August 2009

August 31, 2009

AG Martha Coakley's office and the Division of Insurance announced a mega settlement in the case brought against MEGA Life and Health Insurance, and their alter-egos, HealthMarkets, Inc., Mid-West National Life Insurance, the National Association for the Self Employed, Americans for Financial Security and the Alliance for Affordable Services.

This is the insurer that HCFA Board President Chip Joffe-Halpern exposed as misleading consumers by selling inadequate insurance masquerading as meeting state standards. The AG accused them of multiple counts of deceptive and illegal practices, including deceptive marketing; deceptive sales to seniors; illegal benefit exclusions, such as failure to cover maternity care and newborn visits; and violation of privacy rights. Our legal partner, Health Law Advocates, documented over 37 client complaints and submitted over 100 pages of supporting documentation. Some 27,000 Bay Staters get their "insurance" from the firm and its affiliates.

They're busted.

We first blogged about their misbehavior in 2006, a post that got almost 60 comments as people from all over the country added their tale of woe at the hands of the firm. At issue was the Romney administration's hope that the Connector would bless their plans and allow them into the Commonwealth Choice program.

Now they must leave the state entirely. The AG's settlement bans them from selling coverage in Massachusetts for at least 5 years, and forces them to clean up their act and comply with all state laws if they want to come back. The $17 million in fines is the largest of its type.

The AG urges consumers concerned about deceptive health insurance practices in the Commonwealth to call the Health Care Hotline at (888) 830-6277.

The DOI also reached a settlement with the firm for violations of insurance regulations. Under the DOI agreement, the firm will pay $2 million to the Commonwealth, and will also be subject to payment of $3 million more if it does not adhere to provisions in the settlement. Also, they will reimburse customers for claims improperly denied.

This is a MEGA win for consumers in Massachusetts. It shows the power of the kind of insurance regulations and consumer protections being proposed in Washington for national applicability. Congratulations to the AG and Insurance Commissioner Nonnie Burns for their ongoing work to protect all of us.
-Brian Rosman

UPDATE - a page 1 story on the Berkshire Eagle exposes how rapacious the MEGA guys were:

A company salesman had convinced the couple to buy a bare-bones policy for more than $200 a month even though they were eligible for Commonwealth Care, the state insurance plan that runs $35. The salesman misled them when he said they would be fined $1,400 if they didn't buy the plan.

"And then when Ernie turned 65, they told us we should keep the policy as a supplemental one in addition to Medicare, but it wasn't even valid," Beth Tatro said.

August 31, 2009

Late this morning, Governor Patrick announced a plan to use the $40 million allocated by the Legislature to cover the 31,000 legal, taxpaying immigrants in Massachusetts (called "aliens with special status," or AWSS, by the MassHealth system) who will be losing their Commonwealth Care after today. After receiving proposals from CommCare managed care providers, CeltiCare was chosen to provide coverage for this population in FY10. (Globe story here; Governor's press release here)

According to the Administration, CeltiCare will provide comprehensive coverage to all 31,000 legal immigrants. Benefits will be similar to those in current CommCare plans; however, dental, vision, hospice, and skill nursing services will not be covered. CeltiCare still needs time to develop its provider network statewide, and therefore, coverage will phase in for AWSS in the Boston area by October 1st and statewide by December 1st. Health Care For All and ACT!! will monitor the progress of the provider network

Until the new plan is established, legal immigrants in the AWSS population will be eligible for the Health Safety Net; some will also be eligible for MassHealth Limited, which covers emergency care. Folks should contact their provider(s) and find out if they accept HSN; if not, they should contact their local community health center to ensure they continue to get the care they need.

We still have lots of questions. More details will be posted here as we learn them. We expect the administration to issue an information sheet soon, which we will link to or post.
-Suzanne Curry

UPDATE - Some more details from the administration (see these FAQs):

  • the program will be phased in with Greater Boston people enrolled on October 1; northern and southern parts of the state on November 1, and the central and western areas on December 1.
  • the plan will automatically cover all of the 31,000 legal immigrants who will be lose their Commonwealth Care coverage on Sept. 1, but new enrollees who qualify as AWSS will not be able to join the plan. They will be eligible for the Health Safety Net.
  • people enrolled will face higher copayments for some services. Primary care office visits and generic drugs will be free. But a 30-day supply of a non-generic drug will be $50, with no cap on pharmacy out-of-pocket costs. We think this is unaffordable for this group, most of which are below the poverty level. A HIV-infected person needs multiple brand-name drugs to live and someone with a low income has no way of coming up with $50 a month for each prescription.
August 28, 2009

One of the most important initiatives included in the Senate HELP Committee's health reform bill is the "CLASS Act," authored by Senator Kennedy. CLASS stands for Community Living Assistance Services and Supports, and the proposal is a long-term care insurance plan to help those with functional impairments pay for support services while allowing them to remain independent, employed and a part of their community (read a summary here). Senator Kennedy insisted that long-term care assistance be included in any national health reform bill.

When the bill was introduced, Senator Kennedy said, "Too many Americans are perfectly capable of living a life in the community, but are denied the supports they need. They languish in needless circumstances with no choice about how or where to obtain these services --- this is an issue I intend to address in the reform of the nation’s health care system. Too often, they have to give up the American Dream – the dignity of a job, a home, and a family – so they can qualify for Medicaid, the only program that will support them. The bill we propose is a long overdue effort to offer greater dignity, greater hope, and greater opportunity."

As the Medicare Rights Center reminds us,

"Currently there are 10 million Americans in need of long-term care services and supports, and the number is expected to continue to increase. Too often, many of these individuals are forced to quit their jobs and spend down their income and assets, just so they can qualify for Medicaid in order to get long-term care. These folks often end up in nursing homes because they are offered or have no other alternatives.

"The CLASS Act would create a new national insurance fund for long-term care services by enrolling eligible workers into the program, unless they choose not to be enrolled. Financed through payroll deductions, the fund would provide a lifetime benefit ranging from $50 per day to $100 per day, depending on the needs of the person. This cash benefit would provide the recipient a great deal of independence and control over the care to be received and allow individuals to choose to remain at home and active in their communities."

The CLASS Act is one of the little-known components of federal reform. Its inclusion in the final bill would be a part of the way we honor Senator Kennedy.
-Brian Rosman

August 28, 2009

We are very pleased to congratulate Dr. Riley on his appointment as the Executive Director of the Board of Registration in Medicine.

As director of the board’s Patient Care Assessment division since 2006, Dr. Riley has worked to improve the quality of health care in Massachusetts. He has worked closely with the Department of Public Health to improve and streamline the system for reporting Serious Reportable Events and working to reduce their occurrence, and he is a member of many advisory committees and work groups seeking to reduce errors and improve patient safety.

Dr. Riley has shown his commitment to Massachusetts’ health care consumers over the past 3 years and we look forward to continuing to work with him in his new role.
-Deborah W. Wachenheim

August 27, 2009

In his August Executive Director’s Monthly Message, Kingsdale dispels the top ten myths about Massachusetts health reform. Click here to read his memo, which includes detailed citations and links for all the facts. In this climate of continued attacks on the Massachusetts model, we thank the Connector for the reminder of all of our achievements.

Here are ten truths about Massachusetts health reform:

  1. Commonwealth Care is not markedly more expensive than budgeted; the increase in costs is due to higher than anticipated enrollment, with costs per person rising less than 5% per year.
  2. Health reform is sustainable with current offsets and federal assistance, costing the state just 1% of its annual budget.
  3. Private insurance premiums have increased at a slower pace since health reform was passed, and the merger of the small and non-group markets created reduced premiums for individual purchasers.
  4. Massachusetts is creatively working to increase its primary care workforce, and the state has better access to care than the national average.
  5. Massachusetts has the highest rate of insurance in the nation, at over 97%.
  6. Approximately 430,000 Massachusetts residents are newly insured, thanks to health reform, with 44% in private health plans.
  7. There has been no significant “crowd out,” or shifting of insurance from the private to the public sector.
  8. Public support for the law remains high, with 7 out of 10 residents positive about health reform.
  9. Under the law, minimum creditable coverage creates a baseline of comprehensive coverage under the individual mandate.
  10. Massachusetts has kept its health safety net under the law, moving many onto subsidized insurance and also maintaining services for those ineligible.

The other truth is that behind the statistics are our neighbors, real people every one who are able to live their lives with decent health coverage. Fox covered one of them last night:

“It was becoming a life or death issue, because I couldn't afford to stay alive without health insurance,” says 28-year-old Charli Henley, who has a rare autoimmune disease. Henley is one of the more than 430,000 newly insured people in Massachusetts and is on the state-subsidized Commonwealth Care.
-Lindsey Tucker

UPDATE: This video features Kingsdale refuting the myths on CNBC:

August 27, 2009

A recent study in the New England Journal of Medicine has found a significant link between radiation exposure and imaging procedures such as CT and PET scans. The use of such technologies has grown from just 3 million in 1980 to 67 million in 2006, and has contributed, some estimate, to upwards of 2% of fatal cancer cases— the risk rising from 1 in 1000 for adults to 1 in 500 in children.

Much of the problem seems to center around a general lack of awareness—studies have shown that there is little consumer understanding of the risks involved in being subject to such procedures. One such study, performed by the Journal of Pediatric Radiation showed that only 3% of patients knew of the risks associated with radiation exposure from CT scans; and while their use continues to rise, these methods contribute not only to greater radiation exposure, but to more expensive health care.

Federal law allows physicians to earn a profit from the use of imaging machines that they use, and as a Washington Post article noted early last year, the number of CT scans ordered grows when a physician has an associated financial interest. On a different note, Dr. Harlan M. Krumholz proffers that the use of CT scans is increasing because they have become part of our culture. “People use imaging instead of examining a patient; they use imaging instead of talking to the patient,” (New York Times, Study Finds Radiation Risk for Patients, August 27, 2009).

For these reasons, imaging technologies have become a common diagnostic tool even when they are not required. For example, it is becoming more common for doctors to order routine heart scans for patients, even when they do not experience symptoms associated with heart disease. As such, numbers suggest that as many as 50% of ordered scans could have been replaced by safer and less expensive modes.

Representative Kulik's legislation, House 2118, An Act to Investigate the Use of Computed Tomography (CT) Scans in the Commonwealth, attempts to address the issue of overuse of imaging technologies by allowing the Department of Public Health to look into their use and instate guidelines for their appropriateness. It's time Massachusetts began looking into scans.
-Caitlin Bethlahmy

August 26, 2009

Health Care For All is deeply saddened by the passing of Senator Edward Kennedy. Today, Massachusetts and the country lost its liberal lion in the Senate, the greatest legislator in our history and champion for the most vulnerable among us. But we will go forward remembering the senator’s passion and leadership and his belief that each one of us deserves the dignities of equal rights, a meaningful education, and affordable, accessible health care.

The senator dedicated his life to serving others, the state, and the country he loved. We will live into his legacy every day by carrying with us his boundless energy and eternal optimism.

I had the tremendous privilege to work for the senator and I believe there could be no greater honor for him and his life’s work than to pass meaningful health care reform now. We will continue to persevere to bring access to health coverage that will allow all of us to live the fullest, healthiest lives possible. We believe it is the right thing to do and the senator believed that too.

Thank you Senator Kennedy for all that you have done, and thank you to your family who shared you with us so generously. You will be missed, but your cause, hope and dreams will never die.
-Amy Whitcomb Slemmer

August 25, 2009

According to the World Journal of Surgery, it is estimated that surgical sponges are left in a patient’s body in between 1 in 2,000 and 1 in 6,000 surgeries a year in the United States. A recent article in the Telegram highlights the work being done by St. Vincent Hospital in Worcester to decrease the occurrence of these medical errors.

Out of more than 17,000 surgeries that took place last year at St. Vincent, medical staff mistakenly left four objects in patients, one of which was a sponge. These errors were reported to the State and are part of the public report of Serious Reportable Events (SREs) that was issued earlier this year and will be issued annually by the Department of Public Health. Health Care For All and the Consumer Health Quality Council successfully advocated for public reporting of all SREs and healthcare-associated infections. The purpose of the law is to both inform consumers and to encourage hospitals to take further steps toward improving the quality of care they deliver. Based on this article, the latter seems to be happening.

St. Vincent is the first Massachusetts hospital to implement the RF Surgical Detection System, a new device that can detect if a sponge is left in a patient’s body before a surgery is complete. The device is used three times during surgery to keep track of sponges. The surgical team at St. Vincent are also continuing to conduct sponge counts before, during and after surgery. We applaud St. Vincent for implementing these measures to ensure patient safety.

While leaving sponges behind is a serious patient safety issue, there are other errors that can and do occur during surgery. HCFA and the Consumer Council are advocating for legislation requiring hospitals to use “checklists of care” in order to prevent surgical and other errors. One step on the surgical checklist is counting sponges but it also has a number of other components. Please click here to learn more about checklists of care. If all hospitals in MA implement the checklists and also seek to take additional measures, such as St. Vincent is doing, to prevent errors, the Commonwealth will lead the way in patient safety.
-Kuong Ly

August 24, 2009

As the Globe reported in its lead story Saturday, a new report by the Commonwealth Fund found that Massachusetts has the highest health insurance premiums of any state.

But the Globe article hinted at something else the study found. Health insurance is expensive here, but incomes are higher here, too. As a percent of median household income, Massachusetts premiums are the 41st highest nationally. This means that in 40 states, the median family pays more for health insurance premiums than we do in Massachusetts. By this measure, we're one of the better states, as illustrated in the second slide on the accompanying charts.

Of course, this finding is of little solace to families earning substantially below our median income of $63,867. We hear repeatedly from people in the 300%-400% of poverty range (about $32,000-$43,000 for an individual) that they can't afford coverage. Commonwealth Care's sliding scale help only goes up to 300% of the poverty level; we hope that national reform will up that to 400%.

The report's authors used the study to advance the case for national reform. In a blog post that accompanied the study, Commonwealth Fund president Karen Davis writes that Congress needs to pay as much attention to the need to bring family costs down as it does to the cost to the government of the health reform program. She makes a strong, research-based argument for a public plan option that is able to control costs by reducing overhead, negotiating for prices, and using its leverage to improve the delivery system.

We think affordability has to be a top focus of health reformers. Kaiser Foundation President Drew Altman makes the point well in this summary of the affordability issues in reform. One of the lessons of Massachusetts for national reform is the need for significant subsidies and broad coverage as well as cost control in order to reach everyone.
-Brian Rosman

August 23, 2009

This is what makes it all worthwhile. Having to again wade through all the clips to select the best for the blog. The Betsy McCaughey interview is even important. Enjoy:

Betsy McCaughey Part 1
Jon asks Betsy McCaughey to find the page in the health care bill that makes end-of-life consultations mandatory (background on McCaughey)

<td style='padding:2px 1px 0px 5px;' colspan='2'Betsy McCaughey Pt. 1
The Daily Show With Jon Stewart Mon - Thurs 11p / 10c
www.thedailyshow.com
Daily Show
Full Episodes
Political Humor Healthcare Protests
<td style='padding:2px 1px 0px 5px;' colspan='2'Betsy McCaughey Pt. 2
www.thedailyshow.com

Barney Frank slams back:

<td style='padding:2px 1px 0px 5px;' colspan='2'Barney Frank's Town Hall Snaps
www.thedailyshow.com

Colbert looks at Obama's op-ed in the Times

<td style='padding:2px 1px 0px 5px;' colspan='2'Obama Publishes Health Care Op-Ed
The Colbert Report Mon - Thurs 11:30pm / 10:30c
www.colbertnation.com

And check out this from The Onion. Excerpt:

Congress Deadlocked Over How To Not Provide Health Care

August 23, 2009

For the weekend, we're going to do a mix of heavy and light posts. First, the heavy:

The centerpiece of the proposed payment reform recommended by the Special Commission is the creation of "Accountable Care Organizations" (ACOs) that would receive global payments - that is, lump sum amounts to provided all the care needed for their patients for a year.

Two weeks ago, the Commission's co-chair, Administration and Finance Secretary Kirwan and DHCFP Commissioner Iselin published an op-ed in the New Bedford Standard Times setting out the basics of the proposal.

Now Health Affairs, a leading policy journal, published two thoughtful blog posts taking opposite views on whether the plan would work.

Debating the negative is policy analyst Jeff Goldsmith. In his blunt post, "The Accountable Care Organization: Not Ready For Prime Time," he calls the proposal "reckless":

Unless they are very careful, and build on existing risk-sharing arrangements, the Massachusetts ACO experiment is likely to be a gory and comprehensive failure. Virtual assignment of patients, virtual organizations, “shadow capitation” superimposed on fee-for-service based economically independent docs, further consolidation of local hospital monopolies: we really ought to know better. Those single-specialty monopolies and scarce specialists mentioned above will be able to name their price (just as the big teaching hospitals in Boston do today) and grab a big piece of the virtual pie.

The sad reality is that most hospitals, even the well-managed ones, simply lack the tools, leadership, and leverage to enable them to bear and manage global risk. Many will not possess them in a decade. The mandatory ACO ... is one of the worst health system reform ideas since the Health Systems Agency.

On the affirmative side are some of the originators of the ACO idea, Aaron McKethan and Mark McClellan of the Brookings Institution and Elliott Fisher and Jonathan Skinner of Dartmouth College. Their article, "Moving From Volume-Driven Medicine Toward Accountable Care," addresses some of Goldsmith's concerns, and points out the work being done now with ACO-like pilots. They emphasize that Medicare should be included in the pilot programs, and that comprehensive performance measurement that includes patients’ experience of care, health outcomes, and the overall costs of care will be critical. They end on an optimistic note:

Achieving major delivery system reform will not be quick or easy. But it should be very clear by now that it will not happen under the status quo of existing payment systems, or through patches or add-ons to those systems. Only by fostering real accountability for results will be able to address the major gaps in quality and costs in our health care system. We believe ACOs represent a critical step in moving away from purely volume-driven payments to payments based on what we really want to support: better health and better care at a lower cost.

As the legislature moves towards its consideration of the payment reform plan, policymakers will need to closely look at both sides of the policy debate. The nascent experience of Blue Cross' "Alternative Quality Contract" should be reviewed carefully. As yesterday's Globe headline ("Bay State Premiums Highest in Country") illustrates, the stakes couldn't be higher.
-Brian Rosman

August 21, 2009

If you see someone drowning in a river you should swim out to save them; and when another person is seen floundering in the tides, you can do the same for them. This is the medical approach to solving health care issues. To go upriver and see who is throwing people in the water—that is the public health approach.

Dr. Michael A. Grodin, a professor at Boston University’s School of Public Health, used this analogy to illustrate the difference between today’s existing dual models of health care. Dr. Grodin addressed a standing room only crowd yesterday at the DPH’s “A Dialogue on Human Rights and Public Health in the 21st Century.” His talk, which was focused on what he called the “inextricable link” between basic human rights and health care, was ultimately a call for education.

After citing startling statistics regarding global wealth distribution (the 3 richest people in the world have assets greater than the GDPs of the 48 least developed countries), he came to the eventual conclusion that “the primary determinant of a country’s medical care is their socioeconomic status, and the primary determinant of a country’s socioeconomic status is educational status!” Tracing the history of human rights by citing such documents as the Torah and the Magna Carta, Dr. Grodin suggested that human rights ultimately have to do with the relationship between the state and the individual; and deal with the entitlements and obligations associated with that relationship. The state, he proffered, has the obligation to “respect, protect, and fulfill” the basic human rights of its people—rights to which the people are naturally entitled. Human dignity, he ultimately argued, is at the root of human rights, which is in turn the most basic element with regard to access to health care.

To simplify his argument and make the “inextricable link” evident, Grodin asserted that “the goal of health care is the alleviation of suffering, and the goal of human rights is the alleviation of suffering.” Both, he argued, have the same ultimate objective and rely on the same understanding of basic human values.

A quotation from Nobel Laureate Wangari Maathai adorned the front of the program brochure: “we know what to do, why don’t we do it?” In answer to this question Dr. Grobin suggested, “you find an issue, and like a laser you focus on it.” Despite his deep understanding of the issues facing health and human rights, Dr. Grobin is still a self-proclaimed optimist with regard to the issue of global health care. He suggests that if we all work to achieve small successes we will ultimately overcome the larger issues. In closing he offered a similarly optimistic African proverb: “if you put enough spider webs together you can catch an elephant.”
-Caitlin Bethlahmy

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