May 2014

May 30, 2014

DPH Chart showing decline in central line infections

The MA Department of Public Health recently released its latest set of data (read it here, and scroll down to HAI Data Update) on healthcare-associated infections in Massachusetts acute care hospitals. The data looks at central line associated bloodstream infections (CLABSI) and a number of surgical site infections (coronary artery bypass graft, knee replacement, hip replacement, abdominal hysterectomy and vaginal hysterectomy).

Massachusetts hospitals ICUs overall have rates of CLABSIs that are lower than or equal to what would be predicted based on earlier data but burn ICUs have rates higher than expected. For surgical site infections, aggregate rates are lower than or equal to predicted except for vaginal hysterectomy SSIs which are higher than expected. This higher rate had already been a concern at DPH and they convened a workgroup to look more closely at possible explanations. So far they have not found a conclusive cause for this high rate.

This most recent data release only includes aggregate data, with just a few hospital specific items in the slides. For the most recent hospital-specific infection data, you have to look back to a June 2013 data release (on the same webpage, called “2012 Hospital Specific Data Sheet). While we appreciate that there has been an aggregate data update one year after the last update, it would be helpful to Massachusetts consumers to have access to annually updated data for every acute care hospital. We encourage DPH to update both aggregate and hospital-specific data on a regular basis and to widely publicize the data release so that the media and the general public are aware of its availability and how to interpret it.

For additional infection data, visit the CHIA website to see a summary of changes in infection rates in MA from 2008-2012. This shows statewide decreases in rates of CLABIs, abdominal hysterectomy SSIs, and colon surgery SSIs but an increase in catheter-associated urinary tract infections (UTIs). 

   -Deb Wachenheim

WSJ Marketwatch bolg: Is Health Reform Working In Massachusetts?
May 28, 2014

A meta-study is research that combines results of lots of other studies. Like a meta-joke is joke about jokes ("A priest, a rabbi and a leprechaun walk into a bar. The leprechaun looks around and says, 'Saints preserve us! I'm in the wrong joke!'").

Geoffrey T. Sanzenbacher, a research economist at Boston College, published a useful compendium of research on Massachusetts health reform for their Center for Retirement Research. The meta-study looks at the impact of Massachusetts health reform on coverage, health outcomes, costs and the labor market.

The study was itself summarized by noted BC economist Alicia H. Munnell (a meta-meta study?) in a column for the Wall Street Journal today.

Munnell's summary is a great cheat-sheet on health reform in Massachusetts:

Insurance coverage. The impetus for the Massachusetts reform was to increase access to health insurance. In this goal, the reform has been largely successful. The percentage of the population age 19-64 without insurance halved between 2004 and 2012. And, in 2012, only 4.9% in Massachusetts were not covered, compared with 21.2% nationally.

The major concern of such a rapid expansion of coverage is costs. By 2009, rising health-care costs forced Massachusetts to turn its attention to this issue. This effort seems to have had some success. From 2009-2012, Massachusetts’ health-care expenditures grew at a slower rate than the state’s economy (3.1% vs. 3.7%) and at the same rate as U.S. health expenditures (3.1%).

Provision of health services. The purpose of expanding health-insurance coverage is to allow increased access to health-care services and ultimately better health. Here again the news is good. From 2006-2010, the share of non-elderly individuals with a usual source of care increased significantly, and a higher share of care recipients reported receiving good or quality care in 2012 than in 2006.

One special area of interest is emergency-room usage. On this point, the evidence in Massachusetts is mixed. A comprehensive study of all emergency room admissions found an increase in volume, but the number of low-severity visits declined slightly.

Health outcomes. Increasing insurance coverage and increasing access to health care are a means to better health. Several studies, relying on self-reported health status, have concluded that Massachusetts residents are healthier following the reform. As with any self-reported data, care must be taken in over-interpreting these results. However, mortality data appear to support the conclusion that residents are getting healthier.

Labor-market effects.  One fear following the Massachusetts health reform, and reiterated on the national stage, was decreased labor supply–making it easier to get health insurance not tied to employment might cause some individuals to stop working. It was also feared that employers would cut back on employees or hours to avoid the requirement to offer health insurance, which is based on the number of full-time equivalent workers.

A comprehensive study conducted using Current Population Survey data compared Massachusetts to four other states and found that the level of employment relative to the working-age population (i.e., the employment rate) followed a generally similar pattern in all of the states after the reform. The same study found that Massachusetts did not see relative increases in the share of workers working part-time.

Regarding the provision of health insurance, another concern was that employer-sponsored insurance would be crowded out by public insurance, as employers simply dropped coverage and paid the $295 fine per employee. In fact, the percentage of employers offering coverage actually increased after the reform.

We agree completely with Munnel's summary of the summary of the summary (meta-meta-meta analysis): "Thus, a wealth of research on the reforms suggests that insurance coverage and access to health care have increased, that health outcomes appear to be improving, and that the worst fears about employment have not come to pass in Massachusetts. Costs, however, remain an issue: Although growth has slowed in recent years, Massachusetts costs still remain above the national average."

Interest in this work nationally is all about its applicability to the ACA. For us, it's that, and also why we will keep fighting to preserve the gains of Chapter 58, the 2006 reform law.

  -Brian Rosman

 

HPC Agenda slide
May 28, 2014

 

The Health Policy Commission (HPC) met on Thursday, May 22 to cover a range of HPC activities including updates on the patient-centered medical home certification program, the registration of provider organization program, and the CHART Phase 2 investments. Slides from the meeting (pdf) have lots of details on the discussion. Keep reading for our detailed summary of the agenda points and discussion.

May 27, 2014

Have you ever experienced a long wait in an emergency room?  Did it ever push you to the brink of frustration that you wanted to pull your hair out? Or your teeth? 

That may be because the elimination of most MassHealth adults' dental care resulted in more trips to Massachusetts emergency rooms for dental issues. In addition to adding to the overcrowding of emergency departments, those dental visits were expensive, costing way more than the charge for regular dental care.

In 2010, MassHealth adult dental benefits were severely cut. Until recently, if a MassHealth member has a case of tooth decay causing some serious pain they only have a few covered options: go to the emergency room for the pain, or visit a dentist who could only diagnose the problem and ultimately pull the tooth. Fillings, dentures, and many other services were not covered. This year, coverage for fillings was restored, but many other services are still not available.

Following the cut in benefits, oral surgeons at BU School of Dental Medicine noticed that the Boston Medical Center Emergency Department was being flooded with patients seeking dental care. They just published a study in The American Journal of Public Health looking at the data. The study (here is BU's summary, and the full report (pdf)) analyzed dental-related Emergency Department visits to BMC, comparing data collected three years before and two years after MassHealth adult dental benefits were significantly cut (July 1, 2007 to June 30, 2012).

Comparing average visits and spending in 2007-2009 to 2011, the study found:

  • Dental-related ER visits for adults increased by 14%. The greatest growth was among those 55 to 64 years old, which jumped an astonishing 50%. ER visits by seniors 65 and older went up by 45%.
  • The average cost per dental-related ER visit also soared by 27%. Combine more visits and increased costs per visit, and total dental spending in the BMC emergency department increased by 44%, from $8.4 million to $12.1 million.

The study's conclusions are clear:

This study found the largest increases in people with caries and soft tissue pathologies. These conditions are best treated in dental practices and community health centers. Importantly, individuals seeking dental treatment in EDs do not receive definitive treatment. Most dental treatments provided in the ED are transitory or palliative (temporary treatment, analgesics and antibiotics, or referral to a dental care provider) and have significant implications in terms of cost

One of the study co-authors commented pointedly, using researcher understatement: “Use of EDs for dental care points to an inappropriate use of resources and lack of continuity of dental care,”

The findings of the report support what oral health advocates have been saying for years: lack of treatment options causes the state to waste millions on emergency room care for dental issues. As the cuts continue, the state will continue to spend more and more on palliative care.

The just-concluded Senate budget includes funds to restore coverage for dentures as of April 1, 2015. This would be another step to ending this cruel, costly cut. Soon a House-Senate conference committee will meet to craft the final budget. Please call your representative and senator today (find yours here), and urge them to support this small step towards restoring MassHealth dental coverage.

   -Courtney Chelo

 

May 23, 2014

Massachusetts Alliance for Communication and Resolution following Medical Injury

 

All hospitals should CARe, or in other words, all hospitals, and other health care providers, should implement the Communication, Apology and Resolution (CARe) program that was the focus of a gathering yesterday at the MA Medical Society.

The CARe program focuses on internal communication and communication with patients and families following the occurrence of a medical error or unanticipated medical outcome. The conference was organized by the Massachusetts Alliance for Communication and Resolution Following Medical Injury (or MACRMI). Six hospitals in Massachusetts (BI, BI-Milton, BI-Needham, Baystate, Baystate Franklin, and Baystate Mary Lane) have been part of a pilot program looking at how to implement the CARe initiative. Atrius Health and Sturdy Memorial Hospital will be implementing CARe soon.  Look through the MACRMI website for lots of great CARe resources.

Kenneth Sands , the Senior VP for Health Care Quality at BIDMC, spoke about the lessons learned from implementing the CARe program. Many of the lessons learned have to do with the culture change that needs to happen for a hospital to successfully implement the CARe program. He said that what helps CARe succeed includes leadership buy-in, an existing baseline culture of safety, having staff dedicated to overseeing the program, and support (both clinician peer support and support resources for patients and families).

One audience member asked if patient and family advisors from the PFAC had been invited to participate in any of the processes following the occurrence of a medical error. Evan Benjamin, Senior VP for Health Care Quality at Baystate, said that they have started to invite PFAC members to sit in on root causes analyses discussions and that their presence has been powerful, bringing more of a focus to the patient and the communication with the patient.

See this trailer below for a preview of an upcoming documentary (release date TBD - it's still a work inprogress) on the project, “Full Disclosure: The Search for Medical Error Transparency.”

 

May 23, 2014

This Vox piece dredged up a 4-year oldie but goodie: What if air travel worked like health care? It's a great companion to Martha Bebinger's sad-but-true, real life adventure from just last week, The 26 Steps I Took To (Try To) Comparison Shop For A Bone Density Test.

Secretary Polanowicz addresses the PFAC Conference
May 19, 2014

On May 14, HCFA held its second annual statewide Patient and Family Advisory Council (PFAC) conference. The conference took place in Worcester and brought together 175 participants from 54 hospitals and health centers. Twelve workshops covered a wide variety of topics, including recruiting to represent the community, improving patient safety and transparency, raising the PFAC’s profile in the hospital, educating the public on end-of-life care and palliative care, and more. See a list of workshops here.

The keynote speaker was EOHHS Secretary John Polanowicz. He spoke of the importance of patient and family involvement in improving care and he also spoke from a personal perspective about his health care experiences while caring for loved ones. Participants were overwhelmingly positive about the day and are excited about future opportunities to continue making connections across PFACs. The Worcester Telegram and Gazette covered the day. Read their coverage of our event here

HCFA was the lead advocate for the 2008 law requiring all MA hospitals to establish PFACs and since then we have had a role in ensuring successful implementation. HCFA gathers all PFACs’ annual reports and posts them on our website so that members of the public can learn about PFACs’ work and so that PFACs can learn from one another. Just two days before the conference we released our third annual report summarizing the work of Massachusetts PFACs based on our analyses of their 2013 annual reports.  We also coordinate monthly PFAC webinars covering topics such as recruitment strategies, placing patients and family members on hospital committees, and improving mental health care.  

HCFA is organizing a Statewide PFAC Advisory Board to work with us as we continue our PFAC efforts and take them to another level, including convening regional PFAC gatherings and looking at policy initiatives. We are excited to continue working with the many dedicated patients and family members who participate in PFACs across the Commonwealth.

-Deb Wachenheim

May 16, 2014

The Department of Public Health recently released the 2012 figures on drug industry marketing spending on gifts and meals for Massachusetts doctors.

Remember, halfway through 2012 the state legislature weakened the state's rules, which had banned out-of-office meals provided by pharma sales representatives as part of their drug marketing and promotional campaigns. The new provision was supposed to allow only "modest meals," but the DPH regulations did not put any practical limit on the wining and dining, allowing even alcohol to be provided to medical professionals as part of so-called "educational" presentations.

The results were very predictable.

Spending for food and drink skyrocketed, as you can see below. (By the way, under DPH rules pharma companies only have to report spending for food if it exceeds $50 per person. So this chart only captures spending ABOVE $50 per person per event). With just half a year of relaxed regulations, spending went up 40% for the entire year.

Pharma payments for food and drink for Massachusetts doctors soared 40% between 2011 and 2012

It's been shown again and again that these marketing ploys are effective (see below). After all, why else would the pharma companies spend so much on it. What's worse is that the cost of these meals and drinks (a) get passed on as part of the cost structure of the pharma industry, increasing the cost of prescription drugs for all of us; and (b) are tax deductible as marketing expenses, lowering their tax burden and raising ours.

Coincidentally, Dr. Aaron Carroll of The Incidental Economist blog posted of number of tweets today on the topic of pharma marketing via gifts to doctors. A sampling is below - click on any tweet to go to the post and the link to the supporting data.

22% of patients know docs accept dinners from pharma. 48% think it's unacceptable. 70% believe gifts influence docs.

 

Only 39% of medical residents think they're influenced by pharma. But 84% think other doctors all are.

 

Docs claim they're not influenced by interactions with drug reps or gifts. Guess what happened next?

 

Docs went on paid symposium trip. 85% said couldn't be influenced. Guess what happened next?

May 12, 2014

AIM blog post on the economic benefits of health reform in Massachusetts

Associated Industries of Massachusetts is one of the leading business groups in Massachusetts, and its President/CEO, Rick Lord, is a long-time champion of business concerns. He also served as the small business representative on the initial Health Connector board.

Rick has a blog post out today that expands on the recent finding that health reform in Massachusetts saved lives. (if you missed that, look here (NYT) and here (The New Republic) .

Rick writes: 

From the employer viewpoint, it is particularly notable that the study focused on people aged 20 to 64 – working-age adults. The diminution of the death rate and presumed improvement of health status among this population strongly suggests that despite the additional costs incurred, the move towards universal coverage brings real economic benefits. This is, of course, a major reason that nearly all AIM member-employers already offered employee health benefits before 2007.

The new study provides hard evidence that health care reform based on shared responsibility and mandatory participation really can succeed, if it is implemented properly. The problems surrounding the federal Affordable Care Act are attributable in large part to the absence at the national level of the unified will to make reform work that we had in Massachusetts.

With Massachusetts health reform entering another critical phase as we integrate with the ACA, we again need a unified effort to make reform work. We should all keep Rick's view in mind as we work together.

       - Brian Rosman

May 8, 2014

Connector Summary of Path to 2014

 

Today’s Health Connector Board meeting focused on the big news of the week – the Connector’s decision to implement a dual-track plan to fix their underperforming health coverage website. On a 10-1 vote, the Connector endorsed the approach recommended by the administration. Health Care For All supports the decision, and Executive Director Amy Whitcomb Slemmer issued this statement following the meeting:

"Health Care For All strongly supports the decision by the Patrick administration to implement a health care coverage website that is tailored to meet the needs of the people of Massachusetts. We concur with the overwhelming affirmation of this strategy by the Health Connector Board this morning.

"Massachusetts continues to be a leader in expanding affordable coverage to all residents of the Commonwealth. Consumers expect a website and eligibility system that is easy to use and that allows them a choice of affordable plans that meet Massachusetts standards for good coverage. While the federal healthcare.gov option should be kept as a fallback, the state would best be served by a website that supports state affordability standards and allows access to all state-specific coverage programs.

"We will continue to work with the Health Connector, MassHealth and the Governor's office to bring the voice of consumers to the table as the next steps are being planned and implemented. We will also call on the federal government to continue its support of the Massachusetts process, which can again lead the way in providing a national model for successful health coverage programs.

"Massachusetts views health care as an essential public good, and our state leaders in both government and the private sector have a long-standing shared commitment to making quality, affordable coverage available to everyone. We are pleased that today's decision upholds these values that we all strive to fulfill."

The board meeting slide deck is available here, and today's updated "Dashboard," showing over 270,000 new enrollees in subsidized coverage programs, is here. Our report is below: