November 2011

November 29, 2011

Barney Frank at a health care town hall meeting Barney Frank was and is a fierce defender of health care. Losing his voice in Congress will leave a big hole. I've followed Barney's career since working in Congress with a close colleague of his in the early 80s, and as a constituent since the late 80s. We at Health Care For All worked closely with office over the years, and he was an aggressive advocate for health care. His top-notch staff always helped out when federal issues needed tending. The Globe's Politics blog captured a number of his best lines through the years. He was at his best in confronting the know-nothings at the tumultuous town hall meetings during the ObamaCare summer of 2009. Barney's response to a question equating health reform with Nazism is classic:

On what planet do you spend most of your time? ... Ma’am, trying to have a conversation with you would be like trying to argue with a dining room table. I have no interest in doing it.

Click to watch Jon Stewart's presentation of Barney in action. Thanks Barney. -Brian Rosman

November 23, 2011

The proposed initiative to repeal the individual mandate as part of the 2006 Massachusetts health reform law has failed to gather sufficient signatures to get a place on the ballot next year.

In an email to supporters yesterday, the "Massachusetts Against the Individual Mandate" (MAIM - seriously?) group, sponsored by Mass Citizens for Life, acknowledged that they were not able to get enough volunteers to gather the 69,000+ signatures needed. The effort never seemed to take off. For example, their Facebook page peaked at 34 "friends", and their website stop adding posts in mid-October.

This campaign had to swim upstream against broad support in Massachusetts for health reform. Polls have repeatedly shown supermajority support for the law in general, and majority support for the individual mandate. It's telling that despite the huge uproar against the mandate in national politics, not a single bill has been introduced in the Massachusetts legislature to repeal the mandate or the health reform law.

We know what it takes to gather the signature to put a ballot initiative in play. In 2005 and 2006, HCFA and the MassACT! Coalition (website still up, for history's sake) collected 138,000 signatures in an all-volunteer effort that engaged hundreds of supporters throughout the Commonwealth. It took a massive campaign, with dedicated volunteers stalking town dumps, street fairs, malls and going door-to-door. A poll had shown 62% support for our initiative, with just 33% opposed. In the end, our effort made a major difference in getting a strong bill approved by the legislature. As former speaker DiMasi told the New York Times when Chapter 58 passed, "I used the threat of the ballot measure to pressure the business community. I told them you'd better do something or you're going to lose the ballot question."

Happy Thanksgiving!
-Brian Rosman

(P.S. - I wasn't an uninterested observer of the MAIM effort. Now it can be revealed that I had more than just policy concerns riding on their signatures.)

November 23, 2011

This week the federal Centers for Medicare and Medicaid Services (CMS) recognized HCFA's Children's Health Policy and Outreach Manager, Dayanne Leal, for her outstanding efforts to identify and enroll eligible children in MassHealth and other children's health program. Dayanne was one of 10 honored by CMS for their efforts on behalf of enrollment.

CMS's award citation noted the collaborative efforts of many organizations in Massachusetts who work together to find and enroll children in health coverage:

Dayanne's efforts across Massachusetts include work with community and faith-based organizations, as well as the ethnic media. She is always looking for new ways to reach families with eligible children and get them enrolled in health coverage. One example is the successful phone-a-thon she organized during which the Health Care For All helpline enrolled over 300 children in one day -- triple the number that the helpline usually handles over a three-month period. To build a sustainable campaign to keep kids insured, Dayanne is committed to engaging community leaders and agencies across the State. To that end, she organized a one-month long “Statewide Enrollment Challenge” where a group of 66 organizations ranging from community-based organizations, community-health centers and hospitals were equipped with outreach materials in eight different languages and redoubled their outreach efforts during the month. This successful collaborative approach and the hard work of these organizations resulted after one month in 1,479 newly enrolled children who previously were uninsured.

HCFA continues to work aggressively on reaching families to promote health coverage. Our campaign has expanded its focus to include coverage retention, a critical challenge. Too many families on MassHealth and other programs are unaware of the need to reverify eligibility each year. A study of churn among Massachusetts children found that some 16,000 kids cycle on and off coverage every year, costing the state millions in administrative costs. We are building plans to make sure all eligible kids that are enrolled, stay enrolled.

Congratulations Dayanne on your honor!

November 22, 2011

Health Reform 5-year Progress Report Cover
On Friday, the Blue Cross Blue Shield of Massachusetts Foundation released Massachusetts Health Reform: A Five Year Progress Report (pdf). The report, written by Alan Raymond, is the key summary of the status of coverage reform in Massachusetts in 2011.

At 98.1% Massachusetts has the highest rate of insured residents in the nation.  This fact is largely due to the passage and implementation of Chapter 58, Massachusetts’ landmark 2006 health reform law.

The Blue Cross Blue Shield of Massachusetts Foundation report finds that Massachusetts health reform has been largely successful in meeting its goals:

  • Make coverage affordable for uninsured, low-income residents who do not have access to employer coverage and who do not qualify for Medicaid: Prior to health reform, nearly three-quarters of the state’s uninsured were from low- and moderate-income families whose earnings were too high to qualify for Medicaid coverage.  Commonwealth Care now covers most uninsured adults in this population.
  • Maximize enrollment of low-income residents eligible for Medicaid and CHIP and take full advantage of federal matching dollars available through the state’s MassHealth waiver: The 2006 health reform law also expanded MassHealth (Medicaid and CHIP) eligibility and restored programs and benefits that had been suspended during a state budget crisis several years earlier.  For both Commonwealth Care and MassHealth, statewide coordinated outreach and enrollment efforts were integral to connecting people to the coverage they are eligible for.
  • Maintain a mechanism to pay acute care hospitals and community health centers for “essential health care services” provided to low-income, uninsured and underinsured Massachusetts residents:  When tens of thousands of the state’s previously uninsured, low-income residents were converted to coverage at the outset of health reform, the use of the new Health Safety Net – formerly the Uncompensated Care Pool – care fell dramatically, as expected. Due to the economy and several budget cuts mentioned above, HSN utilization has trended upwards in the past three years, but is still below pre-reform levels.
  • Create the largest possible pool of insured in order to spread the financial risk among healthy and sick residents; discourage “free-riders” who do not pay into the system even though they cannot be denied needed care; and encourage more workers to accept their employer’s offer of coverage: The 2006 law requires all Massachusetts residents 18 and older to obtain health insurance if affordable coverage is available, or else be subject to a state income tax penalty. The most recent data provided by the Department of Revenue, show that 97% of those who were required to verify their health insurance status, complied with the requirement.
  • Make employers financially accountable for failing to participate in their employees’ health coverage: Data from the Commonwealth’s 2010 fair share contribution filings show that more than 95 percent of employers subject to the requirement are meeting the “fair and reasonable contribution” standard.
  • Spread the financial risk of ensuring individual and small group populations over a larger pool of insured and help make individual insurance more affordable:  After the individual and small-group markets were merged on July 1, 2007, coverage for non-group members became significantly more affordable
  • Create a “health insurance exchange” that makes it easier for individuals and small businesses to find and purchase affordable coverage: The Commonwealth Choice program through the Connector allows individuals and small businesses to make apples-to-apples comparisons of quality health plans.
  • Increase the public’s access to cost and quality information and act as a catalyst for health system changes that enhance the quality and affordability of health care in Massachusetts: The Health Care Quality and Cost Council has created a website called MyHealthCareOptions, which allows consumers to compare hospitals and physician groups using quality- and cost-related information.
  • Understand and begin to address the various factors, both inside and outside the health care system, that contribute to disparities: The Health Disparities Council has adopted a framework for planning, implementing, and evaluating efforts to eliminate racial and ethnic health disparities.

Overall, expanded coverage has been accompanied by improved access to care, especially among low-income adults, with significant increases in physician office visits and the use of preventive care, and in the percentage of adults with a usual source of care. Fewer residents report they have unmet needs for care, with decreases especially notable among middle- and low-income residents, racial and ethnic minorities, and people with chronic diseases.  And, the state did this without breaking the bank.  In fiscal year 2011, the state’s share of spending for health reform amounted to just over 1% of the state’s $32 billion budget.

November 17, 2011

JudyAnn Bigby, MD, Secretary of the Executive Office of Health and Human Services, was recognized today by Delta Dental of Massachusetts, Lynn Community Health Center and the Massachusetts League of Community Health Centers at the Lynn Community Health Center in Massachusetts for her focused efforts on improving access and promoting oral health for the most vulnerable in the Commonwealth.

Earlier this year, after six years in the courts and five years of remediation, the Health Care For All v. Romney lawsuit came to a close as the court ended its jurisdiction over the case. Under the leadership of Secretary Bigby, many improvements, outlined here, have been made through the remediation period.

The Patrick-Murray administration has shared a vision with local oral health leaders to ensure that care for children is more patient-friendly and dentist-friendly. The administration has helped realize this vision by increasing fees, including paying dentists an extra fee for caring for Medicaid children. It has also worked to allow non-dental providers to apply varnish and reimburse those that do.

Health Care For All congratulates Secretary Bigby, and looks forward to continued collaboration with the EOHHS as we work to improve access to oral health care for Medicaid adults.

-Courtney Chelo

November 16, 2011

Today’s announcement that Tufts Medical Center and its physicians at the New England Quality Care Alliance (NEQCA), and Blue Cross Blue Shield of Massachusetts hit a contracting impasse (see coverage from WBUR, and this personal story, and the Globe story), has our heads spinning. As advocates for creating a more patient centered health care system, we see today’s announcement as both a step in the wrong direction, and a clarion call for a more comprehensive solution to the problem of escalating health care costs. Most importantly for us is our concern about the effect that this will have on the some 130,000 Blue Cross members who depend on Tufts Medical Center for their health care. Consumers are caught in the middle of a fight over which we have no control, yet which will have the direct consequence of disconnecting more than 100,000 of us from the care we depend on. These two critically important members of the Massachusetts health care community -- Tufts and Blue Cross -- went through a similar exercise three years ago, which was also painful, confusing and unnecessarily disruptive to patients and consumers. We are concerned to find ourselves here again, and believe that similar disruptions will be threatened, and perhaps experienced without some sort of systemic response. Health Care For All believes strongly that this is a wake up call about the role that government will have to play to provide consumer protections, rate reviews and, when necessary, perhaps even direct intervention to prevent the outcome that is being threatened today. Is the Tufts contracting request reasonable? Is Blue Cross acting prudently to control costs? Are Tufts’ patients having better outcomes and receiving higher quality care than they are from other providers, so increased or higher rates are justified? We don’t know. What we know is that these two entities are at loggerheads because of money. What we also know is that the contracting price that insurers like Blue Cross and hospitals and physicians like Tufts negotiate is influenced by a whole host of factors that are not directly tied to the cost or quality of the services being delivered. Rather, much of the price reflects the relative market power of the insurers and the hospitals, and the price that the market will bear. That is extraordinarily difficult for consumers, because those factors are beyond our control. At the top of our always ambitious and full policy agenda is to change the way we in Massachusetts pay for and receive health care services. Health Care For All believes that health financing should reward coordinated, high quality care, and should incentivize keeping us well. We see a future with a true health care system, rather than the sick care system we are living in today. Today’s announcement was a sure sign that our system is not healthy or required to act in the best interest of patients. Over 130,000 Massachusetts residents are threatened with feeling the brunt of this disagreement. After tomorrow, the 2011 legislative season will be over, and the legislature can turn to next year's agenda. We know the leadership and staff are working on comprehensive reform legislation. We hope today's news will push them to do their best for the patients and consumers at the heart of health care. -Amy Whitcomb Slemmer Are You Affected?: The HCFA Helpline - 800-272-4232 - is available to help members of Blue Cross who receive care from a Tufts-affiliated clinician. People with questions can also refer to this BCBS web resource, and Tufts Medical Center has set up a site on the issue at

November 16, 2011

This lede from the NY Times says it all:

Doctors who earn money for cardiac stress testing are much more likely to prescribe the tests than those who don’t, a new study has found.

The study, in the Journal of the AMA, looked at records for 17,847 patients nationwide who had coronary revascularization and a cardiac outpatient visit more than 90 days following the procedure. Their physicians were classified as billing for both the test and the professional fees (like supervision or interpretation), professional fees only, or not billing for either (on straight salary, for example). Logistic regression models were used to evaluate the association between physician billing and use of stress testing, after adjusting for patient age, disease characteristics and other physician factors.

The findings were dramatic. Doctors who were being paid for both the test and professional fees performed the nuclear stress test on 12.6% of patients. Those who were paid for just the professional fee ordered the test on 8.8% of their patients. And doctors who were not specifically paid for anything performed the test on 5.0% of patients. For stress echocardiography, same thing. Among physicians who billed for the test and professional fees, professional fees only, or neither, the cumulative incidence of testing was 2.8%, 1.4%, and 0.4% respectively.

How much would Massachusetts save if physicians were not paid on a fee for service basis? Based on this study, the costs of these cardiac tests might decline by more than half. That's why we need payment reform.
-Brian Rosman

November 14, 2011

Health Care For All’s Consumer Health Quality Council ( turned 5 years old yesterday!

This group has accomplished an amazing amount in 5 short years, and none of it could have happened without the involvement of the dedicated consumer volunteers who were willing to tell their stories and speak up for change (click for links to videos and stories). From testifying at the State House to speaking to the media to giving presentations at events and conferences, the members of the Council have exemplified how one person’s story and one person’s drive can really make a difference.

Congratulations to the members of the Consumer Council for all of their work and accomplishments and we look forward to seeing what this group will accomplish in the coming 5 years and beyond!
-Deb Wachenheim

November 14, 2011

The Health Care Quality and Cost Council is meeting this Wednesday, November 16, 1-3pm, at 1 Ashburton Place, 21st floor, Boston. Meetings are open to the public. You can see the agenda here (pdf). In addition to updates from committees, the agenda includes an update on traffic on the MyHealthCareOptions website, a presentation on health care price transparency, and a presentation on communicating with consumers about health care value. Also, the agenda indicates that the QCC’s annual meeting will take place on December 14, 8:30am-12:00, in Worcester.
-Deb Wachenheim

November 14, 2011

Wonkblog headline on payment commissionWhy should an obscure state advisory board make national observers take notice? Because it's a strong indication that Massachusetts is moving towards taking strong action to control health care cost growth.

The board is the "Special Commission on Provider Price Reform," created under last year's chapter 288. The members included representatives of the hospitals, insurers (MAHP and BCBS), physicians, the GIC, and a Kennedy School health economist. No consumer representatives were on the panel. Two administration officials (A and F Secretary Jay Gonzales and DHCFP Commissioners Carrington, and then Boros) co-chaired the group.

Most importantly, the commission also included the House and Senate co-chairs of the Health Care Financing Committee, Rep. Steve Walsh and Sen. Richard Moore. They are leading the effort to draft comprehensive health delivery and payment reform legislation, expected early next year. For the legislators, this was an opportunity for them and their staffs to hear and assess lots of vetted evidence, to confront the various interest group positions on cost control, and find a consensus they could agree to on the trickiest issue, state oversight of provider prices.

Last week the Commission voted in favor of a recommendations that include increased transparency of prices, including a method to allow consumers to figure out in advance what a medical procedure will cost them out of pocket. They also recommended public disclosure of the methodology used to assign providers to tiers in tiered network plans. Both of these are long-time HCFA priorities.

The key recommendation was for a short-term process to empower an independent panel of experts to intervene when insurers reject a price increase proposed by a higher-than-average cost provider. The panel would be authorized to judge if the price increase is justified based solely on the quality of the service. This would remove market power considerations from the negotiation equation. The political leadership decided to push this recommendation through, despite opposition from the Mass Hospital Association.

This recommendation got national attention from policy watchers from the Washington Post's Wonkblog to the American Spectator, and others.

HCFA has long supported state oversight of unreasonable provider prices. Along with GBIO, we have formulated 5 benchmarks for payment reform legislation, which includes this:

  • Fair Payment: Effective Public Oversight of Health Care Costs. Unregulated, private market negotiations have failed to produce affordable, fair and equitable payment levels for health care. State government must have authority to require reasonable charges by insurers, hospitals and other medical providers.

We're encouraged by the progress represented by the Special Commission reaching an agreement. The Commission successfully negotiated important policy understandings that represent a real breakthrough in advancing a strong solution to our health care crisis. The dress rehearsal was a success. On to the show - break a leg!
-Brian Rosman

November 11, 2011

As an article in Tuesday’s NY Times highlighted, Medicare is going to start looking at patient satisfaction survey results when reimbursing hospitals.

Hospital representatives quoted in the article are concerned about the negative financial impacts for things they can’t control as opposed to actual clinical quality measures (which will still determine the bulk of the reimbursement they receive). And, of particular note for those of us in MA, hospitals in the Northeast and California are concerned that their patients will “grumble” more than those in other parts of the country!

While patient satisfaction can obviously be more subjective than clinical quality, there have been similar grumblings about clinical quality measures. For a long time, and probably still today for some, infections were accepted as something that happens and can’t be stopped, and there was “grumbling” about public reporting of infection rates, not to mention reducing reimbursements when infections occur in the hospital, as Medicare has been doing for certain infections. But in recent years, there has been a lot of focused work on preventing infections and many hospitals have seen amazing results. And you have to assume that public reporting and financial implications of infections have played some role in this change. So, let’s hope that the same will happen for the patient experience.

The article mentions important innovations that can make patients’ experiences better and help to prevent errors or serious problems from occurring-such as having nurses visit rooms hourly and expecting all employees to respond to a patient’s call light. And the questions that CMS asks patients in the satisfaction surveys include topics like whether or not the patient received proper instructions on what to do when leaving the hospital. With CMS also focused on reducing hospital readmissions, a question like this really gets at whether or not a patient feels prepared to leave the hospital and continue receiving care as an outpatient. If the discharge process does not ensure that a patient is prepared to make that transition, then that patient has a higher likelihood of being readmitted.

In a nutshell, taking steps to improve patient experience will also result in improving care over all. Making care in all settings more patient-centered is one of the priorities of payment and delivery system reform.
-Deb Wachenheim

November 11, 2011

Today the Connector Board met to vote on two consulting contracts, introduce the FY 2013 CommCare MCO procurement, and vote on the A&F Subcommittee’s charter.  They also held a very short annual meeting to re-elect Board Vice Chair Dolores Mitchell and to appoint A&F Subcommittee members: Secretary Jay Gonzalez, Celia Wcislo, and Andres Lopez. They also began talking about the complex issues related to implementing the federal Affordable Care Act in Massachusetts.

Materials from the meeting are a click away, and our full summary is after the break.