July 2012

July 31, 2012

At around 10:30 Monday night, the legislative leadership released the text of their bill called "payment reform" for short in the State House, but majestically formally titled "An Act Improving the Quality of Health Care and Reducing Costs Through Increased Transparency, Efficiency, and Innovation" (read the bill text here, and download the legislature's 4-page summary here (both pdf)).

In its 349 pages, the bill does much more than just push our insurers and other payers to use what are called "alternative payment arrangements." There are major investments in prevention, changes to insurance laws, malpractice and mandatory nurse overtime provisions, hospital checklists, investments in health workforce and health information technology and a restructuring of the state's health care administrative structure (please join me in mourning the demise of the Division of Health Care Finance and Policy, whose name I picked out in 1996). There's a lot here, and we'll be doing a "hidden treasures of the payment reform bill" post in a few days.

The summary of the 349-page bill is titled "The Next Phase of Massachusetts Health Reform." While many will be calling this phase 2 of health reform, our vision goes back much further. By our count, this is phase 4. Our once-a-decade list starts with the 1988 Universal Health Care law that is still the legacy of Governor Dukakis, the creation of MassHealth in 1996, and, ahem, RomneyCare, as they say (we don't), in 2006. This law meets the lofty standard of those 3 earlier reforms, and like the 3 before, will have a national impact.

Today's bill completes the process started in 2007, when HCFA filed comprehensive consumer-driven cost control legislation, and urged the legislature in 2008 to form a payment reform commission. The next phase will be implementation, which, of course, is more complex and more impactful than legislation.

Fulfilling the pattern of 2008 and 2010, the legislature will be voting on July 31, the last day of the session, on a major health care bill. We strongly urge a yes vote. Here's the text of our statement:
-Brian Rosman

Statement from Health Care For All Executive Director Amy Whitcomb Slemmer Regarding the Cost Control and Delivery System Reform Legislation

"We applaud the House and the Senate for reaching an agreement on the health care cost and delivery reform legislation. This historic legislation affirms Massachusetts' leadership in consumer focused health care innovation, and we expect the nation will again look to the Massachusetts experience as a model for quality, affordable care for all.

"This bill is good news for health care consumers in Massachusetts. By changing how doctors, hospitals, and other providers are paid, the bill aligns incentives to promote patient-centered care focusing on health and disease prevention, while lowering health care costs. By paying for quality, not quantity, our state's health care delivery system will be better and more cost-effective.

"The legislation improves the quality of care patients receive by encouraging the active participation of patients and their families in making health care decisions. A truly transparent and integrated system allows patients to make informed decisions about their care. We are particularly grateful for the legislators' vision and requirement for strong consumer representation on the Health Policy Commission and individual ACO governance because it ensures that the patient voice will be represented in decision making.

"We are pleased that the final version of the bill includes a number of provisions that put patients at the center of our health care system. Strengthening the roles of medical homes, community health workers, valuing chronic disease management, and providing for licensed alcohol and drug counselors in the delivery of services is both cost effective and will lead to greater consumer empowerment and better overall health.

"We strongly support the creation of the Prevention and Wellness Trust Fund. By providing $60 million in funding for proven disease prevention programs, the legislation will begin to move us away from a sick care system and towards a true health care system that is aligned and focused on keeping us healthy. This first-in-the nation fund is established for four years in the bill. We support providing the fund with a permanent sustainable funding mechanism so that these cost-saving programs continue to keep us healthy.

"We support the integration of behavioral health into the overall health system through the establishment of behavioral health medical homes and the vigorous implementation of the federal Mental Health Parity and Addiction Equity Act. Together these laws will make it easier to navigate and access this part of our health delivery system.

"We are also pleased that the law continues the Massachusetts insurance rebate program, which provides rebates to consumers when insurers do not spend an appropriate amount of our premium dollars for medical care.

July 24, 2012

With one week to go and around 4 formal session left in the legislative cycle, it's not yet time to haul out The Final Countdown. But it's getting close. Two key bills await action - the comprehensive delivery system reform proposal, usually called "payment reform" for short, and an important bill to curb prescription drug abuse.

Payment Reform: Experts Say Consider Data and Policy Options on Employer Fair Share. Will Legislators Act Anyway?

The payment reform bill is still being considered by the House-Senate conference Committee. We hear the conferees are "making progress." But we don't expect a bill to emerge until Monday or Tuesday of next week, the last days of the session.

One issue in the bills has nothing do with cost control or payment reform. Both the House and Senate bills make major changes to the Employer Fair Share law, enacted as part of chapter 58 in 2006. The House bill makes dramatic changes, by removing the employer responsibility payment obligation for firms with 11-20 employees who don't provide coverage to their workers that meets state standards.

We oppose these changes now. Of course, there will need to be changes to the employer assessment in 2014, as part of fitting Massachusetts law into the ACA. But these changes should come out of a stakeholder process that includes employers, advocates, labor and the agencies involved. For the legislature to make changes now, without a consensus-building process, is an end run around the ongoing process that has been built up over ACA implementation. Legislation should be based on analysis that looks carefully at the data, continues the principle of shared responsibility, and involves the agencies who have the most expertise. None of this happened here.

We think all of these provisions should be deferred (technically, held in conference) so that they can be looked at later in the context of the broad ACA implementation bill that the state will need to enact early next year. Last week, the Blue Cross Foundation issued a report written by Urban Institute researchers looking at some of the complex issues involved, like state revenues and coverage distribution. The report highlights the complexity of the decisions, and the need to consult data to inform policy decisions.

We have lots of urgent priorities in payment reform. On this topic, policy experts counsel more analysis, and we hope the legislature agrees.

Before we are done, let’s make progress on substance abuse disorders.

One segment of health care that often gets overlooked is substance use disorders, and how policy can address the issues from a systems level.

Back in February, the Senate unanimously passed S. 2125, a comprehensive approach to reducing prescription drug diversion, abuse and addiction. Massachusetts struggles with a severe opioid problem.  Approximately 10 Massachusetts residents a week die from opioid and prescription drug abuse. Hundreds more overdose and require emergency care. Investments in substance abuse disorder prevention and treatment is a demonstrated cost saver.

The legislation is pending in the House Ways and Means Committee. We hope action happens in the final week, to get this bill to the Governor.

The bill is a multifaceted omnibus package to address the prescription drug abuse epidemic gripping our communities. Specifically, it:

  • Requires prescription painkillers come with an easily-understood pamphlet explaining the dangers of prescription drug abuse, where to turn for help, and how to safely store and dispose of the medications.
  • Ensures that prescriptions for painkillers are written on secure, tamper-resistant prescription pads to discourage tampering.
  • Requires doctors, dentists and other practitioners to check patient drug histories through an existing database once before prescribing painkillers, while providing exemptions for emergency situations.
  • Sets up a working group of doctors, nurses, and other health care providers to establish best practices for the prescribing of painkillers.
  • Increases opportunities for pharmacists to check patient drug histories to prevent fraud.
  • Makes sure parents or guardians are notified when their child is treated in the emergency room for an overdose
  • Bans the sale, manufacture and use of “bath salts.”
  • Strengthens the state’s Medicaid prescription drug fraud program
  • Establishes new professional substance abuse training for court personnel and attorneys.
  • Provides for a pilot substance abuse education curriculum for five school districts with high prescription painkiller abuse rates.

We urge people to call your Representative today to support this bill (find your Representative here).

July 24, 2012

Last Friday, HCFA hosted a conference call to discuss the Supreme Court decision on the ACA and its implications for both Massachusetts and the nation at large.

The key takeaway from the call? The Affordable Care Act needs to be defended in the upcoming policy debates, even here in Massachusetts.

Folks on the call and regular readers of this blog know that the ACA is good for Massachusetts. That’s why we’re asking: will you write a Letter to the Editor in your local paper supporting the Affordable Care Act?

On the conference call, Lorianne Sainsbury-Wong at Health Law Advocates talked about how the Supreme Court upheld the individual mandate as constitutional. Katherine Howitt at Community Catalyst warned us about how millions of people could still go insured if states do not expand Medicaid – a fight that’s brewing in states all around the country (but not in Massachsuetts). And Brian Rosman listed off the many ways that national health reform is helping Massachusetts every day – and the big decisions we’re going to have to make.

Our conference call exceeded our expectations – dozens of folks from all across the Commonwealth tuned in and asked their questions. And we agreed: the next step in achieving universal healthcare is protecting the ACA right here at home, in the upcoming elections.

Now, last week, US Senator Scott Brown wrote an editorial in the MetroWest Daily News slamming the Affordable Care Act claiming it’s bad for Massachusetts. He’s flat out wrong. And we need to get out the truth.

The truth is that the ACA is good for Massachusetts. It’s good for our seniors, who’ll save money on their prescription drugs. It’s good for our young adults, who can stay on their parents plan until they’re 26. It’s good for our small businesses, which get tax credits to cover their employees.The Affordable Care Act is good for all of our health because well over 780,000 people in our state have already received free preventive services – such as mammograms and colonoscopies – or a free annual wellness visit with their doctor.

And much, much more.

We don’t know if Senator Brown will continue writing these kinds of editorials, but we do need to respond.

Please voice your support for the ACA and the SCOTUS’s ruling by writing a letter to your local newspaper and get involved with HCFA. A basic template to base your letter on can also be found at that same link.

Included here is a list of local towns, newspapers, and letter to the editor email addresses based on the RSVPs we got to our conference call.

Again, thank you to all who participated in the call, and a special thank you to Brian, Lorianne, and Katherine Howitt for lending us their expertise in demystifying the SCOTUS’s decision and its implications. It’s time to gear up to defend the ACA – and that means supporting it one letter at a time.

-Ari Fertig and Casey Lowell

July 19, 2012

Since the Supreme Court decision on health reform was made, you’ve no doubt heard pundits talk about what it means politically — and probably heard a lot of misinformation about what the Affordable Care Act actually does.

That’s why on Friday, July 20th at 12pm we’re teaming up with our partners at Health Law Advocates and Community Catalyst to discuss what the Supreme Court decision means. 



What does the Supreme Court Decision 

Mean for the Affordable Care Act and Massachusetts?

Time: 12pm Friday, July 20th 2012

Call in number: 877-594-8353

Passcode: 966 88 123

RSVPs not required but requested! RSVP here.

 Once you’ve joined the call, please mute your phone so we don’t have background noise. 

Thank you in advance!

On the call we’ll have a great team of experts:

Brian Rosman, Research Director for Health Care For All

Lorianne Sainsbury-Wong, Litigation Director for Health Law Advocates

Katherine Howitt, Senior Policy Analyst for Community Catalyst

They will go over some of the key points about what’s in the Supreme Court Decision, how it impacts the country, and how it will uniquely affect Massachusetts. Then, you’ll have a chance to get your questions answered! We hope it will be an exciting conversation.

Please let us know if you plan to be on the call! We’re looking forward to talking with you all soon!

 -Ari Fertig

July 17, 2012

A week ago we reminded our readers that just three weeks remained in the legislative session, with the comprehensive health delivery system reform and cost control bill hanging out in the conference committee. Well now there's just 2 weeks left. So we were dismayed yesterday to read in a Boston Globe editorial that “a conference committee is reportedly making little headway on resolving critical differences and arriving at compromise legislation.”

We highlighted a number of critical issues in the balance, beyond the big, important fights over luxury taxes and marketing power. These include funding for community-based prevention, extending the insurance rebate law, structuring payments to reward better outcomes, protecting vulnerable patients, and not preemptively messing with the employer responsibility law.

It is imperative that the legislature not only reach a compromise but ensure that the legislation that is reported out be consumer-focused. Let’s make sure we have a fully funded Prevention Health Trust, that we reward those systems that have better health outcomes. Lastly, let’s make sure that in the give and take debate of the economics of this issue we not forget the most vital component of a health care system, the patient. There's time left, and we're not panicking. But we'd urge people to call their legislators to let them know how critical these issues are. Let the nation look to us once again for our guidance on health reform, reducing costs while improving quality.
-Paul Williams

July 11, 2012

State Senator Dan Wolf Testifies on ACA before House Committee

Today the Republican-controlled US Congressional House Oversight Committee held a hearing on the horrors coming to the economy due to the Affordable Care Act. The hearing, using favored Republican terminology, was titled "Examining the Impact of Obamacare on Job Creators and the Economy," and was in preparation for yet another inconsequential vote to repeal ObamaCare scheduled for tomorrow, the 31st time the House will vote on repeal. The forecasted disasters were interrupted, however, by testimony from Massachusetts State Senator and Cape Air owner Dan Wolf (see testimony, pdf).

While other hand-picked testifiers worried about the uncertainty and taxes, Senator Wolf gave the Committee his honest assessment of business under Massachusetts health reform:

I’m here to debunk myths and dispel fear and misunderstanding about the 2006 health care reform act that Massachusetts enacted with strong bipartisan support. It also is the template for much of the Affordable Care Act now sanctioned as the law of our land....

Here’s what really happened: ...

Health care reform has not stifled business. The Massachusetts Health Care Reform was designed to ensure access, not curtail cost. With landmark state legislation now close to passage, building on the success of the 2006 act, Massachusetts is on the verge of implementing new strategies to contain costs, while continuing to provide coverage for more than 98 percent of Massachusetts residents.

But I can also report that health care costs have not spiraled because of the plan, far from it. This year, Cape Air saw a 5 percent increase in premiums – too much, but far from the 15 to 20 percent increases we saw year after year before reform took effect. Last year, our increase was 4 percent. The previous year, we were able to negotiate a 5 percent decrease.

So Cape Air’s success should be seen in a state context. Unemployment in Massachusetts has dropped from 8 percent in 2009 to 5.8 percent in May of this year. This is 2.4 percent below the national average. Massachusetts ranks eighth in the nation in job creation this year, adding 37,800 new jobs through May. Since January, 2007, Massachusetts ranks third in the nation in economic performance, as defined by our gross state product.

Meanwhile, additional state spending for health care programs resulting from payment reform only represented 1.4 percent of the state budget in 2011 -- again, with more than 98 percent of our residents covered, which includes a 400,000 net increase in the number of non-elderly insured residents.

And the Health Connector – the Massachusetts version of the health insurance exchanges in the Affordable Care Act – has reduced premiums in the last 2 years by 10 percent. These facts explain why surveys consistently find that about two-thirds of our residents support the state’s health reform.

While the Republicans on the Committee tried to get Wolf to admit that higher taxes would somehow hurt his business, he replied with knowledgeable defenses of health reform based on on-the-ground experience. He repelled every attack directed at him by the Republicans, and refuted the misinformation coming from the other witnesses. He also spoke first-hand about the human impact of expanding coverage on his workers, who were able to get the medical care they needed because of the good insurance provided by his firm. He explained clearly that expanding health coverage was humane, compassionate, and also smart business.

When the House votes on party lines to repeal the ACA, we think at least some of those voting yes who heard Senator Wolf's testimony will have a little voice of ambivalence in the back of their heads.

We congratulate Senator Wolf, a good friend of HCFA who has already made his mark on health policy in his first term in the Senate, for his outstanding testimony.
-Brian Rosman

July 11, 2012

Can't Keep Paying For Poor Outcomes

Today marks three weeks until the final day of formal legislative sessions, July 31 of even-numbered years. On July 31, 2010, the legislature enacted a major health care bill. On July 31, 2008, the legislature enacted a major health reform bill (actually, that wasn't passed until a few minutes after midnight on August 1). See the pattern?

So we expect that the House-Senate conference committee working on reconciling the health care payment and delivery reform bills (H. 4155 and S. 2270) to finish their work close to the end of the month, if not on July 31. Senator Richard Moore, co-chair of the conference, told the State House News last week that they were hoping to finish in the next couple weeks, but had no deadline other than July 31.

Both bills take a comprehensive approach to controlling health care costs and improving health care quality, so there are dozens of provisions at stake. Our Campaign for Better Care has focused on promoting prevention and patient-centered delivery system reforms, and HCFA has looked many other issues, including insurance regulations and changes to the employer responsibility sections of chapter 58.

There are many very strong provisions in both the House and Senate bills, and we support many proposals in each bill. Among our many concerns, these in particular stick out as conference priorities:

  1. Fund Community Prevention: Community-based prevention is vital to improve health outcomes and address preventable and chronic health conditions. Preventing people from getting sick in the first place is way less expensive that treating people for chronic disease. And many chronic illnesses, like asthma, heart disease and diabetes, can be prevented by community-based programs that keep people healthy. Both the House and Senate bills provide for a Public Health Trust that would give grants to the most effective local programs with proven results. But the House bill provides just $20 million of one-time funding, while the Senate bill provides for $100 million over 5 years. We urge the conference committee to fund the Public Health Trust at the $100 million level.
  2. Don't Sunset Insurance Rebate Law: Massachusetts law requires insurers covering individuals and small businesses to devote at least 88% of their premium dollars to medical care. Insurers that spend too much of our premiums on administration, marketing and profit have to pay a rebate to their customers. This year, these rebates will total $57 million, from 5 insurers. About 50,000 individual policy holders and nearly 50,000 employers will receive rebates. The law makes sure consumers and small businesses realize the full value of their health insurance payments and makes health coverage more affordable. This law is scheduled to sunset this year, but the Senate version of payment reform extends this statute (called the "minimum loss ratio") for another two years. We urge the conference committee to continue the insurance rebate law.
  3. Reward Better Health Outcomes: The Senate bill includes language supporting use of payment incentives to reduce avoidable hospitalizations, avoidable readmissions, adverse events and unnecessary emergency room visits. Rewarding providers who perform well on these outcome measures gives patients assurance that the system’s incentives promote better care. This is not new. Currently, MassHealth links hospital payments to risk-adjusted preventable readmissions. Maryland and New York also link payments to good outcomes, and Texas and several other states plan to implement similar policies. We urge the conference committee to include payment incentives for good outcomes in the final bill.
  4. Keep Employer Fair Share Contribution: Both House and Senate bills weaken the employer Fair Share Contribution law, a central pillar of Chapter 58. The Senate bill excludes some employees from the Fair Share calculation, while the House version includes provision to increase the minimum size of employers responsible for complying with the Fair Share requirement from 11 to 20 workers, as well as the Senate provision. The Fair Share law will need to be reexamined in light of the federal health reform law, but including these provisions in payment reform sidesteps an ongoing process involving all stakeholders who are working to reach a consensus on changes to the statute. We urge the conference committee to exclude provisions that arbitrarily impact the Fair Share Contribution law.
July 5, 2012

Glaxo-Smith-Kline's ‘pheasant hunting junkets in Europe’ and other illegal kickbacks to doctors show that the strongest possible ban on inappropriate gifts is needed.

(Guest commentary by Wells Wilkinson, from Community Catalyst's Prescription Access Litigation Project)

Yesterday’s new record-breaking settlement of $3 billion with Glaxo-Smith-Kline provides even stronger proof that the Massachusetts ban on inappropriate drug industry gifts to doctors is essential to preserving the integrity of patient care.  The settlement and related documents revealed that GSK salepeople paid or compensated doctors  through illegal kickbacks related to seven different drugs: Avandia, Paxil, Wellbutrin, Imitrex, Lotronex, Flovent and Valtrex.

"GSK's salesforce bribed physicians to prescribe GSK products using every imaginable form of high priced entertainment, from Hawaiian vacations to paying doctors millions of dollars to go on speaking tours to a European pheasant hunt to tickets to Madonna concerts, and this is just to name a few," said Carmin M. Ortiz, U.S. attorney in Massachusetts.

These expensive dinners were used by GSK to illegally promote the unapproved use of the drug Paxil to treat depression in children under 18. At the same time, the salespeople were giving doctors lavish spa treatments, while misrepresenting how effective Paxil was for these vulnerable patients, and withholding studies that failed to show Paxil was effective.

And GSK illegally promoted the drug Wellbutrin by paying ‘millions’ to doctors to travel to lavish resorts.

Yet at a time when state and federal regulators and investigators are ferreting out these illegal and inappropriate practices, Glaxo-Smith-Kline and big Pharma are throwing their weight around at the Massachusetts State House, and have succeeded in weakening the state’s ban on industry wine-and-dine practices in a budget bill to be sent to the Governor.

Why have these practices, more and more commonly seen as a form of bribery, become so widespread?  Because they work.

The reality is that if a new and expensive brand-name drug is uniquely effective, doctors will not need all these kinds of gifts to try it.

But if it’s a brand-name drug that is competing against other more affordable alternatives, that’s where these lavish marketing practices come in.

As Dr. Marcia Angel, the former editor of the New England Journal of Medicine, said "The fact is that marketing is meant to sell drugs, and the less important the drug, the more marketing it takes to sell it. Important new drugs do not need much promotion.”

The Governor should take this to heart, and veto the partial repeal that stands to weaken the strong gift ban law here in Massachusetts.

July 3, 2012
Well, it’s the Tuesday after the Supreme Court of the United States has upheld the Affordable Care Act. There have been some great reactions that we’re sure that followers of this blog have already seen. Today, we’re rounding up some of the press hits we’ve got from last week:

The San Francisco Chronicle has a great gallery of photos from our press conference and highlights Madelyn Rhenisch and Amy Whitcomb-Slemmer.

22 WWLP gives us reactions from HCFA in addition to the Governor, Senate President and Speaker. And they followed up with a second part of our press conference.

You can read a lot of reactions from around the health care community on the Boston Globe here.

The Cape Cod Times asked us before the ruling what would happen to Massachusetts if the mandate were struck down and Amy Whitcomb-Slemmer was on the case.

CBS Atlanta and other local affiliates highlights Amy’s reaction about how we’re moving forward in Massachusetts. As did the Public News Service.

Check out this great gallery of reactions to the news. (See Amy in at #10 with Secretary Bigby and an amazing advocate Rosemary who spoke at our press conference.)

Our Communications Director Maria Gonzalez was on Univision and our Government Affairs Director Matt Noyes was on NECN.

Finally, even the Tampa Bay Times covered us here.

What’s been your favorite reaction so far? (Besides the memes...)

--Ari Fertig