November 2009

November 30, 2009

The New York Times Magazine yesterday published a letter-to-the-editor sent in by HCFA in response to the article on Intermountain Healthcare that was published 3 weeks ago (read our blog overview of the story).

The letter points out that while the article focuses on the high quality of care provided at Intermountain as a result of its work on evidence-based medicine, it gives very little attention to the role of consumers, and even dismisses the consumer role to some degree. As the letter mentions, Massachusetts is looking to include consumer engagement in payment reform, recognizing the important role that consumers can play as partners with their providers in making treatment decisions.

November 30, 2009

Thursday, the legislature’s Joint Committee on Health Care Financing will hear two key bills affecting young people:

The hearing will be at 11:30 am in State House Room A-1, on Thursday, December 3 .

S. 39/H. 188, introduced by Senator Flanagan and Rep. Story, is a legislative priority of the Children’s Health Access Coalition and HCFA. This bill would provide 12-month continuous eligibility for children enrolled in MassHealth. Currently, children can lose their MassHealth coverage if his or her family’s income rises above 300% of the poverty level (FPL) at any point after they are deemed eligible. It is not uncommon for the income of a family living close to 300% FPL to fluctuate over the course of a year. When this happens, children cycle on and off of their public program and have intermittent coverage, which as you can imagine, is never a good thing.

The federal government allows states to establish 12-month continuous eligibility under these programs. The Commonwealth should join the 29 other states that have already implemented this policy, including Maine, New York, New Jersey, and Pennsylvania. We think this bill is budget neutral and good policy in tough financial times like these.

S. 609, filed by Senator Richard Moore, would require all student health plans to meet the state’s minimum creditable coverage standards. As it stands, some plans offered through colleges and universities do not cover preventive treatment or behavioral health services, cap prescription drug coverage and impose a low cap on medical benefits. A report released in early November by the Division of Health Care Finance and Policy shows that a number of national, for-profit health insurance firms are gouging over 95,000 students in Massachusetts with very high premiums for very little benefits. We are particularly concerned that while the major non-profit private insurers based in Massachusetts do just fine spending about 10% on administrative costs, and earning a 2% profit margin, some students are being forced into plans where 25% of the premium goes to administration, and another 20% to profit. The average for all plans offered by insurers was just 67% of premiums going to medical costs. The average profit margin was 10%, compared to 2% for private employer plans. Health Care For All supports this bill and additional policy solutions that level the playing field for this population who often experience other barriers to their education – their health should not be one of them.
- Jessica Hamilton

Jessica Hamilton

November 25, 2009

Congratulations to HCFA Outreach Manager Dayanne Leal on receiving the Community Activist of 2009 award.

Dayanne was honored this week by Assistencia Total Brasileira at its First Annual Thanksgiving Fundraiser and Award Dinner. Assistenica Total recognized Dayanne for her outstanding work for social justice here and in Brazil.

Dayanne is a devoted outreach staff member doing valuable work for the Brazilian community in Massachusetts. She founded the charity Tropical Angels Project which supports needy children and families in Brazil.

The HelpLine team, Denise Moran, Kate Bicego, Carlos Solis, and Hannah Frigand joined Dayanne to celebrate her good work! Congratulations!

November 23, 2009

Senator Paul Kirk has published his reflections on voting on health care reform. He cast his vote Saturday from Senator Kennedy's desk, and it surely weighed on him:

Kennedy’s voice, his energy and his unique legislative skills are deeply missed as the Senate prepares, at long last, to act on this historic legislation. But I believe we should be mindful of his spirit and his commitment to this cause as the debate goes forward. Now is the time to pass health care reform and fulfill what he called “the cause of his life” for all Americans.....

Inaction is not an option. To accept the status quo is to fall further behind. The quality of life, especially for seniors, for people with disabilities and for middle-class families, hangs in the balance. The cost of health care is now a burden that is far too heavy for the American people and for our economy. Too many of our seniors must pay out of pocket for expensive prescription drugs, too many parents stay up at night worrying that they will not be able to afford care for their children, and too many youths graduate from college and find themselves without health insurance.

Now is not the time for partisan games and the arguments of the past. I think often about how Kennedy, never ashamed of his liberal label, would set aside ideology and find common ground for compromise if it meant that the American people would benefit. Hopefully this will be a time when a solid majority of senators find a way to come together to repair our flawed health care system and make it capable of bringing quality, affordable health care to all Americans.

November 23, 2009

A Boston Globe article looks at the decrease in infection rates at a number of Boston-area hospitals and cites a number of possible reasons for the decline.

Among those reasons mentioned are the upcoming public reports on hospital-acquired infections that will be issued through the Department of Public Health early next year. An annual public report on infections became law in Massachusetts as a result of the advocacy of Health Care For All and the Consumer Health Quality Council.

Other reasons for the decrease include the implementation of steps to reduce bloodstream infections in the ICU, similar to a program in Michigan hospitals that reduced such infections by close to two-thirds. One element of that program is the use of a checklist to prevent the infections. HCFA and the Consumer Council are advocating for legislation that would require hospitals to use checklists such as this one, that have been proven to be effective, to prevent infections and other complications. New England Baptist, one of the hospitals mentioned in the article, screens all incoming patients for MRSA and has seen its infection rates drop as a result of this and other protocols it has put in place.

HCFA and the Consumer Council are also advocating for legislation to require hospitals to screen high-risk patients for MRSA upon admission in order to prevent its spread to other patients. Despite the long-held belief, as is mentioned in the article, that infections are inevitable in hospitals settings, it is clear that the increased focus on decreasing their occurrence by consumer advocacy groups, medical providers, government regulators and others has had an impact.
-Deborah W. Wachenheim

November 23, 2009

On Friday, Dr. James Mandell, CEO of Children’s Hospital Boston, presented “Children are not Little Adults: A Pediatric View on Payment and Insurance Reform” at the Health Law and Policy Forum Brown Bag Lunch Series.

Through case studies, Dr. Mandell emphasized that the issues surrounding pediatric care are different than those surrounding adults. Yet, most of the thinking and analyses of health care is taken from the adult care system. The Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program is the child health component of Medicaid. While EPSDT is required in every state and is designed to improve the health of low-income children by financing appropriate and necessary pediatric services, those measures are not part of the analyses or discussion of health care reform. In many of the national health reform proposals, children are placed into so-called Exchange programs that are primarily designed for the health needs of adults. Inclusion of an EPSDT wrap is imperative in these cases.

Dr. Mandell also found that the cost drivers in pediatric care are different than those for adults. Pediatric health care spending in the United States is 13% of health care dollars. While the cost of health care for most children is relatively low, those who require hospitalization or specialty care experience a tremendous increase in total cost. While 95% of kids average barely $400 per year in health costs, there are a small number of children (1%) who need more than $30,000 in annual care.

The unique needs of children should be included in health care reform. Instead of treating children as little adults in terms of health care, children’s needs should be specifically addressed. Coverage for children should include coverage for hospitalization. Early screening and prevention should be part of the scope of benefits. Reimbursement rates should reflect the actual cost of medical procedures. Even though it is often more expensive than it would be to do the procedure on an adult, Medicaid/SCHIP currently pays 30% less for pediatric procedures. Inequity in provider payments makes it hard for kids to get the care needed for complex medical procedures. A shortage of persons who train for pediatric subspecialties limits access for children who need specialized care.

In closing, Dr. Mandell remarked that pediatric health is more of an investment rather than a cost, and one that has significant long term benefits.
-Jaspreet Chowdhary & Yelena Kuznetsov

November 21, 2009

Is the individual mandate unconstitutional? Experts say no, but the far right keeps claiming the mandate goes beyond the power of Congress to regulate interstate commerce. The Senate health reform bill includes a section to make the case that the mandate is allowed, and cites the experience of Massachusetts to prove the point.

The Senate health reform bill (pdf) includes a 3-page preamble (section 1501, starting on page 320) of Congressional findings before the legal language setting up the individual mandate. The findings are essentially an advance brief to the Supreme Court in case a constitutional challenge is ever raised on the issue. The findings declare that health care is an economic activity that affects interstate commerce, and that the individual mandate furthers economic goals. The section includes the following:

(D) The requirement achieves near-universal coverage by building upon and strengthening the private employer-based health insurance system, which covers 176,000,000 Americans nationwide. In Massachusetts, a similar requirement has strengthened private employer based coverage: despite the economic downturn, the number of workers offered employer-based coverage has actually increased.

This is yet another, unexpected example of how Massachusetts health reform has paved the way for national reform.
-Brian Rosman

November 19, 2009
Nancy Ridley being congratulated by DPH Commissioner Auerbach

Nancy Ridley being congratulated by DPH Commissioner Auerbach

The Public Health Council met on Wednesday for its monthly meeting. The Council meeting was the last time Nancy Ridley would present to the group, and as Commissioner Auerbach noted, “probably no person has come before the PHC as many times as Nancy.”

Nancy started her career with the Department of Public Health in 1977. In her 32 years with the Administration, she has worked on a myriad of issues, including emergency preparedness, laboratory regulations, food and drug programs and health care quality. For the past 8 years, Nancy Ridley has been the Executive Director of the Betsy Lehman Center for Patient Safety and Medical Error Reduction. The Commissioner thanked Nancy for her patient safety program legacy in the Commonwealth and announced that the 2009 Betsy Lehman Center Award in Patient Safety will now be called the Nancy Ridley Award.

Public Health Council member Albert Sherman stated that former Speaker Tom Finneran once said that Nancy Ridley was one of the 2 most powerful women in the state and everyone needed to know her to get anything done. HCFA joins others in thanking Nancy for her leadership, dedication and vision on patient and consumer safety issues in the state. We wish her all the best!

The meeting began with the release of the third expert panel report from the Betsy Lehman Center. The Center was created by Legislative statute in 2001, thanks to the dedication in large part of Senator Richard Moore. The Center serves as a clearing house for the development, evaluation and dissemination of best practices for patient safety and medical error reduction. The report covered Patient Safety in Obstetrics in Massachusetts. Despite the line item for this report being slashed as a result of 9C cuts, it was finished and released. The report made recommendations concerning electronic fetal monitoring, elective delivery, the need for hospitals to ensure that labor and delivery unit staff are well-rested, and pre-natal records being available when patients arrive in the unit. The report also noted the dramatic increase in cesarean section rates over the past decade. Finally the report recommended that every maternity hospital should have clinical guidelines and protocols for the care and management of maternal hemorrhage (from 1997-2007 there were 18 maternal deaths related to maternal hemorrhage in the Commonwealth).

The PHC also received a presentation on a DPH report on the MassHealth Smoking Cessation program and an update on H1N1 by Dr. Lauren Smith, DPH Medical Director.
-Mehreen Butt

November 18, 2009 reports on the story of a pregnant woman named Kerry who was given a CT scan of the abdomen when she went in to the emergency room after experiencing bleeding.

It turned out that the hospital made a mistake in giving her a CT scan. The scan was meant for another patient with the same first name. As a result, Kerry and her husband are now concerned for the health of their now 15-month-old son, as experts believe that a fetus exposed to radiation may develop physical and mental growth problems.

The hospital was very up-front about the mistake, which they realized and revealed to Kerry and her husband right after the CT scan took place, and the emergency room doctor apologized for the error.

The article then goes on to list ways in which patients can be part of ensuring that such errors do not happen. While it is important for a patient, when physically possible, to be aware of what is happening and speak up if he/she sees something that is wrong, the patient is not the one being paid to provide health care services. Medical providers and institutions are being paid to provide high-quality care.

Systems need to be put in place to prevent errors from happening. Rather than relying on the patient to say, as the article suggests, "My name is Mary Smith, my date of birth is October 21, 1965, and I’m here for an appendectomy,” it would be preferable to not have to rely on a patient who is vulnerable, scared and in intense pain, awaiting an appendectomy, to be the one to make sure the surgery is being done on the right patient. It should be normal procedure for medical providers to ask each patient “Are you Mary Smith?” “Were you born on October 21, 1956?” and “Are you here for an appendectomy?”

If these questions had been asked of Kerry, perhaps she and her husband would not have to live with the worry that their son may be harmed as a result of a serious error.
-Deborah W. Wachenheim

November 18, 2009

Massachusetts does it again! By thinking outside the box, the state has provided accessible tools for MassHealth adults to quit smoking, and the program has seen unprecedented success.

Today, on the eve of the Great American Smokeout, the Massachusetts Tobacco Cessation and Prevention Program held and event at the State House to release data showing the significant health impact of the MassHealth cessation benefit.

Nurses’ Hall was packed with legislators, advocates, consumers, and press who listened as Department of Public Health Commissioner John Auerbach shared the highlights of the research. The results are impressive, and demonstrate that investing in good health policy reduces health care costs quickly. The research shows that 77% of adult smokers in Massachusetts want to quit. Over the course of only two months, nearly 10,000 Massachusetts residents requested the free nicotine patches offered by MTCP in 2008 after the cigarette tax increase.

Research shows that with the appropriate support and medication, smokers are more than twice as likely to successfully quit. As the Globe reported on the front page today, about 75,000 people on MassHealth have used smoking cessation treatment and 33,000 have been able to successfully quit. MTPC highlights further ways the state has saved money among MassHealth adults by providing a cessation benefit:

  • 38% decrease in hospitalizations for heart attacks;
  • 17% drop in emergency room and clinic visits due to asthma; and there were
  • 17% fewer claims for adverse maternal birth complications since implementation.

This relieves a heavy burden on the state – in Massachusetts alone, tobacco use costs $4.3 billion in health care costs every year. MassHealth cessation benefits have made history by sharply reducing smoking rates, costs, and health outcomes in the course of a year.
-Courtney Chelo

November 18, 2009

As we posted last night, we understand the deep fiscal pain the Commonwealth is undergoing. That's why we support looking at balanced revenue approaches, such as closing loopholes in our tax expenditure budget, or rethinking the planned drop in corporate tax rates (details, from Mass Budget and Policy Center).

But while revenue proposals are pending, we acknowledge that the pain should not be concentrated in any single area of the budget. That's why we urge the legislature to support what's called "expanded 9C," authorizing the Governor to make budget cuts in areas of government not directly under the executive branch. With the news today that tax revenues continue to fall, it's important that health and human services programs not take the full brunt of the cuts.

State House News reported this morning that the legislature was not planning to support the expanded 9C. On this last day of the session, we hope the House and Senate reconsiders this option.
- Brian Rosman

November 18, 2009

The upcoming Disparities Council meeting originally scheduled for Monday, November 23 has been canceled. For more information about the Council, please visit their website.
-Jessica Hamilton