Friday, May 29, 2009

Health Care Reform in Massachusetts

A reader recently asked that one of my next postings provide an update on health care reform in Massachusetts.

While I claim no inside information, it happens that the lead front page article of May 28 issue of The Boston Globe dealt with the subject. The following is my summary of the contents:

- The article’s headline was “Costs snarling health overhaul.” The opening sentence read “Soaring healthcare costs, combined with the recession, are threatening to undermine the gains from Massachusetts’ 2006 healthcare overhaul.”

- An increasing proportion of the population is reporting problems paying medical bills.

- The program continues to enjoy the support of 70% of the people.

- 3% of Massachusetts residents are uninsured, compared with a national average of 15%.

- 91% of residents say they have a regular health care provider, up from 86% prior to the program.

- Use of hospital emergency rooms has not changed.

The May issue of H&HN, the journal of the American Hospital Association, also had an article on the topic. Here is one quote:

“Original budget projections for the Massachusetts program were $160 million in fiscal year 2007, $400 million in FY2008, and $725 million in FY2009. At $133 million, actual costs came in lower for 2007, but shot up to $625 million in 2008. The state funding request for 2009 was $869 million, with some estimating that actual cost could reach $1.1 trillion.”

One unanticipated effect discussed had to do with so-called safety net hospitals. Certain hospitals in Boston and elsewhere that care for a disproportionate number of the indigent and uninsured used to get support from a special state fund. That support was cut back in the reform program on the premise that those patients would now have insurance from which the hospitals would be able to collect. But many of those patients ended up being covered by insurance that paid at Medicaid rates which are seriously below cost. The result is that the safety net hospitals are in financial trouble.

Thursday, May 28, 2009

Time to Speak the Unspeakable

It is time to undertake the consolidation of the professional and institutional components of health care.

I was reminded of this while perusing a recently issued supplement to the journal Health Affairs entitled Value in Health Care. Eleven articles were included

As I skimmed through the material, I was struck by the frequent use of code words that implied such consolidation. Examples include “system fragmentation,” “clinical integration,” “bundled payments,” “accountable care entity,” “accountable care organization,” and “physician-hospital integration.”

Only one author, Frances J. Crosson of Kaiser Permanente, was bold enough to address the issue head-on, saying that “Integration must occur at the clinical, operational, financial, and cultural levels….”

I would add that the result should be a single corporate entity headed by unitary management and governance that can be held accountable for the cost and quality of the care it provides.

There are a number of such entities now and so there is no shortage of models or precedent. The Mayo Clinic, Cleveland Clinic, and Henry Ford Hospital are examples. Even Myrtue Medical Center in my home town of Harlan, Iowa is so organized.

Creating these entities will not, by itself, achieve reform. Those that exist are generally considered to be among the better providers, but they do not stand out in any spectacular way. Although they are positioned to be accountable, our society has not, generally speaking, held them so and they have tended to follow traditional patterns of providing care.

To achieve real reform, other measures, like getting rid of fee-for-service, must also be implemented. But a number of them depend for full effectiveness on consolidating the provider system. Also, we need to be developing a cadre of leaders who know how to run such organizations.

And so we ought to get on with it and the first step is to agree publicly that it needs to be done, even if that requires speaking what up to now has been the unspeakable.

This page is powered by Blogger. Isn't yours?

FREE counter and Web statistics from sitetracker.com