October 2012

October 25, 2012

Admittedly, "Studies Look At Massachusetts Impact of Policy Choices" could be an entrant in a boring headline contest. At HCFA, we don't endorse candidates or take any partisan positions, but we do want our readers to understand the impacts of policy choices for Massachusetts health care. Hence this post.

Repealing ACA would Raise Medicare Costs

First, Community Catalyst Action Fund released a devastating new report (pdf) this week, looking at the impact of repealing the Affordable Care Act on Massachusetts seniors and people with disabilities receiving Medicare. The Affordable Care Act (ACA) lowers costs paid by Medicare beneficiaries by cutting excess spending such as overpayments to private insurance companies, by providing no-cost preventive care, and by helping seniors cover their prescription drug costs.

If the ACA is repealed, Bay State seniors will pay hundreds of dollars more in premiums and cost-sharing each year, largely to restore unnecessary payments to health insurance companies and to hospitals and other providers. They once again will be required to pay cost-sharing for important preventive services. These changes would cost the average Massachusetts Medicare beneficiary nearly $5,000 over the next decade.

Tens of thousands of Massachusetts seniors with high prescription drug use would pay even more after repeal. Because they no longer will be protected against the donut hole coverage gap, repeal would cost them nearly $17,000 over the next decade, or $1,700 each year.

The report provides details on where the savings come from. Seniors and other Medicare recipients pay premiums based on the overall cost of the program, as well as deductibles and coinsurance. By reducing overpayments to insurers, cutting payments to some providers and incentivizing higher quality care, the ACA creates direct savings for seniors. This will save seniors hundreds of dollars per year. People will also save by closing the infamous prescription drug benefit “donut hole.” Already, more than 60,000 Massachusetts Medicare beneficiaries with high prescription drug use are saving on their drug costs. For those hitting the donut hole, these savings will average $1,700 per year over the next 10 years.

In addition to raising their costs, repeal of the ACA would take away expanded benefits added to Medicare by the law, including free preventive care services. These changes mean seniors can now get many important preventive services, such as screenings for diabetes, high cholesterol, and cancer, as well as vaccinations, at no cost. These changes do more than save money, they will save lives.

Second, a study (pdf) released this week by the authoritative Kaiser Commission on Medicaid and the Uninsured looks at the impact on Medicaid of the House Republican budget plan, which resembles former Governor Romney's campaign plan. The study includes state-by-state data, which lets us zoom in on the impact in Massachusetts.

House budget plan would require large Medicaid cuts

Overall, the House budget (which includes a repeal of the ACA and converts Medicaid to a fixed block grant) would require deep cuts in federal Medicaid spending, as shown in the graph above. This gets translated into a combination of large cuts in enrollment, increases in state spending, or cuts to provider rates.

For Massachusetts, the study estimates that the Commonwealth would lose $32.7 billion in federal revenue from 2013 to 2022, a staggering 30% cut. The impact would be massive. Even if Massachusetts were to make unprecedented efforts to control spending growth - greater efficiency than ever achieved - this cut would result in 435,000 people losing coverage. Many of those losing coverage would be likely be children.

To avoid those cuts, the state would have to spend an extra $5.4 billion in 2022. Or, it make deep cuts to payments to hospitals and nursing homes, totaling $11.2 and $7.7 billion, respectively, over the 10-year period.

The study ends with a grim conclusion:

October 24, 2012
Alan Woodward and Jeff Catalano at HCFA --  10-24-12 Left: Alan Woodward of Mass Medical Society; Right: Jeffrey Catalano of Mass Bar Association

Health Care For All and Health Law Advocates cosponsored a talk earlier today (see the slides (pdf)) featuring attorney Jeff Catalano and Dr. Alan Woodward talking about the new medical malpractice laws in Massachusetts and the on-going efforts to move hospitals and other healthcare providers toward a culture of openness and transparency. The ultimate goal is to make care more patient- and family-centered and improve patient safety by learning from errors so that they can be prevented.

Dr. Woodward talked about a collaborative effort among a number of Massachusetts organizations, starting before the new laws were enacted, to move the state’s hospitals towards a system of “DA&O” or “Disclosure, Apology and Offer.” (Read this Business West article to learn more.) The system encourages disclosure of medical errors or adverse medical events to patients and families and an apology and offer of financial compensation when appropriate. The purpose is to be completely open with patients and families, who so often have found that there is no acknowledgement of what happened following a medical error, and to allow the process of healing on both sides (patient and provider) to begin during a period of communication about what happened and what will be done to prevent it from happening again. The University of Michigan’s health care system has been using DA&O since 2001 and has seen a large drop in the number of lawsuits filed, quicker resolution of cases, and, therefore, a decrease in cost, freeing up money that could be put toward patient safety initiatives. They have also seen a culture change with more reporting of incidents because of decreased fear by staff of what would happen if they reported an error or a near-miss. A number of MA hospitals are in a pilot program to implement similar systems and the goal is for all hospitals to implement, especially now that they are required to develop such programs under Chapter 224.

Mr. Catalano described the historic and unique collaboration between attorneys and doctors that allowed for the DA&O legislation to become law. As he said, for years the doctors and the lawyers would argue against one another at the State House and nothing would happen, so they decided to come together and forge a compromise, keeping in mind their shared goal of preventing patient harm and improving patient safety.

This partnership led to the provision in Chapter 224, something that has been a priority of the Consumer Health Quality Council and Health Care For All for 6 years. Many members of the Council had experienced medical errors, directly or through loved ones, and found that, in addition to trying to heal physically, they could not heal emotionally because they often never received an apology or acknowledgement of what had occurred. This law, we believe, will help patients and families in that healing process, and hopefully will reduce harm and change the culture of health care as it is implemented in hospitals across the state.

October 19, 2012

Springfield Channel 22 covers demonstration at State House on prescription marketing rules

(Click on picture above to see full video report)

  Thursday at the State House, some 20 medical students and physicians joined with Health Care For All, Community Catalyst, Representative Jason Lewis, and others to bring attention to Friday's DPH hearing. At the hearing, medical clinicians, experts, consumer, health care, senior and community advocates will voice strong opposition to emergency regulations weakening the state’s prescription and medical device marketing law. Med students serve "lobsters" and "martinis" at State House eventThursday's event garnered lots of attention. The demonstration was covered by the State House News, Springfield's channel 22, the Boston Herald, and WBUR's CommonHealth blog ("Do You Like Your Docs Shaken or Stirred?"). Modest Means Modest The regulations implement a law passed last summer to relax state restrictions on meals provided by pharmaceutical and medical device companies to doctors. Under the previous law, meals may not be provided unless in a clinical setting. The amendment permits “modest meals and refreshments” to be offered at educational programs outside of a health care setting, such as a restaurant. The rules ignored the legislative direction to limit permitted meals to those considered modest, and instead defined “modest” as “similar to what a health care practitioner might purchase when dining at his or her own expense.” As a result of the new regulations, drug companies are free to ply doctors with lavish multi-course meals and drinks, paid for by pharmaceutical industry marketing budgets, and ultimately tacked on to the price of prescriptions. Med students deliver petition to Governor's office The students delivered a petition signed by some 150 medical students, calling on the Governor to reverse the preliminary DPH decision. Join us at the hearing, Friday at 10 am, DPH, 250 Washington Street, Boston.

October 17, 2012

These are just two of the health care quality-related events happening over the next two weeks:

Wednesday, October 24, 12:00-1:00pm: “Medical Malpractice Reform in Massachusetts,” a brown bag lunch talk at 30 Winter Street, 9th floor, Boston looking at new malpractice laws under Chapter 224-their purpose, implementation, and the collaboration between the legal and medical communities that gave rise to the new laws. Speakers are attorney Jeff Catalano and Dr. Alan Woodward. Please RSVP by October 19 to Deb Wachenheim at dwachenheim@hcfama.org.

October 21-28: “Choices at the End of Life,” a series of events hosted by First Parish in Lexington looking at various aspects of end-of-life care. Registration required. Learn more and register on this website.

--Deb Wachenheim

October 17, 2012

This summer, Massachusetts relaxed the Pharmaceutical Gift Ban. The Legislature passed and Governor signed a law that opened the door for Big Pharma to go back to their old ways of wining and dining doctors, but said that the meals had to be “modest.”

Now, it’s up to the Department of Public Health (DPH) to determine how to enforce and regulate this new law. But instead of limiting permitted meals to those considered modest, DPH has released a temporary regulation defining “modest” as “similar to what a health care practitioner might purchase when dining at his or her own expense.”

So, according to DPH, pharmaceutical companies can now woo our doctors with meals and alcohol so that doctors prescribe us expensive, brand names drugs. Now, I don’t know about you, but this makes me mad.

Now, it’s up to the Department of Public Health (DPH) to determine how to enforce and regulate this new law.  And now it’s up to us–as patients, advocates, and activists–to put in our two cents and urge DPH to change this regulation. Here’s the kicker: we only have until *this Friday* to make our voice heard before DPH’s public hearing.

So, we need you!

Write your own e-mail DPH and tell them that you don’t want industry profits to come before your health. E-mail Reg.Testimony@state.ma.us with “Code of Conduct” in the subject of your e-mail.

Here’s what you can write to DPH:

  • If you are going to allow pharma representatives to take my doctor out for a meal, at least set a clear dollar limit. I don’t want drug companies to buy my doctors lavish multi-course meals and drinks.
  • Don’t let drug companies buy my doctors alcoholic drinks. My doctors shouldn’t be drinking while learning about drugs and treatments that affect my health.
  • If my doctor is getting taken out to dinner by a drug company, I have the right to know about it. All meals and gifts given to doctors should be reported and public.

When writing to DPH, you must include your full name and address in the body of the email and type “Code of Conduct” in the subject line. And, because this is the public comment period, all emails will be public and posted online.

Again, please e-mail DPH today at Reg.Testimony@state.ma.us and let them know that you don’t want industry profits to come before your health.

It’s really quite simple: pharma shouldn’t be wining and dining our doctors. But since the state already passed a law that says they can provide modest meals, there ought to at least be a dollar limit, a ban on serving alcohol, and the requirement of public reporting on the meals provided. I don’t think that’s a whole lot to ask to protect my health.

And, if you’re able to attend the hearing in person here are the details:

DPH Hearing on Loosening the Pharma Gift Ban
Friday, October, 19th at 10 a.m.
DPH Public Health Council Room,
2nd Floor, 250 Washington Street, Boston, MA.

If you’re interested in attending and providing oral testimony, please contact Alyssa Vangeli at avangeli@hcfama.org or 617-275-2922.

--Ari Fertig

(Crossposted to Blue Mass Group)

October 12, 2012

Today, the Connector Board met to discuss key issues the Connector must consider for implementation of the Affordable Care Act (ACA) – which programs, processes, and policies can they keep and which need to change?  Materials from the meeting are here.

October 11, 2012

Join us for Health Care For All's ALUMNI REUNION!   Tuesday, October 23, 2012 6:00 PM - 8:00 PM 49 Social Restaurant and Bar 49 Temple Place Boston, MA 02111   Reconnect with old friends, enjoy great food, and learn about new ways to stay involved! Event Emcee Brian Rosman Speakers Susan Sherry Rob Restuccia John McDonough Amy Whitcomb Slemmer This event is FREE for all HCFA Alumni. RSVP to Melissa Freitas at: freitas@hcfama.org  or 617-275-2926. Please spread the word to your former colleagues and friends from HCFA! We look forward to seeing you there! Stay Connected: Join HCFA's Alumni Facebook Page --Melissa Freitas

October 5, 2012

Health Care For All and the Consumer Health Quality Council are pleased to release a new report (PDF) on the efforts and accomplishments of MA hospitals’ Patient and Family Advisory Councils (PFACs). The Consumer Council advocated for the 2008 law requiring all hospitals to establish PFACs and has been following their progress. For the past three years, members of the Consumer Council have gathered hospitals annual PFAC reports/plans and reviewed them. For the 2011 reports (which were due to be completed October 1, 2011), the Consumer Council members decided to gather the reports, review them, develop a survey instrument and then analyze them and record data. With those findings, the Council wrote the summary report. The report also includes a list of questions that Consumer Council members would like to see hospitals address in their next reports, which were to be finalized by October 1, 2012. Thank you to the Consumer Council members who spent many volunteer hours doing this work. The report gives a wonderful overview of all hospitals’ efforts. If you want to learn about a specific hospital’s PFAC, please visit the hospital PFAC page on the HCFA website  and click on the link for that particular hospital. We will start linking to 2012 reports as hospitals send them to us. Overall, we found that some hospitals have made great strides in engaging and empowering their PFACs and making changes based on their feedback and ideas. Others were still at the initial stages of developing the PFACs. And many were somewhere in between. In the 2012 reports, we hope to see many more examples of PFAC involvement in improving the care experience for patients and families. --Deb Wachenheim