May 2011

May 31, 2011

Today’s NY Times includes an article about hospitals’ efforts to improve response time when a patient presses the call button. The article gives some specific examples of times when patients did not get a response and also discusses how small changes can make a big difference. Some hospitals have calls sent directly to a central operator so that he/she can assess the situation and determine who to send to assist the patient. Another hospital trains all hospital workers, including care providers, security and maintenance staff, etc., to look in on a patient if the call light is lit and respond as needed. Hospitals have also implemented “rounding” programs in which care providers stop by the patient’s room once an hour to, it is hoped, proactively address patient needs.

The article brings to mind the Rapid Response Methods that all Massachusetts hospitals are now required to have, and that many other hospitals across the country also have. Any patient, family member or staff person can activate an immediate response if it appears that a patient’s health is deteriorating. And some hospitals have found that other processes, such as the rounding procedure described above, can prevent the need to activate the rapid response.

Hospitals are busy places and it can be hard for individual patients to get attention when needed. Patients feel vulnerable enough lying in a hospital bed, and imagine the frustration when calls for help are not heard. These systems are examples of how hospitals can be innovative as they work to put the needs of the patients first.
-Deborah Wachenheim

May 27, 2011

Where in the state were our community organizers?

Word is getting out!

Health care is complex. But not too complex for advocacy groups throughout the state who are putting on their thinking caps about how to improve care, while reducing health care spending and waste.

This week, Ari and I traversed the state meeting with concerned health care consumers in Springfield, Gloucester, Lynn, Martha’s Vineyard, and Winthrop. In Springfield, 40 Medicare leaders signed on to stay informed about the Campaign for Better Care. In Martha’s Vineyard, Ari had a great discussion with 25 members of the Dukes County Health Council about community benefits and ACOs. In Gloucester, 5 clergy are grappling with what they could do in their communities about high health care costs. And 20 concerned Democrats of Winthrop are now hitting the streets, canvassing businesses, and spreading the word that 400,000 Bay Staters, who were unable to afford health care insurance five years ago, now get the care they need.

So, as pools open up across the Commonwealth, grills get cleaned, and fridges get stocked, nearly 100 consumers are newly fortified to talk health care and cost control by the grill:
What can you do? Host a training. Learn how to talk the talk. Contact Paul Williams (pwilliams@hcfama.org), Celia Segel (csegel@hcfama.org) and Ari Fertig (afertig@hcfama.org).
-Celia Segel

May 27, 2011

Today the Division of Health Care Finance and Policy issued critical two reports in preparation for the grueling "health policy boot camp" scheduled for the last 4 days in June (see DHCFP press release).

The reports highlight the value of transparency and concrete analysis, and they point even more strongly to the need for smart, comprehensive reforms of our health care payment and delivery system. Governor Patrick's statement said it well:

“These reports must serve as an alarm bell sounding the need for urgent action to control rising health care costs in the Commonwealth,” said Governor Deval Patrick. “If passed by the Legislature, the health care cost containment bill I filed earlier this year will make significant strides in helping to achieve needed relief for consumers and businesses who are paying far too much for health care.”

Premiums grew faster for small group plansThe first report looks at premium levels and trends in private health plans from 2007 to 2009 (full report and executive summary). The findings are not particularly newsworthy, as they confirm what we all know. From 2007 to 2009, private group premiums in Massachusetts increased roughly 5 to 10 percent annually, when adjusted for benefits. This compares to consumer price index increases averaging 2.0 percent annually over the same time period in the Northeast.

While prices went up, benefits went down, particularly for small groups. Among small groups, average benefits decreased 3.6 percent from 2007 to 2008 and 6.6 percent from 2008 to 2009.

The report ends with a stark warning:

The findings of this analysis indicate that health insurance premium increases in Massachusetts continue to outpace inflation. This trend presents a multitude of challenges to nearly every facet of the Commonwealth’s health and economy. If health care costs and health premiums continue to rise faster than wage growth, employees may struggle with increased premium contributions and cost-sharing responsibilities. Furthermore, with ever-higher premiums being quoted by carriers to local businesses, many employers will continue to “buy down” benefits, potentially leaving employees and their families more exposed to cost and less likely to access needed care because of additional copayments, co-insurance, or deductibles. The continued growth in health insurance premiums threatens the welfare of the Massachusetts economy.

The second report will be more politically explosive (report, summary and appendices). It looks at price variations paid by insurers for both hospital and physician services. Expanding substantially on the analysis done last year by Attorney General Coakley, the report finds dramatic disparities in prices. For example, prices paid for an appendectomy varied by more than 11-fold for a low-severity stay and 16-fold for a moderate-severity stay. Prices paid for each of the other selected diagnoses varied less significantly, but in every case they varied by more than 300 percent statewide. Less extensive variations were found in physician prices.

When looking at individual hospitals, the disparities are stark. For a cesarean delivery, Cambridge Health Alliance is paid 30 percent below the state median, while Mass General Hospital is paid 49 percent above the median. For heart attacks, the highest paid hospital (U Mass Memorial Medical Center) received 97 percent more than the lowest paid hospital (South Shore Hospital).

(Update: The Globe has a detailed story, and an easy-to navigate web chart showing the prices for common procedures at various hospitals)

These differences in prices were not based on quality, as most hospitals in Massachusetts have very good quality scores on the standard measures.

The study also compared MassHealth rates to private insurance rates. Not surprisingly, MassHealth pays on average substantially less than private payers, though the discrepancy varies depending on service. Two important exceptions are that in many hospitals cesarean and vaginal deliveries Medicaid prices exceed private payer prices.

The comparison of MassHealth and private rates led to a key take-away. As the report says, "Providers occasionally cite Medicaid’s lower payments for services as a key factor underlying private payer price variation, arguing that hospitals must negotiate higher private payments to offset low public payer payments." Yet this connection was not found. Higher rates of MassHealth patients do not correlate with higher private insurance prices.

May 27, 2011

As the Senate winds down it’s work for the second (and probably last day) of debate on the FY 2012 State Budget, we can look back and take stock of how some key health issues made out.

Children’s Mental Health was a big winner, with the Senate increasing funding for child and adolescent mental health services, and including language that requires commercial insurers to pay their fair share for the Massachusetts Child Psychiatric Access Project (MCPAP). Big thanks to Senator John Keenan for doing the heavy lift on both of these amendments.

On the Oral Health front, Senator Harriett Chandler got language inserted requiring MassHealth to report on the impact of dental cuts for certain vulnerable populations, including individuals with developmental disabilities, those living with HIV/AIDS, pregnant women, and medically compromised patients.

Despite a strong speech by Senator Sonia Chang-Diaz, the Senate did not restore legal immigrants to full Commonwealth Care benefits, choosing instead to continue the status quo until the courts will likely force the issue.

Likewise, an amendment offered by Senator Sal DiDominico that would have funded outreach grants failed to pass and one sponsored by Senator Jamie Eldridge that would have asked MassHealth to seek a Medicaid waiver to allow the state to grant 12 month continuous eligibility for children and their familes was withdrawn.

Finally, long-time health champion Senator Richard Moore offered further amendments that made two bad amendments a little less bad. The original amendments were attempts to legalize pharmaceutical coupons (which drive up health costs for everyone by encouraging consumers to gravitate toward more expensive name-brand drugs when cheaper and virtually identical generics are available). Senator Moore’s amendment to the amendment inserted some additional consumer protections into the amendments by requiring a report from the Division of Health Care Finance and Policy on the cost impact of the coupons and preventing pharma from offering coupons with expiration dates that get consumers hooked, only to quickly take away the discount. Differences between what the House and Senate passed on this issue will be worked out in the conference committee; we urge that the Senate language be adopted if anything on this is to be included in the final budget..

All-in-all, it was a busy and eventful debate. Huge thanks goes out to HCFA’s many friends in the Senate, both Senators and aides, who were invaluable in helping us do our work on behalf of consumers, and to Senate President Therese Murray and Ways and Means Chair Stephen Brewer who shepherded this budget through a complicated process during difficult economic times.

Good work to all . Now we can get some sleep and gear up for Conference.
-Matt Noyes

May 27, 2011

The Governor of Nevada signed into law a bill requiring hospitals to use checklists for treatment and other care processes. The statute is not specific about what checklists should be used but does mention that checklists should be developed for use by health care providers and also employees whose duties affect the health of the patients, such as janitors. There is also specific mention of developing a checklist to be used when discharging patients which includes at the least verifying the patient received instructions on medications, aftercare, and anything else needed upon discharge. The bill also specifies that the hospitals must develop a policy for identifying patients before they receive treatment and a policy relating to hand hygiene. Hospitals are required to review their checklists annually and to report on their checklists annually to the legislature. There are sanctions for hospitals that don’t comply.

In Massachusetts, we are advocating for a checklist bill that would require the Department of Public Health to develop guidelines and would allow hospitals to develop their own checklists. The bill would require them to report on their use of checklists annually to DPH. (Learn more about the checklist bill on the HCFA website.) The hearing on this and other patient safety/quality of care bills was recently postponed to June 14, 10am-1pm, in hearing room A-1, State House. Contact Deb Wachenheim (dwachenheim@hcfama.org) with any questions, and contact your legislator encouraging him/her to support the use of checklists in hospitals. Let’s join Nevada in making patient safety a priority this legislative session!

On another quality of care front, Steward Health Care System, a for-profit chain that recently bought a number of Massachusetts hospitals, just published Quality Care Ratings on-line, with data on patient experience, clinical quality, and safety (Globe coverage). It indicates for each measure whether a given hospital was above or below the national average and by how much. The website also allows users to compare each hospital’s ratings with its competitors. This is a step in the right direction as all health care stakeholders, including consumers, talk about the need for more transparency and for making the information accessible and understandable to a broad range of consumers. We encourage more hospitals to take such steps toward ensuring consumers are more fully informed.
-Deborah Wachenheim

May 26, 2011

As the Senate begins to wrap up day 1 of the FY 2012 Budget debate, a quick recap.

Anyone who wasn’t in the gallery (or watching online) at 10 this morning missed quite a performance of the National Anthem by Senator DiDominico’s son’s preschool class. I can think of some professional singers who could learn a thing or two about singing the Star Spangled Banner from this group of 4 and 5 year olds.

But I digress.

For the most part, today’s debate dealt with issues other than health care. One exception was Senator Sonia Chang-Diaz’s amendment closing the tax loophole on non-cigarette tobacco products, such as smokeless tobacco and flavored cigars that tend to appeal to young people. Senator Fargo joined Senator Chang-Diaz in speaking passionately for the amendment. Stand-alone legislation on this issue has been a priority of the Oral Health Advocacy Taskforce for several years, and we were disappointed that the amendment was rejected by a 15-23 vote.

This is an issue that continues to be an OHAT and HCFA priority and we will work with our friends at Tobacco Free Mass to see that this gaping loophole is closed.

Tomorrow promises to be a busy one for health issues. Keep your eye here for a wrap-up on the important happenings on Beacon Hill.
-Matt Noyes

May 25, 2011

More than five years after filing a lawsuit against the state, HCFA and the Oral Health Advocacy Taskforce (OHAT) are happy to announce today that Massachusetts’ children’s dental programs have been given an ‘A’ by the Pew Children’s Dental Campaign.

HCFA could not be more excited by these survey results, which prove the state’s efforts to better children’s dental programs through improved management of Medicaid and expansion of access to school-based dental programs. A significant improvement from last year’s C-rating, the state earned its top-rank based on streamlined administration, making payments to providers more quickly and the fact that Medicaid participants using dental services in Massachusetts has more than doubled. HCFA and OHAT are excited to see these improvements after filing the lawsuit in 2005, and we look forward to further advances we can make together.

Because families seek care as a unit, one of those next steps includes An Act to Restore MassHealth Adult Dental Benefits (S. 1079/H. 1529), which would grant more than $50 million to the MassHealth dental programs and eliminate the potential for untreated oral issues and diseases. At the minimum, we are seeking funding for some of Massachusetts’ most vulnerable populations, including the developmentally disabled, pregnant women and HIV/AIDS patients.

"‘A’ shouldn’t stand for all done," Andy Snyder, a researcher in the Pew survey, told the Boston Globe. “When adults have dental coverage, they’re likely to seek care for themselves and also seek care for their kids.”

OHAT members have ensured that state legislators know that overall health means proper oral health, so “health insurance” and “dental insurance” should be the same, too. In addition to Snyder’s claim that good oral health in adults means the same for kids, the New York Times also told us that cavities can be contagious, the U.S. Department of Health and Human Services told us that we must reduce the amount of dental decay and extractions by 2020, and countless patients have told us that their healthy diets and lifestyles are dependent on adequate oral health care. Obviously, providing restored benefits and improved quality care is important to everyone, both kids and adults alike.

HCFA is proud to have been a part of the transformation of the state’s dental care for children, but with this top-ranking for children’s programs, Massachusetts is part of the health-elite, once again, and it is time that adults get in on the action, too.

-Katy Capers

May 25, 2011

Tomorrow (Wednesday), the state Senate takes up its version of the budget for fiscal year 2012. Today, the Mass Medicaid Policy Institute issued its analysis (pdf) of the Senate budget proposal for MassHealth and other health care programs.

Highlights:

There are some key differences between the SWM budget proposal and the final House budget proposal. In particular, SWM included:

  • $42 million to fund a full-year of Commonwealth Care Bridge for those 18,500 legal immigrants currently enrolled in the program (the House funded the program for six months);
  • No change to adult day health services, a program that saw cuts in both the Governor's and House budgets;
  • $18 million in cuts to MassHealth funding, with the suggestion to reduce adult day habilitation services from 6 to 5 hours a day to meet this cut;
  • New funding in the Office of Medicaid for MassHealth audits, as part of a comprehensive "program integrity" initiative; and
  • Creation of a new caseload forecasting office to better project spending, including for MassHealth.

Health Care For All and the coalitions we lead will be pushing for a number of amendments during the floor debate. As we all know, this is a challenging year for the Ways and Means budget writers, and HCFA was pleased that the Senate Ways and Means Committee worked hard to include funding for a number of vitally important health programs, including Early Intervention, the Children’s Behavioral Health Initiative, and a funding level for the Department of Public Health that was higher than the House proposal.

As the debate progresses, there are a number of amendments (see complete list of health-related amendments) that HCFA will be watching closely:

  • Amendments 446 and 503 – Oppose. These amendments would legalize prescription drug marketing coupons, driving up health costs by encouraging the use of name-brand drugs.
  • Amendment 461 – Support. Directs MassHealth to seek a Medicaid waiver allowing the state to establish 12-month continuous eligibility for children and their parents, addressing the issue of churning.
  • Amendments 464 and 465 – Support. Reinstates dental coverage under MassHealth for individuals with developmental disabilities, those living with HIV/AIDS, and pregnant women.
  • Amendment 511 – Support. Increases funding for children’s mental health services.
  • Amendment 519 – Support. Requires commercial insurance companies to pay their fair share for utilization of the Massachusetts Child Psychiatric Access Project (MCPAP).
  • Amendment 531 – Support. Provides funding to community organizations to enroll individuals in health coverage and keep them enrolled.
  • Amendment 546 – Support. Reinstates Commonwealth Care eligibility to legal immigrants who have been residing in the US for less than five years.

The next couple of days will be exciting ones in the State House. Please call your State Senator and ask him or her to stand on the side of health care consumers with their votes on budget amendments.
-Matt Noyes

May 24, 2011

The Health Care Quality and Cost Council is meeting this Thursday, May 26, 1-3pm, at 1 Ashburton Place, 21st floor. See the agenda here . Topics to be covered include committee updates, introduction of new QCC members and discussion of replacing the chairs of the Quality and Patient Safety Committee and the Cost Containment Committee as well as the Treasurer, and discussions about cost trends and “systemness” measures. Meetings are open to the public.

May 23, 2011
This American Life Report on Drug Coupons

Click to hear story

This weeks Senate budget debate will include two amendments to allow pharma industry marketing of "coupons" for brand name drugs - amendments 503 by Senator Michael Moore, and 446, sponsored by Senator Tarr and three other Republicans. A similar provision already passed in the House, where it was buried in a consolidated amendment with numerous other provisions.

These amendments would open up a whole new marketing ploy for pharma. Drug coupons are a way to entice consumers into purchasing more expensive brand-name drugs, where the biggest beneficiaries are the drug companies. Once the initial supply of coupons in exhausted, the consumer is left paying the high co-pay for the duration of the prescription. Coupons are already banned by Medicare and Medicaid, and the Commonwealth's longstanding policy in this area should be maintained.

These issues were clearly explained, and humanized, in a fabulous This American Life report. NPR's Planet Money reporter calls drug coupons part of an escalating arms race, as the drug industry tries every way possible to market its high-margin drugs. The story provides an example of an acne drug that costs over $600 more than the generic version, because the manufacturer adds a wipe to the package - a wipe you can buy over the counter for $10. The story tells how the coupons used to be distributed solely to doctors, but now are marketed directly to patients (low-rent example).

Well worth a listen.
-Brian Rosman

May 20, 2011

Community Connect to Research will be at the ABCs of Clinical Research Educational Fair in Dorchester tomorrow (Saturday, May 21) from 10am to 2pm.

Come learn about how new medications and treatments are developed, how to become more informed about your health care needs, and receive free resources and giveaways on health topics such as cancer, HIV, diabetes, and HPV.

Community Connect to Research is a health information and health research resource for patients and families in Massachusetts. They will be demonstrating how you can use their web site to become more informed about health topics and health research. When you stop by their table, enter a raffle for $25 Stop and Shop gift cards!

Breakfast and lunch are provided at the fair! Please RSVP to Jennifer Opp at 617-432-1736

May 19, 2011

Don't understand our state's gift ban? Check out this fun breakdown explaining why we need it and what we stand to lose if it's repealed. "Pharma with a Chance of Meatballs" tells the story of how big drug companies wined and dined docs before our state acted to eliminate this conflict of interest and how these fancy meals cost consumers by jacking up the price of Rx drugs. Check it out and share it with your friends!

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