October 2010

October 29, 2010

As the video above says, Question 3 on the Massachusetts ballot next week would cut the state sales tax, devastating health care programs. Health Care For All urges a no vote on the Question 3 (and Question 1). An analysis by the Mass Taxpayers Foundation concluded that the measure would require a staggering $4.8 billion cut spread across the $16.9 billion in discretionary funding that could be cut. For human services, the report finds the consequences enormous, "affecting the lives of tens of thousands individuals and families and resulting in the elimination of scores of programs that have met important individual and societal needs for decades."

In fact, the sales tax burden in Massachusetts is much lower than in most states. Our middle-of-the-road rate, combined with many exclusions, results in relatively low sales tax collections. This chart from the Mass Budget and Policy Center's analysis shows that we are around the 41st highest state in terms of sales tax revenue as a percent of personal income:

In yesterday's Worcester Telegram, UMass Memorial Health Care CEO John O'Brien forcefully describes the impact of Question 3 on health care in Massachusetts:

As a hospital executive and head of the UMass Memorial Health Care system, I am also deeply concerned about how Question 3 will hurt health care services. Community hospitals, school nursing services, public health initiatives, community mental health and substance abuse services and local health centers will all struggle to stay afloat while continuing to provide quality care to patients. Here are three specific examples of the impact in health care if Question 3 passes.

Hospitals and health centers would certainly experience further cuts in their MassHealth (Medicaid) reimbursement rates. Numerous layoffs at hospitals across the state, including painful ones in our hospital system, have already occurred due to cuts in payments to hospitals and physicians. Additional financial losses through the repeal of the sales tax will only increase the immense pressure on hospitals and will likely translate into further hospital staff reductions at almost every hospital in the state.

Hundreds of thousands of residents with Medicaid and other state-supported health insurance coverage would likely see their insurance affected through freezing or reducing enrollment or raising co-pays. This could in turn reduce patient access to their primary care providers, resulting in patients delaying treatment and ending up using already overcrowded emergency rooms.

The Health Safety Net, a fund that partially reimburses hospitals for health care services that they provided for free to those most in need and who lack insurance, is already facing its largest shortfall in many years due to the recession. Further cuts would be likely, meaning that our hospitals will be further burdened with trying to cover this shortfall.

So, please resist the superficial appeal of a sales tax cut. Please join with so many others in our community who aspire to continue to keep our communities strong, safe, healthy and vibrant. Please vote “no” on Question 3 on Nov. 2.

We join John and others in urging a no vote on Question 3.
-Brian Rosman

PS - Needless to say we have long opposed Question 1, which would give a special tax break to alcohol, and slash funds dedicated to substance abuse and public health. They need help before the election- see their site for details, and email info@dontrepealacoholtax to get involved.

October 28, 2010

If the scenario sounds like a nightmare, it’s only because it is one.

Imagine you are the parent of a child with significant mental health needs. One night, your child tells you that he is hearing voices. Soon thereafter, he no longer recognizes you or his siblings. Clearly, a crisis situation.

You rush your child to the emergency room, internally breathing a sigh of relief, expecting help to be coming soon.

Instead, there you sit for hours.

For a day.

For two days.

All the while waiting with your child.

In a locked room.

Not getting help.

Being told that your child can’t be admitted because his condition is “too acute” for the hospital to deal with.

In recent months, the Parent / Professional Advocacy League (PAL) has heard stories similar to this one across the state. Last week, they wrote to EOHHS Secretary Dr. JudyAnn Bigby, asking her to look into the issue. This morning, the Boston Globe wrote about one family’s story.

Health Care For All is an executive committee member (along with PAL, Children’s Hospital Boston, MSPCC, and Health Law Advocates) of the Children’s Mental Health Campaign, an advocacy coalition made up of more than 130 member organizations across the state dedicated to improving the children’s mental health system in Massachusetts.

One of the Campaign’s most significant achievements to date is the passage and enactment of Chapter 321 of the Acts of 2008, An Act Relative To Children’s Mental Health. Among the law’s provisions is an attempt to reduce the number of “stuck kids” – those who unnecessarily remain in inpatient treatment settings when they are ready to return to the community.

Although we have been successful in bringing these numbers down, the Globe article shows that we still have a long way to go before we can claim victory in totally reforming the children’s mental health system.

The work of the Campaign continues. If you are interested in learning more, or getting involved, visit the Campaign’s website.

The time is NOW to make real changes and address these issues.
-Matt Noyes

October 26, 2010

Deb Wachenheim, HCFA’s Health Quality Manager, was interviewed recently by Helen Osborne, a health literacy expert, about Patient and Family Advisory Councils-what they are, how they can make a difference in health care, and how HCFA and the Consumer Health Quality Council were able to successfully advocate for legislation requiring all Massachusetts hospitals to have them in place by October 1, 2010. Go to the website Health Literacy Out Loud to listen to the podcast and see links to on-line resources. Scroll through the website to find links to many other interesting podcasts on a variety of topics relating to health literacy, communication, and patient engagement. For more about PFACs, an op-ed about PFACs, signed by HCFA executive director Amy Whitcomb Slemmer, recently appeared in the Standard Times. -Deb Wachenheim

October 26, 2010

“How should we talk about oral health?” This Thursday in Hyannis!

Oral health IS health. We want your opinions to help shape a new campaign focused on improving access to critical oral health care, including restoring full MassHealth benefits for adults and ensuring care for kids.

WHAT: Community Focus Group

WHERE: Community Action Committee of Cape Cod

115 Enterprise Rd
Hyannis, MA 02601

WHEN: 10-11AM, Thursday, October 28, 2010

$20 gift cards to Stop & Shop will be provided to participants.

RSVP to Christine: 617-275-2919 / ckeeves@hcfama.org or Cheila: 508-771-1375 / cheilamageste@yahoo.com

October 25, 2010

MIT economist and Connector Board members Jonathan Gruber uses the Massachusetts experience to provide two smart, analytic defenses of health reform. Both columns appeared on the Citizen Cohn blog at The New Republic.

In A Health Reform Critic Flunks Math, Gruber takes on the miscalculations of Tennessee Governor Phil Bredesen. Breseden published an article in the Wall Street Journal last week claiming that under health reform it would make financial sense for Tennessee and other employers to drop coverage and let their workers get federally-subsidized coverage through the Exchange.

Gruber finds the holes in Bredesen's faulty math (most workers wouldn't get much or any subsidies, among other issues), but also points to the Massachusetts experience as a valid comparison. Employer coverage soared in Massachusetts following health reform, and more employers began offering coverage. Rather than erode coverage, the combination of employer fair share requirements, individual mandates, and sliding scale subsidies shores up the employer coverage system at a time when its in steep decline.

Gruber's second post defends the individual mandate by comparing Massachusetts to Vermont. While both states have subsidies to help low and moderate-income families afford coverage, only Massachusetts includes a mandate to have coverage. Gruber shows that Massachusetts has a much lower uninsurance rate, and coverage is more comprehensive for roughly the same premium.

With Massachusetts years ahead of national reform, we provide a true laboratory to see how health reform works, and what are the pitfalls. In the four years since chapter 58 was enacted, the state and the Connector have made numerous adjustments along the way, learning from experience. It's good that we can share that experience with other states, and the national policymakers. This could be the most significant legacy of Massachusetts health reform.
-Brian Rosman

October 24, 2010

In this installment of our Getting to Better Care roundup (see past entries on the HCFA website), we feature some good news, some updates and (as always) a little bit of fun:

  • Massachusetts Medical Society released its ninth annual Physician Workforce Study. According to the study, half of primary care practices in Massachusetts are closed to new patients. Even when open, patient wait times for appointments are 29 days on average.
  • Our local doctor news is bookended with this Kaiser/NPR piece that discusses the migration of doctors to hospital systems and the reasons why.
  • The Wall Street Journal published an article on patient wait-time and how our current payment system forces providers to pack patients into a day’s schedule to promote “efficiency.” The article also lists a number of moves by the industry to tackle increased wait-time, such as open-access scheduling, advanced preparation, and teamwork.
  • The New York Times reported on a new payment structure that some major insurers, including UnitedHealthcare, plans to implement for cancer treatments, with the hopes to lower doctors’ preference over expensive individualize and unproven top-of-the line treatments over routine guidelines.
  • The QCC payment reform subcommittee met on Wednesday to discuss ACO provider composition, members, governance, and oversight. Flexibility was a major theme. There was a consensus on a number of areas, including the necessity for consumer representation on ACO governance. The full QCC also met, where several members proposed an interesting approach to the issue of measuring preventable readmissions. Since the expert panel could not decide between the various methodologies for counting preventable readmissions (see this powerpoint for details), the idea is to start by publicly reporting hospitals that score particularly high or or low on the two leading measures.
  • Our own GIC joins the Boeing Company, Delta Air Lines, Equity Healthcare, GE, the Intel Corporation and Wal-Mart Stores in an effort to advocate for healthcare payment approaches that reduce costs and waste while spurring higher quality and to work to put such payments in place with the health insurance plans with which they contract.
  • Kaiser reports that health care stakeholders are all maneuvering to gain an advantage under the yet undefined ACO structure. Our favorite quote: "ACOs are the latest fad," said Dan Hawkins, senior vice president for policy and research at the National Association of Community Health Centers. "I call them the hula hoop of health care because everyone wants one even if they haven't actually been defined anywhere. The whole doggone health care community is in a frenzy to own and dominate these ACOs." Read the whole article.
    -The Campaign for Better Care Team: www.hcfama.org/bettercare
October 21, 2010

The Maximizing Enrollment for Kids program works with states to encourage the enrollment and retention of eligible children in Medicaid and CHIP and establish and promote best practices among 8 states, including Massachusetts. The program, funded by the Robert Wood Johnson Foundation, is directed by the National Academy for State Health Policy.

They started a new report series, MaxEnroll Minute, and the first report highlights the progress made by MassHealth: Cutting Red Tape to Keep Eligible Families Enrolled. The report is based on the administrative change that as of September 1st, MassHealth will no longer send out "job update" forms to its members. This administrative simplification will make a huge difference in the lives of MassHealth members, as well as anyone interacts with the program, as it will significantly improve unnecessary breaks in health care coverage. We commend MassHealth’s efforts to cut down on churn as well as extra paperwork in order to ensure continuous coverage for its members.

Based on research Massachusetts officials have conducted, it was found that tens of thousands of MassHealth recipients lose their coverage due to the job change form. The majority of these people are eligible for coverage and will get back on at a later date.

This cycling on and off of coverage is known as ‘churn’ and it is one of the factors that has been found as a barrier to continuous access to health care. This change will significantly decrease churning, increasing MassHealth members’ access to the health care coverage they depend on. It will also save significant staff resources, as state workers will not longer have to send out or process the forms once they’re returned, nor reopen these cases once they have been closed.

Eliminating the job update form is a great first step towards reducing gaps in health care coverage. We urge MassHealth to find other areas to work on maximizing enrollment such as data matching with other federal and state agencies, ‘express lane’ eligibility, and 12-month continuous eligibility. All these enhancements to the MassHealth system would improve access to health care coverage programs.
-Hannah Frigand & Kate Bicego

October 21, 2010

This guest post is by Marc Hymovitz, Director of Government Relations and Advocacy for the American Cancer Society, New England Division. Marc has been a long-time leader in the ACT!! health reform coalition, and a strong advocate for comprehensive health care that meets the needs of patients with cancer.

As leaders in Massachusetts seek to address the unsustainable increases in health care costs, leaders must keep in mind the core goals of the Commonwealth’s landmark health care reform - to not just ensure access to health care for every resident but to guarantee that the care they receive access to is comprehensive and adequate.

Recent suggestions to remove prescription drug coverage from the basic level of services a plan must have to allow a consumer to meet Minimum Creditable Coverage (MCC) are short-sighted and will ultimately increase costs and reduce patient care.

Prescription drugs play a central role in health care today – equal to the role of doctor’s visits and hospital care. In most cases, drugs are the first line of defense in preventing and treating disease and illness. Those who suffer from chronic or acute disease rely on medications to control their illnesses and avoid costly hospitalizations. An avoided hospitalization saves far more than the cost of many courses of prescriptions.

The need for drug coverage is not isolated to those with chronic diseases, however. Drugs including allergy medicines and antibiotics are widely used to stay healthy. In fact, according to the CDC, nearly half of all Americans are using at least one prescription drug in any given month. This is compared to 7% who have a hospital stay in any given year. Additionally, 71% of doctor visits and 73% of hospital visits result in a prescription.

Additionally, ensuring everyone has prescription drug coverage included in their benefit package wisely spreads the costs across all those with insurance lowering the costs for everyone. This is the fundamental idea behind insurance. Without the MCC rules, patients who need prescriptions would face much higher expenses, and would be threatened with worse health outcomes.

We at the American Cancer Society are all too familiar with the need to bring health care costs under control. We hear often from cancer patients and their families who are unable to access or afford the care they need to fight their illness. Removing prescription drug coverage from MCC is counter to all of our shared goal of ensuring access to quality, affordable health care for every resident of the Commonwealth. Having an insurance card is meaningless if it does not provide you access to the care you need.

October 20, 2010

The Boston Globe definitely got it right this morning in its editorial explaining how pharmaceutical company payments to “dodgy doctors” hurt the drug companies’ credibility:

It’s ethically dubious whenever a drug company pays doctors to tout its products, for the practice drives up costs and leaves patients wondering how the money influences what doctors prescribe.

But when the doctors making sales pitches have major blemishes on their record, it further discredits a practice that Harvard Medical School and the Partners HealthCare hospitals, among others, are wisely banning.

The editorial recaps examples from yesterday's blockbuster Globe package of articles on doctors who had received speaking fees from drug companies, including an Ohio physician who was sanctioned by the state’s medical board performing unnecessary nerve tests on 20 patients and subjecting some to excessive invasive procedures. The doctor still received $85,450 from Eli Lilly in the past two years. The Globe and nonprofit investigative journalism outlet ProPublica found that only two of the seven drug companies they surveyed checked state medical board records on the doctors they hired for their speakers’ bureaus. The column concluded that the medical profession should “abandon the practice [of paid practitioners touting data on new drugs at professional events] altogether.”

The Globe package included a list of all payments to Mass physicians from pharmaceutical companies, part of a finding that some $257.8 million in payments were made from seven pharma giants to physicians nationwide since 2009. The Globe estimates that frequent speakers made more than $40,000 from pharmaceutical companies, while Boston’s top-paid doc took in $219,775 in drug company payments.

This is only partial information, based on the voluntary reporting by a few companies. Under Massachusetts' disclosure law, we will be getting much more complete information from DPH, hopefully later this fall. This new data and the Globe’s detailed analysis of it underscores the importance on Massachusetts’ stringent gift ban and disclosure laws, as well as policies by health care systems that prohibit providers from accepting speakers’ fees.
-Elyse Ball

October 20, 2010

Georgia Maheras, HCFA's Private Market Policy Manager, is in Orlando this week as a consumer representative at the National Association of Insurance Commissioners fall meeting. She's one of 28 designated consumer voices, competing with thousands of insurance industry lobbyists for the ears of the 50 state insurance commissioners. Massachusetts Insurance Commissioner Joseph Murphy is in attendance.

NAIC normally stays out of the headlines. But the ACA gives NAIC first crack at recommending the arcane details that determine the reach of the Medical Loss Ratio (MLR) rules. Georgia wrote about the context of the issue on the Healthy Blog in August. The showdown votes at NAIC will come tomorrow. At issue is holding insurers to the standards that determine how much of the premium dollar goes to medical care, and how much goes for administrative costs and profit.

Today's Politco Pulse report gives a good a rundown on the latest maneuvering. And the blog post by fellow consumer representative, former insurance executive Wendell Potter, gives a good flavor of the atmosphere:

I am writing this between meetings at the fall conference of the National Association of Insurance Commissioners (NAIC) here in Orlando. I am one of 28 people selected by the NAIC to represent the interests of consumers. The insurance industry and other special interests are represented here by more than a thousand lobbyists. Like us, they are pacing the hallways waiting to pounce on the commissioners when they emerge from their "regulator-to-regulator" meetings that are closed to the public and the media. It is at these closed-door meetings that some of the most important discussions are taking place, and decisions are being made.

At its summer meeting in Seattle two months ago, the NAIC approved preliminary regulations that represented a reasonable compromise between our positions and those of the industry. The big, for-profit insurers -- including United and WellPoint -- were not at all happy, so in the days leading up to this meeting in Orlando, they dispatched teams of lobbyists to state capitols across the country to cajole and threaten commissioners into seeing things their way. ...The central message of the lobbyists who were deployed from coast to coast as part of their most recent fear-mongering campaign is that they will stop covering people in states where they don't think they can make the profits Wall Street expects them to make if the new "medical loss ratio" (MLR) rules don't cut them enough slack. (Insurers consider the amount of money they pay out in medical claims to be a loss.)

Insurers sent their lobbyists across the country to meet personally with the insurance commissioners (and lobbyists are as thick as thieves here in Orlando) because they want the commissioners to give them the slack they need to continue being able to push their MLRs down to what will be a legal minimum next year. The more they can get the commissioners to write the often obscure but critically important rules in their favor -- even if those rules violate the health care reform statute -- the happier it will make Wall Street. That is what is really going on here. It is as simple as that.

We'll all be watching what happens tomorrow.
-Brian Rosman

UPDATE: Community Catalyst blogs Wednesday afternoon with the latest news, not looking good.

October 20, 2010

Today federal HHS awarded the Commonwealth a $743,000 consumer assistance grant for implementation of national health reform (federal press release, fact sheet, and blog post).

Today Senator Kerry cheered the grant, saying “this investment will ensure that patients across Massachusetts get the health care information they need to protect themselves and their families.”

With the grant, HCFA and Health Law Advocates (HLA) will partner with the state in guiding consumers through the private market elements of integrating the federal Affordable Care Act (ACA) into Massachusetts' landmark health reform. HCFA's Helpline will play a key role in helping consumers navigate health reform. ACA provides consumers with significant new private market protections and coverage expansions. The Commonwealth, HCFA and HLA will use the additional resources to expand our capacity to educate consumers about private market options and protections, assist with difficulties navigating the system, and when appropriate file appeals. The grants will also let us track consumer complaints to help identify problems and improve enforcement.

Community Catalyst places the grants in their national context: "Consumer assistance programs are critical to successful implementation of the new law, and help by providing one-on-one assistance to educate individuals about their health care options, to facilitate enrollment, to maintain coverage, and to troubleshoot problems that may arise. Through interactions with consumers, these programs also capture valuable, early information about implementation successes and problems that can be shared with policymakers and state agencies."

-Fawn Phelps

October 19, 2010

The Consumer Health Quality Council is holding its monthly meeting this Monday, October 25, 6:00pm at Health Care For All, 30 Winter Street, 9th floor, Boston.

This month’s meeting features guest speaker Alice Bonner, Director of the Division of Health Care Safety and Quality at the MA Department of Public Health. She, along with Craig Schneider of the MA Health Data Consortium and Joel Weissman of Harvard Medical School, wrote a strategic plan for the state to work on improving care during transitions (eg. from hospital to home, from nursing home to hospital, etc.). Alice will talk with the Consumer Council about the plan, with a particular focus on how consumers and consumer advocates can play a role in this work. This meeting of the Consumer Council is open to any Massachusetts residents who are interested in learning more about the Consumer Council and how to become a member.

The Consumer Council brings together Massachusetts health care consumers who have been impacted by poor quality health care and/or who are passionate about advocacy for changes to improve quality across the Commonwealth. If you want to make a difference in the quality of health care you and your loved ones receive, then learn more about the Consumer Council. Please contact Deb Wachenheim at dwachenheim@hcfama.org or 617-275-2902 to RSVP for Monday night’s meeting or for more information about the Consumer Council.
-Deborah Wachenheim