November 2010

November 29, 2010

Dr. Joseph Viadero, a primary care physician in private practice in Franklin County, talked to the PBS News Hour a few weeks ago about the impact Massachusetts health reform is having on his patients. In just his own practice, he reports increases in preventive care and screening among his formerly uninsured patients, which has resulted in dramatic medical interventions:

"I already picked up a person with breast cancer who had a mammogram that would not have had a mammogram unless she had preventive care. I had another patient that had a colonoscopy routinely that was asymptomatic, that would have not had sought care without insurance, and ended up having colon cancer. There are a variety of other patients that we detected diabetes or hypertension that would not have come to see us unless they had insurance."


Multiply this small practice times the 400,000-plus newly covered by Massachusetts health reform, and you get lots and lots of people getting vital care they need.
-Brian Rosman

November 29, 2010

You can support Health Care For All by shopping online at over 800 + stores like Borders, Gap, Dell, and Amazon by selecting HCFA as your charity of choice when you join for free!

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As a special incentive, will donate an extra $5 to Health Care For All if you make a purchase within 45 days of joining.

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-The Staff and Board of HCFA

November 28, 2010

One of our top prerequisites for payment reform legislation (you can see them all here) is that transparent patient activation and patient empowerment measures be baked into the reimbursement system. These include validated measures of patient experience, like the Ideal Medical Practices project's survey.

A recent blog post from the project highlights mounting evidence that a positive patient experience leads to better patient outcomes. Some examples, from the post (citations omitted):

  • Patients who get care in practices that are less likely to waste their time in the office and are have physicians who are more likely to listen to them are also more likely to have appropriate colorectal cancer screening.
  • Patients receiving care in practices less likely to delay care ("sorry, the next available appointment with your doctor is...") are more likely to show up for care they need.
  • Patients who receive care from someone they know (good continuity) have better outcomes.
  • Patients who receive good collaborative care (good access, good communication, good continuity, etc) have better rates of appropriate preventive needs met, have better control of their chronic conditions, are less likely to miss time from work/school, and have fewer preventable visits to the emergency room and hospitalizations.

The interesting thing is that there is definitely a link between patient experience of care and important outcomes. As you read these studies it is clear that patients respond positively to clinicians who take time, who treat them with respect (e.g. no intolerable waiting), who listen. We often call this "good bedside manner" though of course it is much more: practices that can do this consistently have good processes in place. It is no fluke that a practice consistently runs on time, gives the provider and patient the time they need, provides high continuity of care.

We can get to this kind of system if we flip the incentives in the fee-for-service system to start rewarding clinical teams for outcomes and quality.

As the debate over ACOs continues to heat up, we urge more attention be paid to the "A" and "C," as opposed to all the attention lavished on the "O."
-Brian Rosman

November 25, 2010

Next Thursday, December 2nd, the Quality and Cost Council will host a Public Forum on Health Care Payment System Delivery Reform (info here). The forum will be held at the Hoagland Pinkus Conference Center in Shrewsbury from 12:30-2:30pm.

The QCC would like to get feedback on the following topics:

  • Establishment of Integrated Provider Organizations: What is your idea of a more integrated provider organization? How do we transition to this service model? What consumer protections should be provided to members of integrated provider organizations?
  • Payment Methodologies: What are your concerns about the current payment system? What payment models/methodologies and financing mechanisms might the Committee and the Council consider? What consumer protections should be provided by these models in the redesigned payment system as well as in the transition period?
  • How should quality performance standards for Integrated Provider Organizations be set, monitored, and evaluated?

In addition to oral testimony, written comments will also be accepted.
-Georgia J. Maheras
(UPDATED 11/29 to revise questions as reformulated by DHCFP - the state is apparently changing terminology from "Accountable Care Organizations" to "Integrated Provider Organizations."

November 23, 2010

Caritas Article

Test link here.

November 23, 2010

Just in time for Thanksgiving, the Connector released two reports reviewing Massachusetts health reform’s progress in 2010.

The Massachusetts Health Care Reform 2010 Progress Report is a very well-designed and colorful summary of Massachusetts health reform’s success to date. The report features vignettes of people who have obtained coverage through Connector programs: CommCare, CommChoice, and Business Express. It also emphasizes the Connector’s work to improve student health insurance.

The Connector’s FY2010 Report to the Legislature, which the Connector is required to submit annually, takes a deeper look at health reform implementation, including CommCare and CommChoice program updates, the development of CommCare Bridge, individual mandate data, and policy decisions around Minimum Creditable Coverage and the Affordability Schedule.

-Suzanne Curry

November 22, 2010

Today, the DPH released the eagerly-anticipated data containing payments made to Massachusetts prescribers by drug and device companies. Payment disclosure is an essential part of Massachusetts' overall efforts to curb health care costs and guarantee the ethical delivery of health services. Using this data, all health care stakeholders, including consumers, will gain a better perspective of the influence industry representatives may or may not have on their health care providers.

Under the law, certain drug and device manufacturers are required to disclose certain payments made to “covered recipients,” including hospitals, nursing homes, pharmacists, health benefit plan administrators, and health care practitioners. This includes payments for product training, compensation for serving as faculty at a continuing education or participation on a Speaker’s Bureau, and grants. However, this does not include payments for genuine research and clinical trials, and rebates and discounts.

While other states have come out with data, Massachusetts’ is the first database that is fully searchable by provider name, company name, or payment category, and is the nation's most comprehensive. Consumers will now have the ability to see if their doctor or hospital received any payments from the industry fostering a discussion between them and their provider.

We thank the DPH for working hard to make such comprehensive disclosure data available for consumers and the public and look forward to future data that will no doubt empower consumers in making their health care decisions.

There's a lot to sift through, but here are the early headlines:

  • The top 10 reporting manufacturer’s reported spending over $14 million on prescribers in 2009. Total payments approached $36 million.
  • The drug and device companies spent nearly $400,000 on "marketing studies," which are research studies developed solely for marketing purposes and not to test efficacy or quality of the drug or device.
  • Several MA hospitals do not receive any reportable money or gifts including Cambridge Health Alliance, Quincy Hospital, South Shore Hospital and Lawrence Memorial Hospital.
  • The data show that it isn’t just doctors who are getting gifts and payments. Several RNs, LPNs, NPs, Pharmacists, PAs and other prescribers are listed, showing that the industry is expending resources on every person who can prescribe, not just physicians.

The data are available in various formats, and some of the options are buried a bit deep. You can download the entire database categorized by Recipient’s Name, ID, License Type, License Number, Manufacturer’s Name, ID, Address, City, State, Zip Code, Payment Category, Number of Events, and Amount Paid. There's also searchable databases, either by Recipient Name or by Manufacturer.

The site also has lots of prepared reports, including the Top 20 Manufacturers (pdf) (numbers 1-2-3 are Boston Scientific - $2.5 million; Eli Lilly - $1.7 million; and Ethicon Endo-Surgery - $1.6 million), and the top 20 physicians (numbers 1-2-3 collected $194,000, $189,000 and $187,000 in round numbers - not too shabby).

Many, many other reports are available, most in both pdf and excel format. The data will be treasure trove for the researchers and journalists who follow this issue, like the ProPublica consortium.

November 22, 2010

For full text link, click here.

-Georgia Maheras

November 22, 2010

The Blue Cross Blue Shield of Massachusetts Foundation has launched a new online resource dedicated to Massachusetts health reform:

The website aims to be the comprehensive clearinghouse of resources on Massachusetts health reform. From the Foundation's release:

[The site] captures the unique accomplishments of the law, the work of stakeholders across the state to realize and sustain reform, and the implications of the Massachusetts experience for national health reform.

The website includes links to scores of documents, reports, data sources and analyses. Users can navigate through sections devoted to the following topics:

  • The Massachusetts Law and its History
  • Health Reform Implementation
  • Health Reform Results
  • Financing Massachusetts Reform
  • Health Reform 2.0: Cost and Quality
  • Lessons from the Massachusetts Experience
  • How National Reform Affects Massachusetts
  • Other Resources

The site also offers new tools for understanding the Massachusetts law and its impact, such as an interactive guide to the most up-to-date version of Chapter 58, with links to regulations, reports, commissions and other results of the law’s provisions, and video clips from the Foundation’s June 2010 national health reform event, including a tribute to Senator Kennedy. The website will be updated frequently to reflect new research, progress in reaching the goals of access, affordability and effectiveness, and changes in laws or regulations.

For me, the coolest part is the "Annotated Chapter 58" section, (Full Disclosure: the section is based on HCFA work going back to 2006, and I helped the Foundation update and prepare the materials.) This section allows one to read a summary and the updated, current text of the Massachusetts health reform law, and see links to web documents concerning implementation of that section. A table of contents and search capability adds to the usefulness.

Congratulations to the Foundation for this groundbreaking step.
-Brian Rosman

November 22, 2010

In this week’s installment of Getting to Better Care, we bring you the importance of pricing in cost control, doctors who practice what they preach and an extra helping of fun. You can also check out our previous blog posts for more information on how we can get to better care.

  • Doctors (and us!) worry that workers and employers may be sacrificing access to preventive care in pursuit of lower premiums. The number of workers with high deductible plans – including deductibles of $1,000 or more for individuals – has more than tripled over the last four years. Federal health reform may alleviate some of these concerns by mandating that insurers pay the full cost of many preventive procedures, but doctors say patients still forgo some necessary treatments that they must pay for out-of-pocket. Check out thisLA Times story.
  • Washington Post columnist Alex MacGillis takes on payment reform, arguing that real savings to the health care system lie in controlling the price of care, not just the quantity of care consumed. “Simply put, Americans pay much more for each bit of care – tests, procedures, hospital stays, drugs, devices – than people in other rich nations,” MacGillis writes.
  • Are Americans getting sicker? Maybe, maybe not. Recent studies show a decrease in healthy life expectancy – the number of years Americans can expect to be free of chronic conditions, like diabetes and hypertension. But, in his upcoming book Overdiagnosed: Making People Sick in the Pursuit of Health, Dartmouth Professor H. Gilbert Welch questions the reliability of this statistic in light of increasingly sophisticated diagnostic technology, as well as lower thresholds for what counts as, for example, a high blood sugar level. 'BUR's CommonHealth has the story, and the chart.
  • The New York Times offered a compelling story that illustrates how doctors can behave proactively to provide better care. One doctor attests that she schedules follow-up appointments with patients she is worried about, rather than simply assuming patients will call if they have not gotten better.
  • Last Friday, U.S. Surgeon General Regina Benjamin and a bevy of Boston doctors took a brisk lap through Boston Common to promote the importance of exercise. Promoters say studies show that healthier doctors have healthier patients. Did you join in the walk?

-The Campaign for Better Care Team

November 22, 2010

One year after the passage of its “Road Map to Cost Containment,” the Health Care Quality and Cost Council discussed the progress it has made at this afternoon’s meeting (agenda and materials).

Using a striking frog-illustrated PowerPoint, QCC members assessed which elements of the “Road Map” have made significant leaps and which elements remain grounded, in search of more resources or greater agency focus. The QCC agreed that efforts to increase transparency, encourage adoption of health information technology, and emphasize promotion of good health and preventive medicine have made significant progress. On the other hand, the QCC felt it had not made great strides toward instituting malpractice reform, supporting innovative health insurance plan designs and engaging consumers.

The QCC voted to allow its staff members to begin working with the Brookings Institution to use electronic data tracking methods to learn more about the costs charged by different providers to treat specific courses of care, like asthma or diabetes. If the program proceeds as planned, the QCC will make its database of relevant information available to Brookings so it can assess the validity and reliability of its statistical measures.

Finally, the QCC discussed adding information on dental charges or costs of health care to uninsured people to the data made available on its website. The QCC noted that consumers may be more interested in accessing data on dental care, because more of the costs may be paid out-of-pocket. Further discussion on this point was assigned to the QCC Transparency Committee. The QCC Executive Committee met in a separate non-public session to discuss other quality measures that may be reported on their website.
-Elyse Ball

November 19, 2010

The People Behind the MassHealth Dental Cuts:
Food, Winter Coat or Dental Care?

We recently met with Cynthia, a MassHealth recipient who has lost most of her dental benefits due to the recent cuts. She is struggling with dental pain that makes it difficult to eat the healthy diet required by her diabetes. Because of the devastation to the MassHealth adult dental program, the only way to stop this pain is with an extraction- without the option of an implant to replace her tooth.

Cynthia is understandably anxious about losing her tooth- she is worried about eating with a space in her mouth, and her dentist has told her that it is not the best option because her other teeth will shift out of alignment to try to compensate.

Unfortunately, even with some of the discount programs offered for care, paying out-of-pocket for an implant would place a tremendous strain on Cynthia’s budget. “I really wanted to get a warm coat for the winter, but I guess I’ll have to wait until next year,” she explains. “I’m not sure why I have to choose between health care and food, but I don’t know how I can afford both,” she continued.

We know there is a serious gap in our system of care when people are forced to make these kinds of choices. MassHealth adult dental benefits are a huge missing piece in this puzzle, and must be restored as soon as possible.

-Christine Keeves