July 2009

July 30, 2009

Deborah Schuss’s op-ed in today’s Boston Globe illustrates the importance of putting the needs, concerns and capabilities of patients and family members at the center of care. Focusing on discharge procedures at hospitals, Schuss shares her belief that hospitals have lost “a genuine sense of caring to accompany the[ir] care”. This bold, uncomforting statement by Schuss arose during her own experience with a hospital’s new agenda.

The author talks about what happened when her dad was admitted to a hospital for treatment of pneumonia and an infection. The discharge process started before he was even admitted and the eventual discharge plan was incomplete, never taking into account, for example, the fact that her father couldn’t walk up his front steps, because the case manager assigned to his case never bothered getting this vital information.

Schuss recollects that not too long ago, a hospital social worker would meet with the family caregiver to plan the patient’s readiness for departure and post-hospital responsibilities. However, she argues that these days, a hospital case manager no longer works as the patient’s advocate.

Schuss highlights the frequent lack of communication surrounding a patient’s discharge from the hospital. A Commonwealth Fund study found that 18% of chronically ill hospital patients were readmitted to the hospital or went to the emergency room due to further complications after being discharged from the hospital.

There are initiatives in Massachusetts designed to reduce readmissions and make care more patient and family-centered. The Patient and Family Advisory Councils that all hospitals are required to establish by October 2010 will bring vital voices and perspectives to hospital care. Discharge planning is one of many areas that hospitals should bring before the Councils so that in partnership, the patients, families and hospital staff can ensure the needs of patients and family are met.

Massachusetts has also embarked on a project to directly reduce these so-called, "potentially preventable readmissions," as part of cost control. A DHCFP study of discharge data has found that 377,000 hospital days in Massachusetts are due to readmissions that could have prevented. These preventable readmissions cost the system a staggering $577 million in 2006 (more details - pdf). The federal government has posted hospital-by-hospital information on readmission rates.

Massachusetts payment reform must serve as a complement to these ongoing initiatives so that all patients can receive more complete care.
-Shikha Jerath and Deborah W. Wachenheim

July 30, 2009

Dr. Paul Dreyer, Director of the Division of Health Care Quality at the Department of Public Health, is retiring tomorrow after 33 years with DPH.

Dr. Dreyer has served as the Director of the Health Care Quality Division since 1995. In the few years that Health Care For All has been involved in health care quality, Dr. Dreyer has been an invaluable source of knowledge and insight. We have been fortunate to have Dr. Dreyer at the table as a member of HCFA’s Quality Advisory Committee. We know that he will be greatly missed at DPH and in the Massachusetts health care policy community. Massachusetts is leading the way in its work to improve the quality of health care for all residents, and Dr. Dreyer played a role in many of those advances. Thank you for your commitment to the people of Massachusetts for the past 30+ years!

July 30, 2009

The State House was up late tonight, as the legislature worked on a supplemental funding bill that funds a number of items vetoed by the Governor, including adding partial funding for legal immigrants eligible for Commonwealth Care.

The final bill passed around 11:30 tonight. Explanatory materials distributed by the House today are here, and the original bill as filed is here.

As reported, the bill increases Commonwealth Care funding by $40 million, and permits the Secretary of HHS and the Connector to devise a plan to cover the 30,000 eligible legal immigrants that does not exceed $40 million. Full Commonwealth Care for this many people would cost around $130 million, so this is far less than the cost of full benefits. The Governor had proposed a compromise to spend $70 million for these people. If no plan can be devised, the $40 million can be added to the Health Safety Net Trust Fund, which reimburses hospitals and community health centers for free care provided to low income uninsured.

There is no plan on the table for how to implement a meaningful health coverage plan for roughly 1/3 of the projected cost of coverage. The ACT!! coalition will be working with the state officials to identify options and make recommendations. Should only a portion of the low-income immigrants be provided adequate coverage? Or should severely inadequate coverage be provided to everyone who qualifies?

One outcome of this should be a strong, concerted effort by state leaders to push for federal reimbursement for all legal immigrants as part of national health reform. We urge the leadership of the legislature to join us in asking Senator Kerry to make this issue one of his priorities as the Finance Committee takes up its bill soon.

The supplemental appropriations also restores some funding for the Evidence Based Outreach and Enrollment program (Academic Detailing), line item 4510-0716 in the supplemental budget passed today. We are grateful for their support of this important program, which will provide immediate savings. We urge the Governor to maintain funding for this program, which he vetoed in the main budget.

The state-sponsored evidence-based outreach and education program (often referred to as “Academic Detailing”) will provide health care providers with balanced information about the effectiveness, safety and costs of all prescription drugs on which they can base their prescribing decisions. The program will give consumers the peace of mind that the drug they are prescribed is the most appropriate drug for them and that the decision of what to prescribe is based on unbiased evidence, not the result of the inappropriate influence of the pharmaceutical industry. Research shows that these programs can save two to three dollars for every dollar spent to implement them.

Additionally, the bill allocates an additional $350,000 for the Department of Public Health’s division of health disease prevention, which includes support for the Betsy Lehman Center. The Betsy Lehman Center was launched in 2004 and serves as a clearinghouse for the development, evaluation, and dissemination, including of best practices for patient safety and medical error reduction. With payment reform in the offing, the work of the Betsy Lehman Center is more critical then ever.

July 29, 2009

Today's Globe includes an op-ed by columnist Jeff Jacoby, Healthcare: Do we need the Lexus? Jacoby argues that mandated health insurance benefits are the reason why health insurance is so expensive, and that states should let the free market determine which benefits insurers should or should not offer.

We've covered this ground many, many times. We've called out a right-wing think tank, the Herald, then Harvard Pilgrim CEO Charlie Baker, and the Mass Association of Health Plans for spreading what we've called the "mandated benefits fallacy."

We don't defend every existing mandated benefit, and we rarely take a position on proposed new ones. But Jacoby is wrong in practice, and in theory.

First, in practice. The Division of Health Care Finance and Policy (DHCFP) looked closely at the mandates we have in Massachusetts. They concluded that the mandates add about 3%-4% to the cost of coverage. Nothing close to the 15% Jacoby quotes in his piece as the national average. For us, he's off by a factor of 5.

Massachusetts has a smart, rational method for evaluating proposed mandated benefits. A provision of general law directs the DHCFP to study the impact of any proposed mandated benefit. The studies, which are provided to the legislature, look at a variety of factors, including:

  • the financial impact of mandating the benefit on premiums, cost-shifting and out-of-pocket costs,
  • the extent to which the proposed coverage might increase the appropriate or inappropriate use of the treatment or service,
  • the extent to which the mandated treatment or service might serve as an alternative for more expensive or less expensive treatments or services, and
  • the medical efficacy of mandating the benefit, including the impact of the benefit on the quality of patient care and the health status of the population and the results of any research demonstrating the medical efficacy of the treatment or service compared to alternative treatments or services or not providing the treatment or service.

The DHCFP has published over a dozen of these comprehensive reviews; they're on the DHCFP web site.

As a result, the legislature has the benefit of a detailed analysis before it makes a decision as to whether or not to approve a new mandated benefit. As an accountable representative body able to refer to objective research, we think the legislature is better able to weigh the pros and cons of any proposal, than an insurer, which has the first duty of increasing its own profits or surplus.

Which brings us to our second point. Jacoby is wrong in theory, too. Jacoby claims that the free market would best sort out which benefits insurers should or should not offer. This shows a fundamental ignorance of how the insurance market works.

Suppose there was no law requiring insurers to cover diabetic treatment supplies (there is; it's here). Any insurer that chose not to cover diabetic treatments would quickly lose members with diabetes. That insurer would be able to lower its premiums dramatically, since it not longer had expensive diabetic patients among its members. All the healthier people would gravitate to this cheaper plan, while the more expensive diabetic patients would be stuck in a more expensive plan. The plans that covered diabetes supplies would either have to raise its rates or eliminate its coverage. In order to compete, there would be a race to the bottom, as insurers stopped covering services that attract sicker and more expensive members.

That would not work. We need a strong floor underneath insurance coverage to make sure plans provide adequate benefits to protect people's health and protect people against damaging medical debt. That's why the "minimum creditable coverage" regulations are so important. In addition to requiring all insurers to cover a core level of benefits, the regulations also limit deductibles and out-of-pocket costs so that insurance provides real protection. The free market is not enough.
-Brian Rosman

July 29, 2009

Chaired by Representative Byron Rushing alongside EOHHS Secretary JudyAnn Bigby, the state’s Health Disparities Council launched in high spirits on Monday.

The assembly focused on a review of the developing state disparities report card; a tool intended to shape program and policy improvements to address health inequities. Dr. Joel Weissman of EOHHS completed a considerable draft model of the report card that includes not only outcome data for chronic diseases and health conditions, but a framework for examining the data by various social, economic, and community dimensions. Council members applauded the notable progress on the report card and discussed next steps related to data completion, artistic presentation, and language accessibility. Some members also emphasized the importance of adding data to the report card that is not hospital based, to capture disparities for populations that may not interact with the health care system.

The meeting also included a presentation from Russell Haynes of the state Board of Registry in Medicine. He updated the council on the Board’s licensing and continuing medical education requirements for physicians, and received feedback from members on the need for the Board to move forward policies that prioritize cultural competency. Members pointed to New Jersey as a model for MA to adopt, as it has required cultural competency training as a provision of physician licensure since 2005. Members also discussed working with the Board to obtain race/ethnicity data on medical errors and patient care assessment reporting requirements. Haynes noted that the Board recently moved physician’s licensure online, and included fields to collect physician race/ethnicity.

The Health Disparities Council will recess for August and reconvene in September. Visit the Health Disparities website:www.mass.gov/hdc to learn more about the discussions, opinions, or members.

July 29, 2009

As the Legislature continues to look at budget overrides, we urge them to override the Governor’s veto of funding for the academic detailing, or evidence-based prescription drug outreach and education, program, line item 4510-0716. This program saves the state money – according to an economic model developed by Dr. Avorn and Dr. Soumerai at Harvard Medical School and Brigham and Women’s Hospital, every dollar spent on academic detailing returns, at a minimum, two dollars in drug costs. The program takes information learned through comparative effectiveness research on drugs and translates it into practice for health care practitioners. This program is designed to generate health care cost savings for the state. Given the ever-increasing cost of prescription drugs, this could amount to millions of dollars in savings annually. This funding will enable to program to continue providing valuable information to clinicians in Massachusetts. The information provided is unbiased and designed to help a clinician make appropriate treatment choices with her patient. At times like these, we need programs that save the Commonwealth money.

Programs such as these will be invaluable as the Commonwealth implements payment reform. Higher quality, lower cost care is only possible if providers are given the tools to deliver that care. Academic detailing is a major tool that will allow us to take the next steps towards payment reform.

Georgia Maheras, Esq.
Private Market Policy Manager

July 28, 2009

Call now buttonAs conservatives step up the rhetoric around health reform, consumer focused organizations like Families USA are mobilizing their supporters and bolstering their advocacy – and they need your help!

Most Americans support health reform, but opponents will do everything they can to block the bill. In fact, some offices on Capitol Hill report that conservative callers now outnumber those in support of reform 3 to 1!

The time for you to act is now – call 1-800-828-0498 and ask to be connected your Representative. Then contact Families USA online and let them know you called.

As we move toward reform, conservatives will redouble their efforts. We can’t let them bully Legislators into preventing the American people from getting quality, affordable health care.

Without reform

  • health care costs will continue to grow uncontrollably;
  • people with pre-existing conditions will be denied coverage;
  • and millions of Americans will never be able to afford the coverage they need;

Call 1-800-828-0498 and let your Representative know that the time for health care reform is NOW! Click here for talking points from Families USA.

July 27, 2009

Boston’s top Catholic official asks lawmakers to keep ALL Massachusetts families healthy. Cardinal Sean O’Malley posted this blog about 28,000 legal immigrants who stand to lose their Commonwealth Care coverage.

“The Governor and the Legislature in the commonwealth face excruciatingly difficult choices this week. Final decisions about the budget bring together the fact of an economy in deep recession, declining state revenues and multiple human needs among the citizens of the commonwealth …

A particular issue of concern to me is the possibility that funding for health coverage for 28,000 legal immigrants may be cut in whole or in part. The Church, through Catholic Charities and through our parishes, is in direct and regular service of the immigrant community.

My hope and my request is that a way can be found to sustain health coverage for these legal members of our community. Their resources are few and their support system is always stretched thin. The commonwealth has done a very commendable job of providing health care to the citizens of Massachusetts. It would be a tragic mistake to let these 28,000 members of our community lose access to the precious good of health care.”

Health Care For All is grateful for the Cardinal’s support and we thank him for publicly speaking out for these 28,000 legal, taxpaying Massachusetts residents. We will continue to urge the Legislature to support the compromise package of $70 million dollars and keep ALL Massachusetts families healthy.

Click here to read Cardinal O'Malley's entire blog post The importance of health care for legal immigrants.

July 27, 2009

While not traditionally discussed in health policy circles, transportation is a key determinant of health outcomes. Transportation policies affect more than the just the ways that people travel, but influence the distribution of goods and services, exposures to pollution, opportunities for physical activity, and other health related matters.

Communities that lack good transportation systems face many barriers to good health, including:

  • Poor access to health care institutions, pharmacies, and grocery stores;
  • Unsafe conditions for physical activities such as walking and bicycling;
  • Harmful exposures from diesel fumes and noise pollution;
  • Social and economic isolation

Low income and rural communities are disproportionately harmed by poor transportation systems, leading in part to health disparities.

Massachusetts’s new transportation reform law provides a fresh opportunity for the state to make critical connections between transportation policy and health. The law establishes a “healthy transportation compact”, convening Health and Human Services and Transportation leaders to develop health supportive policies and practices. The compact will also institute a health impact assessment for use by planners, transportation administrators, and developers. These provisions have great potential for helping Massachusetts build healthier and more equitable communities.

As the state continues implementation of health care reform and works towards the elimination of health disparities, it must also engage non traditional stakeholders in strategies to improve the public health. Interventions in sectors such as transportation create a more comprehensive “health reform” agenda, addressing barriers outside of the health care system that impact health and wellness.

For more information on healthy transportation, download “The Transportation Prescription”, a new report published by PolicyLink and the Prevention Institute.
-Camille Watson

July 24, 2009

The Health Disparities Council will hold its monthly meeting on Monday July 27th from 2pm-4pm ( 21st floor of One Ashburton Place). The meeting agenda is as follows:

  1. Approve last month’s minutes
  2. Updates:
  • Framework Group
  • Report Card Group
  • Interpreter Services Group
  • Commission Recommendations Status Presentation:
    • Provider Cultural Competency Presentation: Board of Registration in Medicine
  • Announcements :
    • No August meeting
    July 24, 2009

    I'm a policy analyst, spreadsheet and chart kind of guy, but too much of the health reform discussion is about numbers and theory. We in Massachusetts know that health reform is about helping real people. The over 425,000 newly covered are not just statistics. That's the message we need to spread.

    In her press conference yesterday, US House Speaker Nancy Pelosi made that point superbly (transcript here). Video highlights are below:

    The event featured four people from different parts of the country.

    Catherine, Molly and Vernon each had crushing medical debt, despite having insurance. Cost sharing for illness and even preventive care left them with enormous debts, destroying their finances.

    The fourth, Jaclyn Michalos, is from Norwood. Here's what she said:

    I never imagined that I could get breast cancer at the age of 27. After graduating college, I taught pre-school for three years and had health insurance, but in 2005, I left my job to work for my father at his restaurant in Randolph, Mass. As a small, family-owned business, he couldn't afford to provide insurance, so I became uninsured. In 2006, I discovered a lump in my breast. I called my doctor to see what it would cost me to see her and she told me it would be $130 out of pocket. She checked me out and told me it was nothing to worry about, I didn't get a mammogram or any other test. I can't help but believe that me not having health insurance affected that decision.

    Then Massachusetts started its new health insurance program that requires everyone to get health insurance. I was happy to, but on my waitress wages, I couldn't afford it, so I was able to get Commonwealth Care. I was still worrying about the lump that hadn't gone away, so I went to see another doctor who had ordered an ultra-sound, a mammogram, a biopsy and I ultimately ended up being diagnosed with breast cancer.

    On July 24, 2007, I got a double mastectomy and reconstructive surgery. The bills totaled about $125,000, a cost we would not have been paid without my parents taking out a second mortgage on their home which would have threatened their financial security as well. But I was able to focus on getting through the treatment and getting well -- not on how we would possibly pay the larger bill. If it hadn't been, if I hadn't had insurance, I probably would not have made the doctor's appointment and gotten the test that turned out to be cancer and I might not be alive today to tell my story. Instead, tomorrow will be my two-year anniversary of being cancer free.

    I want every woman like Catherine and Molly, and every American like Vernon to know that if you get sick, you will be able to get the care you need without having to waste precious energy on worrying about losing your home, or becoming in debt for the rest of your life. I am not a member of any activist group. I don't pay a whole lot of attention to politics. I just try to work hard and make a good life. It makes me sad and angry to hear people try to politicize this and it is about our health and our well being. Please keep focused on something getting done sooner rather than later. Unlike Catherine, I am a relatively lucky person because my state did this. It is an American problem and it needs to be an American solution. Thank you.

    Today is the two-year anniversary of Jaclyn being cancer free. We celebrate all the Jaclyns across the Commonwealth and urge the politicians and the pundits to focus on the human impact of policy.
    -Brian Rosman

    July 23, 2009

    Michael Widmer and the Mass Taxpayers Foundation he heads have long been recognized as one of the preeminent authorities on the Massachusetts budget and spending levels. The Foundation's analysis is considered honest and credible. When Mike Widmer speaks, people listen.

    That's why today's Globe op-ed, "Health law costs aren’t the problem" by Widmer is so important. The Foundation has reviewed actual health reform spending, and corrects the common wisdom:

    WE’VE HEARD the claims repeated from the moment the bill was signed three years ago - Massachusetts’ health reform law is unaffordable. Those claims have come from a wide variety of ideological and political quarters, but what they have in common is a failure to understand how the law works.

    The Taxpayers Foundation recently released an analysis of the costs to taxpayers of achieving near-universal access to healthcare in Massachusetts. The “surprising’’ conclusion: Between fiscal 2006 and 2010, the annual incremental cost from the state budget is less than $100 million, a modest sum for this historic achievement. This cost is very much in line with estimates that were made when the bill was passed.

    Today's article is based on report MTF issued in May, Massachusetts Health Reform: The Myth of Uncontrolled Costs.

    The article also puts the challenge of covering legal immigrants in Commonwealth Care in the proper context. The issue is not unaffordability of health reform, but the plunge in state revenues that is hitting all programs:

    The Legislature’s recent decision to cut the fiscal 2010 budget for Commonwealth Care as part of the state’s enormous fiscal crisis has led to renewed claims that health reform is unaffordable. In particular, the issue of Commonwealth Care funding for legal immigrants, while important in its own right, has led many observers and critics to conclude mistakenly that health reform is unraveling.

    These critics ignore the fact that the fundamental problem is not the costs of Commonwealth Care, but rather the unprecedented collapse of state tax revenues. With the state facing a structural budget gap of $5 billion in fiscal 2010, virtually every state program has hit the cutting board. And as is always the case during economic downturns, caseload-driven programs like Commonwealth Care experience a temporary increase in enrollment.

    Widmer concludes that health reform is worth it:

    To be sure, Massachusetts, like the nation, must address the escalating costs of healthcare - for government, employers, and individuals alike - and Massachusetts has launched a variety of efforts to deal with this intractable problem. But this persistent problem has little to do with the health reform law. These are extraordinarily difficult times for all of state government, and it is not helpful to advance unfounded allegations about the unaffordability of health reform. We need to stay the course on one of the most important state initiatives of recent times, which has become a beacon for the rest of the nation.

    We agree, and appreciate the valuable contribution the Mass Taxpayers Foundation is adding to the health reform discussion.
    -Brian Rosman