Quality Contract — The global payment model created by Blue Cross Blue Shield of Massachusetts. Other major insurers now offer their own global payment contracts.

Bundled and episode-based payments — “Providers are reimbursed for clinically defined episodes of care – that is, a lump sum payment is made to providers in different settings for caring for one patient who has undergone, say, a major procedure.”(From the Massachusetts Hospital Association’s new guide to health reform, “Completing the Journey.”) Continue reading

What Do You Want To Know About Health Reform 2012?

question mark

(fotopedia.com)

Dear readers,
What are you wondering? What are you worried about? Where might we be heading? Please submit your questions about the next, cost-cutting phase of Massachusetts health reform in the Comments section below, and we’ll do our best to answer them ourselves or find someone who can.