Tuesday, February 10, 2015
Still No Portrait in the Lobby
Anyone who knows me well will be aware of my fondness of
aphorisms, one of which is that no hospital administrator ever got his portrait
in the lobby for saving money.
As a follow-on to the publicity about the judicial rejection
of Partners’ expansion plans and the appointment of its new CEO, The Boston
Globe in its February 6 edition ran another front page article under the byline
of Robert Weisman, this time headlined Partners
looks to mend ties, tame costs.
The article pointed out that “Fears of higher health care
costs were at the root of opposition to Partners’ recently rebuffed [expansion]
plans” and that “A state judge cited rising health costs when she rejected a
settlement in late January that would have allowed the [expansion.}”
Later in the article, the new CEO (Dr. David Torchiana) is
quoted as saying “In Massachusetts, there is an almost overwhelmingly singular
focus on cost because access has already been addressed” through the state’s
2006 universal health care law.
That same Globe edition carried an article reporting that
health insurance companies in Massachusetts are projecting a 7% increase in
costs for 2015. That is almost twice the
goal of 3.6% set by the state in 2012.
Dolores Hamilton, a human resources director for the Town of
Framingham, responded to the announced increase by saying "It's a
budget-buster" and the article speculated that many employers would be
passing the increase along to employees through higher copays and deductibles. No mention of the need for providers to find
less costly ways of providing care.
So we may not yet be ready to live with the pain of serious
cost control. There are signs that we
are on the road to getting there but hospital executives who hope to see their
portraits in the lobby will for the time being have to get it some other way.
Sunday, February 08, 2015
No One in Charge
In my professionally active days, I liked to tell young
administrators that a hospital was an institution with nobody in charge and
that success came to those who learned to be productive in that circumstance.
With all the changes that have been taking place in recent
times, I came to think that perhaps that advice was out of date, but apparently
not so.
Partners HealthCare, the Boston health care behemoth, has
just appointed a new CEO, one Dr. David Torchiana. Since 2003, Dr. Torchiana has been chief
executive of the Massachusetts General Physicians Organization, consisting of
some 2,000 physicians on the medical staff of the Massachusetts General
Hospital.
The appointment was announced in a front page, above the
fold article in the February 5 issue of The Boston Globe under the byline of
Pryanka Dayal McCluskey and Robert Weisman.
Part way into the article, the reporters, referring to Dr. Torchiana,
state that ”In the medical world, the doctor group he heads, consisting of some
of the top doctors in the nation, is considered as influential as the hospital
itself.”
So it seems that my old observation still applies at the
Massachusetts General Hospital. It is an
arrangement that can be made to work as long as nobody cares about cost. But that is no longer the case. The Globe article also mentioned the recent
denial of the Partners expansion plan by Suffolk Superior Court Judge Janet L.
Sanders, who, according to the reporters, “was concerned that a bigger Partners
would mean higher health care costs for consumers. Partners is the state’s highest cost health
system.”
The reporters did not connect the reference to influence
with the cost issue, but Dr. Torchiana will have to.
Friday, February 06, 2015
The End of Single Payer?
The dream of single payer health insurance for the U.S. may
have just met its end in Vermont.
For true liberals, national health insurance, aka single
payer, has long been a holy grail – a dream plan for financing health
care to be continually pursued. Every time health care reform has
come up – going all the way back to Franklin Roosevelt – the single payer
people have thought their time had come, only to be disappointed. During the process of legislating Obamacare,
they plumped for something called the public option – a governmental health
insurance program that would compete with the private sector – only to see
President Obama abandon their cause by declining to support it.
Not to be discouraged, the government of the liberal state
of Vermont then proceeded during the following year (2011) to adopt legislation
authorizing a single payer program of its own to be called Green Mountain Care. The law specified that the Governor (Peter
Shumlin) was to develop a detailed financial plan by 2013. He missed that deadline but in December of
2014 issued a report saying that he would not seek funding for the law, saying
that “In my judgment, now is not the time to ask our Legislature to take the
step of passing a financing plan for Green Mountain Care.”
Governor Schumlin’s action was reported in an article
appearing in the January 25 edition of The Boston Globe (Dream meets reality) under the byline of Jay Fitzgerald. According to that article, “Governor Peter
Shumlin released a financial report that showed the cost of the program would
nearly double the size of the state’s budget in the first year alone and
require large tax increases for residents and businesses.” The article also said that the decision
“signaled that the dream of universal, government-funded health care in the
United States may be near its end.”
I have for many years been pointing out that national health
insurance is a remedy for inadequate financing, that the problem in the U.S.
was excessive financing and that we therefore would never have single payer.
I rest my case.
Thursday, February 05, 2015
Partners Decision Reach
The rejection of Partners Health Care’s plan to acquire
additional hospitals and doctors in the Boston area may have widespread
implications.
My earlier posting suggested that it marked a decline in the
veneration of big, prestigious teaching hospitals.
An article in the January 31 issue of The Boston Globe (Partners decision could reach far)
suggests that another consequence may be an increase in the scrutiny given to
the growth ambitions of major hospital systems.
That could well be the case, partly because of Partners’
prominence as a provider of health care, but also because of growing general concern
about the relationship between the high cost of health care and the monopoly
power of hospitals, which have been rapidly consolidating into large, regional
systems.
Laws prohibiting monopolies have always covered hospitals,
but there hasn’t been much public concern about the issue and the laws have
been rather casually applied.
Underlying all that is the question of whether we want
market competition in health care at all.
If we would rather depend on regulation to control cost and quality,
then monopoly status doesn’t make much difference. But if
we are to rely on market forces, then monopolies are to be avoided.
The ruling in the Partners case was somewhat ambivalent on
that issue. On the one hand, it took the
position that the control methods provided in the agreement were inadequate. But it also expressed reservations about the ability
of Partners to demand higher prices, using the market power it would gain if
allowed to expand further.
Perhaps the Partners episode will serve to move us along
towards resolution of the matter.
