July 2011

July 29, 2011

Good news for patients - and for those who want to improve care, and save costs:

House 1519, “An Act reducing medical errors and improving patient safety,” (bill text, (pdf)) was reported out favorably today by the Committee on Public Health.

This bill includes many of the priorities of the Consumer Health Quality Council and Health Care For All, including the use of checklists in hospitals (and see the item in today’s Globe about more checklists being developed to improve OB/GYN care), reducing of MRSA and other infections, reduction of medical errors, investigating the overuse of medicine including imaging technologies such as CT scans, and encouraging providers to apologize following medical errors or unexpected outcomes.

We thank Co-Chair Jeffrey Sanchez for his leadership on this bill (along with his Co-Chair, Sen. Susan Fargo) and also thank the co-sponsors of the bill as it was reported out of committee - Representatives Denise Provost, James Dwyer and Jason Lewis. As payment reform moves ahead, it is important to keep patient safety and quality improvement at the forefront of reform efforts. The health of all residents of the Commonwealth will be improved if these measures become law, and health costs will decline. Learn more about H. 1519 on the HCFA website. Contact Deb Wachenheim with any questions.
-Deb Wachenheim

July 28, 2011

Governor Patrick vetoed three sections in the Massachusetts FY 2012 budget to ensure the state has better control over escalating health care costs. Yesterday the House overrode the vetoes, and they will be coming up in the Senate soon, possibly today. Health Care For All urges the Senate to preserve the Governor’s vetoes because they are in the best interest of consumers. Here’s why:

  • One section Gov. Patrick vetoed would restrict DOI's ability to perform thorough reviews of proposed insurer rate increases in the individual/small group market. Barbara Anthony, the state's undersecretary for consumer affairs, told the State House News that “What’s happening here is the industry is trying to handcuff the regulatory agency which has been probably the most successful insurance agency in the country. What they’re trying to do here is handicap them, tie their hands behind their back in an effort to make sure they’re not going to be effective in their job.” Sustaining the Governor's veto will ensure the state has more control over rising premiums, and consumers will have DOI watching their back when insurers propose unjustified premium hikes.
  • Two other sections that Governor Patrick vetoed would require the Division of Insurance to notify a health plan 60 days before the effective date of the proposed rates if it plans to disapprove unreasonably high rates. If DOI did not meet the time standard, the high rates would be deemed approved. As it stands now, DOI has 45 days to notify health plans before the rates kick in. As Governor Patrick noted in his veto message, this section "inhibits the commissioner from conducting a thorough review of the carrier's rate submission, and automatically allowing rates that have not been thoroughly reviewed could increase premium costs and create confusion in the marketplace."

While the House has rejected the Governor's efforts here to strengthen regulatory oversight of insurers, it’s up to the Senate to help consumers by preserving the Governor’s vetoes. Regulatory review is a critical component of assuring rates that are fair and reasonable. As Governor Patrick astutely states, “If we are serious about controlling the rise in health insurance premiums, we shouldn’t limit the one tool we have to give some relief to small businesses and working families.”
-Amelia Russo

July 27, 2011

Last week, we called on Senator Scott Brown to come down on the side of protecting Medicaid and Medicare in the ongoing budget and debt fights. The Globe had reported that Senator Brown "hasn’t yet taken a firm position. ‘Senator Brown is reviewing the various proposals that are out there,’ said spokeswoman Marcie Kinzel.”

Nothing's changed. Your calls and emails are still critical.

The Blue Mass Group blog has pointed out that Senator Brown has still not taken a position on the debt ceiling alternatives:

From today’s Globe story on the ongoing high-stakes debt ceiling negotiations:

Senator Scott Brown, the Massachusetts Republican, declined to comment on the plans.

“It’s changing by the hour,” he said of the discussions. “My position hasn’t really changed.”

What is his position? Another BMG post quotes yesterday's Globe story:

Senator Scott Brown, a Massachusetts Republican, has remained noncommittal on whether he supports either Reid’s or Boehner’s plan.

“Senator Brown is reviewing both of the proposals that were released earlier today,” spokesman Colin Reed said in a statement. “He remains hopeful he will be able to vote for a reasonable package that cuts spending and prevents our nation from defaulting on its obligations.”

If you can get through, Senator Brown's office number is (202) 224-4543; or you can use this online form to send a message to his office.
-Brian Rosman

July 26, 2011

Siemens Brochure: "Capitalize on imaging opportunities in urology"

We were working on a post about why we spend millions on cancer care, yet little on cancer prevention, and the pressures on physicians to increase costs at the expense of patients' needs, when we came across this post by public health expert Harold Pollack, which linked to this brochure (pdf), from Siemens, a medical device manufacturer.

The brochure urges urologists to invest in the latest CT scanners that can "significantly improve the overall bottom line of your practice," and "maximize your return on investment." "In office CT can be a significant new source of practice revenue. Let us show you how." the brochure gushes. The brochure includes a helpful chart so doctors can figure out their monthly and 5-year return on investment. It turns out, the more scans you do, the more you make:

Chart from Siemens brochure showing increasing profits for performing more CT scans

This encapsulates much of why the fee-for-service payment structure has all the wrong incentives. A doctor's take-home pay is not based on how well he or she protects health or treats disease, but on how many billable procedures and services are performed. Perform 10 scans a day, and you pocket $36,050 each month. Sweet. But there's no reimbursement at all for spending time with a patient, counseling about disease prevention, talking to family members, or discussing treatment options.

We have long been concerned about the dangers of unbridled CT scans. Radiation from CT scans causes 29,000 cancer cases each year in the U.S., and a full third of them are totally unnecessary (see this post for more details). We're working with Representative Stephen Kulik on legislation that will require DPH to make suggestions for reducing CT scan use. But this example is not tied to Siemens, or CT scans, or even medical technology. It's the underlying payment system that drives up our costs, and gives us less of what we need, and more of what's profitable. That's what has got to change.
-Brian Rosman

July 24, 2011

1. Rally Calls on Senator Brown to Support Medicaid: Last week HCFA joined with 1199SEIU, the Boston Center For Independent Living and other groups to firmly call on Senator Brown to protect Medicaid in the debt ceiling and budget fights. The
Globe had reported last week on Brown's lack of conviction on the issue: "Senator Scott Brown, the only Republican in the Massachusetts delegation, hasn’t yet taken a firm position. 'Senator Brown is reviewing the various proposals that are out there,' said spokeswoman Marcie Kinzel." The rally featured a number of Medicaid members testifying on the critical role Medicaid plays in their health and well-being. Click on the picture above to see a video from the rally, courtesy of the State House News Service.

2. Immigrant Case Decision Delayed, Again: Late Friday, Supreme Judicial Court Justice Cordy, who is hearing the Finch case regarding coverage for legal immigrants (background, from Health Law Advocates), decided to send the case over to the full SJC. This will probably require another round of briefs and arguments, delaying a final decision until the fall at the earliest. While the full Court ruled in May that the statute removing full Commonwealth Care benefits from some legal immigrants was almost certainly unconstitutional, the state has been filing additional motions to postpone a final decision in the case.

3. National Health Reform: The Book: Our former executive director John McDonough's book on the making and content of the Affordable Care Act is just out, from the University of California Press. At the Amazon link there's already a glowing, 5-start review. We recommend the book too, and hope you will buy via igive.com, which gives a few cents from each purchase to HCFA (if you designate us as your cause). John also has a monthly column at Kaiser Health News. This month's entry is about protecting Medicaid, which closes the circle and brings us back to the first update.
-Brian Rosman

July 22, 2011

Summer is setting in. Beaches are crowded on Saturdays. Ice cream lines are long. And Friday afternoon traffic out of the city is unbearable. But that isn’t slowing down our health care activists who are now, more than ever, pounding the pavement to get out the word about the Campaign for Better Care.

With payment reform hearings wrapped up—thank you to all who testified—activists are going back to the drawing board, educating health care consumers about what a health care system could look like for better, more affordable care, and what doctors, hospitals, legislators, and activists are doing to achieve it.

In Lynn, members of the Lynn Health Task force are going out into the community, talking with leaders, about how health care can be better integrated to include things like diabetes prevention and behavioral health. In Martha’s Vineyard, community health leaders are grappling with the idea of what an integrated system looks like on an island where people often have to take a ferry to get the care they need.

While the legislature works on drafting its language of the bill, we’re on to the next phase of our campaign: training consumer advocates about what payment reform is and how it will impact them.

Good health care requires a partnership between doctors and patients. So our goal is to make sure that consumers know how the health care system works and the waves of reform rolling in so that they can get involved.

If you are interested in having a training come to you, let us know! E-mail Ari at Afertig@hcfama.org and let us know that your group wants to learn more and get involved.

July 20, 2011

Spending for medical care consumers most health care dollars, yet behaviors are a greater influence on overall health A report card (pdf) released today delivers some discouraging news about Massachusetts public health. The public health report card was developed by The Boston Foundation and NEHI as part of the Healthy People/Healthy Economy Coalition, and highlights areas of strengths and weaknesses in our public health system. Though Massachusetts received zero As, it received five Bs, indicating some modest accomplishments including building walking paths and bike lanes, farmer’s markets, and workplace health programs. However, the coalition that developed the report gave the Commonwealth sub-par marks on rates of daily exercise among high school students and the paucity of supermarkets in many areas of the state. Most discouraging is the failing grade the Coalition gave to Massachusetts for being one of the few states that exempts sodas and other sugary drinks from the state sales tax. Though Massachusetts ranks lower than many states in terms of population obesity rates, obesity is an epidemic of growing proportions, no pun intended. Obesity takes its toll on the state economy, as it contributes to decreased workplace productivity and increased medical spending, costing the state over $1.8 billion per year. According to a January 2011 study published in The American Journal of Public Health, just a 5% reduction in the prevalence of diabetes and hypertension can save the Commonwealth about $450 million each year. In a time where augmented public health efforts are essential for preventing costly illnesses down the road, Department of Public Health funding has consistently been one of the programs on the chopping block. According to the NEHI analysis, between FY 2001 and FY 2011, state spending on health care services rose 76%, while the Department of Public Health Budget was slashed by about a quarter over that same period. Health Care For All supports legislation that will remove the exemption form the state sales tax on sugary beverages (H. 1697). Such a tax can accomplish two goals. First, a higher relative cost of sugary drinks will discourage consumers from purchasing high calorie beverages and instead choose better options such as water. In addition, the revenue earned from such a tax can be used toward public health initiatives that will keep us healthy today, and avoid catastrophic health problems (and costs) tomorrow. Health Care For All also supports the Prevention and Cost Control Trust (H. 1498), sponsored by Representative Lewis, which would provide a stable source of funding for community health programs that prevent disease and cut health care costs. Grants from this Trust would go directly toward programs that target costly, preventable diseases that are disproportionally represented in certain communities. Investing a modest sum in our community health today will yield huge payoffs in the future- both in terms of our health and our wallets. Massachusetts leads the nation in terms of highly-regarded hospitals and percentage of insured residents. It only makes sense for Massachusetts to continue with this trend, and work to lead the nation in public health. -Amelia Russo

July 18, 2011

The MA Health Care Quality and Cost Council is meeting this Wednesday, July 20, 1-3 pm, 1 Ashburton Place, 21st floor, Boston 1:15 - 2:45 pm, at the Division of Health Care Finance and Policy, 2 Boylston St., 5th floor. On the agenda (pdf), in addition to committee reports and director updates, is presentations and discussions on: adding three new hospital cost measures to the MyHealtCareOptions website, health care cost trends and drivers (presented by the AG’s office), and a recap of the cost trends hearing. Meetings are open to the public.
-Deb Wachenheim

July 18, 2011

Today is a big day for MassHealth -- Dr. Julian Harris begins his new job as Medicaid Director. He most recently treated patients at Southern Jamaica Community Health Center and Cambridge Health Alliance.

Dr. Harris has a long list of experiences that he will bring to the agency including working for World Bank Institute AIDS program, health consultant at McKinsey & Company, and Co-Director of the Boston chapter of advocacy group Doctors for America. Dr. Harris currently serves on the Health Reform Task Force of the Massachusetts Medical Society and is a member of the Quality and Patient Safety Committee of the Massachusetts Board of Registration in Medicine. See MassHealth’s press release for more details.

The staff of Health Care For All warmly welcomes and looks forward to working closely with Director Harris in his role at MassHealth. We cannot imagine a more exciting and challenging time in health care history for Dr. Harris to come on board!
-Kate Bicego

July 15, 2011

Connector Accomplishments - national exchange model
Today’s Health Connector Board meeting focused on Health Connector accomplishments so far in FY 11, and Affordable Care Act Implementation progress in Massachusetts (materials).

The Board Chair, Jay Gonzalez, began by updating the board that the Governor signed the FY 12 budget on Monday, and he thinks it will positively change the way government does business. Included in the budget is sufficient funding to sustain subsidies for small businesses and to pay for the Commonwealth Bridge program for the year, pending a decision in the Finch case, which seeks re-integration of legal immigrants into Commonwealth Care. As part of Chapter 288 signed last year, the Connector Board was scheduled to add an insurance broker to the Board, but has not done so yet. Gonzalez gave his appreciation to Terry Dougherty, Director of MassHealth, as this was Dougherty’s last meeting.

Glen Shor, Executive Director of the Health Connector, then provided a brief update in Connector enrollment, which is about 1000 members down in June for both Commonwealth Care and Commonwealth Choice. There are now roughly 159,000 individuals enrolled in Commonwealth Care, and 38,000 individuals enrolled in Commonwealth Choice. The CommCare open enrollment period closed as of July 8th, during which 6.8% of existing members switched plans. Shor mentioned that the Connector website experienced some difficulties during this period due to increased volume, but the issue has since been resolved.

The Connector staff then reviewed the accomplishments for fiscal year 2011, and looked ahead towards the challenges of implementing national reform in Massachusetts. Just click for the rest of the story.

July 14, 2011

A recent post in the New York Times health blog focuses on medical errors and the outcomes for both patients and providers.

Earlier this year, you may have heard about a nurse named Kim Hiatt who committed suicide following a medication error she made in the ICU that resulted in an infant’s death. Hiatt was suspended from the hospital and fired soon after. The pain Hiatt endured, knowing she had contributed to this baby’s death, in addition to losing her job, drove her to take her own life.

Most of us do not have professions where our mistakes can be fatal. Doctors and nurses hold a patient’s life in their hands with each surgery, medication, and procedure. Most providers have impeccable training and only the best intentions, but when errors occur, doctors and nurses receive all the blame, even though mistakes are often the result of a systemic problem rather than the fault of an individual. Though they may feel awful about their mistake, and truly feel their patient’s pain, patients rarely hear an apology straight from the horse’s mouth. Providers don’t usually apologize or explain mistakes directly to their patients because of fear of malpractice, and it’s not common practice in today’s modern medicine. This poor communication contributes to the lack of a meaningful relationship between patients and their docs, and this erosion of trust compromises the quality of care we receive.

In the future, we hope that doctors and nurses will feel more comfortable explaining their errors to patients and families. This will build a more trusting relationship between patients and providers, and improve quality of care in medical settings. We know our health providers are human, but since patients have so little face to face interaction with them as is, the failure to apologize for a medical error often causes patients to feel doctors simply don’t care for their well-being. It is clear from Kim Hiatt’s story that they do care and it’s worth recognizing all the good that doctors and nurses continue to do for their patients.

The author of the post, Theresa Brown, also a nurse, discusses a medication error she had made during an extended 12-hour shift (not recommended for a nurse, and an example of a systems issue that could lead to medical errors). Luckily, the error did not have any clinical consequences, but it pains Brown to think about the mistake’s potential to be a fatal error. The medical team at the hospital fully explained the situation to the patient, and reassured her that there was no resulting medical harm. The patient, who was relieved by the knowledge there was no harm done to her, felt sorry for Brown, and told the medical team that Brown delivered great care the night before, and she should not be punished for her mistake. Admitting to faults and involving the patient with a conversation about their care will go a long way toward repairing relationships between patients and their doctors and nurses.

Health Care For All and the Consumer Health Quality Council are supporting a bill that encourages medical providers to apologize following a medical error or unexpected outcome. Contact your state Senator and Representative asking for their support.
-Amelia Russo

July 12, 2011

Even though Dr. Welby was a fictional physician, he embodied what every patient wants to see in his or her doctor; he was smart, caring, and outwardly committed to his patient’s well-being. In today’s complex health care system, often patients do not see this type of doc. Though most of us trust that our physicians have sound medical knowledge, many doctors fail to properly communicate with patients and colleagues, often to the detriment of patients’ health. To some, the allure of being a successful doctor is more important than having good and communicative relationships with patients. Poor communication between doctors and patients and between medical providers has too often led to preventable deaths and complications. This trend needs to change, and a new medical school admissions process may facilitate the transition to better quality care.

Traditionally, medical students have been chosen based on strong academic records and performance in a standard, one-hour interview. However, medical school admissions officers are beginning to understand that medicine is changing, and our future physicians need to reflect these changes.

An article in yesterday’s New York Times describes how 13 medical schools in the US and Canada are now using a new innovative admissions process to choose medical school candidates based not only on academic performance and standard interview competence, but also their ability to respond to difficult ethical and social situations.

This new process is referred to as the “multiple mini interview” or MMI. Akin to speed dating, candidates show up for a process of mini situational interviews, in which they read an ethical scenario and have 8 minutes to discuss how they would proceed with the situation. There are multiple scenarios, and each is discussed with a different interviewer. There is no right or wrong answer to these situations, but if an applicant jumps to conclusions, fails to listen to an opposing argument, or communicates too strongly, he or she will be graded harshly because these behaviors indicate the candidate may not work well in a team, and may disregard a patient’s opinion in favor of his or her own.

Though this process is grueling for applicants, it allows interviewers to assess a candidate without bias, and will more easily identify character or communication flaws that would be difficult to discern during a standard, one hour interview. Applicants who are successful in this process will likely become excellent doctors who communicate well with their colleagues and patients.

As patients, we need intelligent doctors who know what they’re doing medically, but we also need doctors who we can talk to and who will listen to us. The outcome will be the coveted doctor-patient relationship that is the key to quality care.
-Amelia Russo