Health Care for All Blog

The Senate will be making another attempt to extend enhanced FMAP (federal Medicaid reimbursement; background) on Monday. The additional funds are critical for Massachusetts. Among the many programs dependent on FMAP is coverage for legal immigrants. Without these funds, we know additional cuts will need to be made to state health programs.

Senator Brown is a critical swing vote. Please contact Senator Brown over the weekend to urge him to stand for the Commonwealth by supporting the FMAP extension.

You can submit a comment on his web site, or call his office at (202) 224-4543.

The proposed conversion of the Caritas Christi Hospital network from a non-profit to a for-profit owned by the Wall Street public equity firm Cerberus appears to be on the fast track. Health Care For All and residents in the hospitals’ host communities are looking to the Department of Public Health and Attorney General Martha Coakley to slow down the train and do their due diligence on this project before they give it the OK.

In comments submitted today to the DPH’s Public Health Council, Health Care For All requested that conditions be put on the sale to reduce the risk that comes with private equity money and ownership and what that means to the accessibility, affordability and quality care at the six Caritas hospitals.

The proposed purchase and for profit conversion of the six community hospitals that comprise Caritas Christi Health Care is unprecedented for the Commonwealth of Massachusetts and has significant implications for the future of health care in the state. In particular, Health Care For All has concerns about Cerberus’ long term commitment to the operation of the hospitals, Cerberus’ commitment to serving the broad needs of the community, and the ability of the Commonwealth to monitor operations and enforce future conditions at the hospitals.

Cerberus Capital Management is a Wall Street private equity firm that has never run a hospital. Its traditional business model consists of purchasing distressed properties, cutting expenses, and then selling the newly-slimmed down business for profit. The public has concerns on how this business model will apply to a network of hospitals providing health care to many of eastern Massachusetts’ most vulnerable residents. Many of the vital services that community hospitals traditionally provide are not money making practices.

With the conversion from a non-profit entity to a for-profit, Cerberus will take on four additional, and significant, financial obligations – taxes, investment return, staff at Cerberus, and continued funding of the pension fund. It is incumbent upon all parties to determine how Cerberus plans to maintain a commitment to the health of community residents currently served by Caritas Christi Health Care while also fulfilling its new fiscal obligations. We are concerned that Cerberus may cut vital services, such as behavioral health care, that have historically been money-losing enterprises. Will Cerberus reduce staffing levels? Will it close money-losing hospitals?

Health Care for All requests that the Public Health Council keeps the following four principles at the forefront in its deliberations and includes the following specific recommendation as conditions for their approval.

1. Continue to run a transparent, accessible, and inclusive review process.
   While understanding the need for the review process to move along in a timely manner, we want to make sure consumers, community groups and advocacy groups have the necessary time to negotiate with the network and the specific hospitals to develop conditions for the conversion. We encourage the DPH to work with the public to ensure the Determination of Need decision occurs after these negotiations are completed.
2. Ensure Cerberus’ Commitment to the Hospital Network, the Host Community, and its History
   The provisions of the sale, as currently structured, call for a three year period during which Cerberus is obligated to maintain Caritas’ level of charity care and scope of services. (At around three years, private equity firms tend to sell, or flip the company.) When compared to other similar sales around the country, this is an unusually short time period. In at least one case, a twenty-five year clause was included. To ensure the long-term access to health care for the Caritas communities, Health Care For All calls for a seven-year minimum ownership period in which Cerberus commits to operate all six hospitals and to maintain or increase the percentage of patient service allocated to free.
3. Ensure Cerberus’ Commitment to Community Hospitals
   Cerberus must continue its dedication to the community hospital ideal in its priorities and practices. Since its inception, the Caritas hospitals have been driven by an unwavering commitment to community health care. Community hospitals represent a cost-effective, culturally competent, and efficient acute care delivery system. Health Care For All believes that community hospitals are an integral part of the fabric and the well-being of a community. When run well, these hospitals provide vibrant and robust outreach, care and support for the communities they serve. In addition, community hospitals are vital to a community’s economic well-being as they are often the largest employers in the area.

   To provide a comprehensive assessment of the health needs of the community, Cerberus should carry out a Community Health Needs Assessment in all the six Hospital catchment areas within one year. Cerberus must address the results of the needs assessment, to the satisfaction of the DPH, through its services and community benefits program. Until this assessment is completed, all current services and community benefit programs must be maintained at current or higher levels.

   A robust, well-funded and accountable Community Benefits Program provides vital health services for a community. Programs should be developed in coordination with the concerns of community groups and the Community Health Needs Assessment. In addition, a process with public review needs to be established when the hospital wished to eliminate a program or service.

   We ask the Public Health Council to endorse the Attorney General’s Community Benefit Guidelines for Non Profit Acute Care Hospitals (2009) and encourage the development and implementation of model community benefit programs in a number of areas including cultural competency, mental health, transportation, childhood obesity, elder care, HIV/infectious disease, green building and operations, substance abuse, violence and diabetes.

4. Ensure that the Conditions are Measurable and Enforceable
   As outlined in Attorney General an independent Health Care Access Monitor should be hired by DPH to report quarterly on community health care access at each respective Cerberus hospital.

   In addition, Cerberus agrees to appear before the Public Health Council within six months after the date of sale, and on an annual basis thereafter, to report on compliance with the aforementioned conditions.

With the health of so many residents at stake, Health Care For All wants to make sure conditions are in place to ensure that the new owners will have the capacity and the will, now and in the future, to continue to provide accessible, affordable and high quality care across the Commonwealth.
-Matt Wilson

UPDATE 4:00 pm Friday: State House News Service is reporting that the conference committee compromise preserves the pharma and medical device gift ban and marketing restrictions. HCFA thanks the conferees and the House and Senate leadership for their support.

Time is short, so we’ll be brief:

With a day and a half remaining in the formal legislative sessions, it’s now or never for anything controversial. The small business/individual health care premium cost control bill is the most important health priority in the pipeline. We hear the conference committee is making progress and we look forward to a bill being ready tonight so it can be voted on tomorrow. Also,

• The Legislature should not repeal the drug and device company gift ban and disclosure law. It would be a step backwards on health care cost containment and giving patients information they deserve about their providers. Put patients ahead of profits.

  This sentiment is echoed in today’s Boston Globe:

  … Economic development. House and Senate leaders part company on multiple aspects of a complex economic-development bill. Here are two: First, in the guise of helping restaurateurs, the House would repeal a recent law requiring drug and medical device companies to disclose substantial gifts to medical professionals. The disclosure rules should stay, because drug and device marketing drives up health care costs…

• Health coverage for over 20,000 low-income legal immigrants hangs in the balance. Unless something happens, the Commonwealth Care Bridge program ends August 31. The Governor has asked for authority to keep the program going on fumes for a few more months, and the legislature should grant that authority.
• Congress is going to make another try to extend enhanced FMAP, with the Senate vote scheduled next Monday. The legislature should not lose the opportunity to direct where those funds go (if they are approved), and override the Governor’s vetoes of FMAP-dependent line items.

-Mehreen Butt and Georgia Maheras

Access to oral health care is essential to maintaining overall health. The Oral Health Advocacy Taskforce supports measures that promote access and delivery of crucial oral health services through having a strong network of multiple providers. In the current economic climate, it is essential that we find creative ways to improve access, and as the 2009-2010 legislative session draws to a close, a bill has made its way to the Governor’s desk that, when enacted, will do just that.

The Volunteer Dentistry Bill, proposed by the Massachusetts Dental Society, will improve access by allowing retired dentists to volunteer their services in qualified free-care programs. Dentists must abide by all of the requirements for a dental license set by the Board of Registration in Dentistry, but the fee for licensure will be waived. With 20% of the state’s population living in dental health professional shortage areas, this is a welcome change.

The bill was filed by Senator Marc Pacheco, and was also championed by Senators Harriette Chandler and Susan Tucker, and Representative John Scibak.

At a time when MassHealth adult dental cuts have created another barrier to care, this measure will help to alleviate the barriers of provider shortages, geographic access, and cost.
-Courtney Chelo

This week, advocates for children with special needs were pleased that the Autism Bill looks to be on track to move toward passage before the end of the Legislative session. The bill, which will require insurance coverage for a number of autism services, will provide much-needed help to thousands of Massachusetts’ families. The cost of this relief is a bargain at an estimated 83 cents per member per month.

At a time when everyone is concerned with health care expenses, lead sponsor Representative Barbara L’Italien said, “We’re pretty confident we can manage those costs in a responsible way.”

Along the same lines as the Autism Bill is legislation supported by the Children’s Mental Health Campaign – An Act Relative to the Coordination of Children’s Mental Health Care. This bill too would help parents of children with mental health needs by working to ensure that the care for these children is well coordinated between counselors, physicians, teachers, and other people in the child’s life.

If the Autism Bill is a bargain at 83 cents per month, the Care Coordination legislation is a downright steal. According to a report by the Division of Health Care Finance and Policy, the cost of coordinating mental health care for children is a mere 5.5 cents per member per month, or 66 cents per year!

With the end of the 2009-2010 session rapidly approaching, the legislature should move now to pass both the Autism Bill and the Care Coordination legislation. These parents can’t wait.

The time is NOW to act!
-Matt Noyes

Tomorrow at the State House, the Massachusetts Public health Association (MPHA) will be hosting a celebration for the signing of the School Nutrition Bill (download invitation here).

The bill will be signed tomorrow by Governor Patrick. The law, championed by Representatives Koutoujian and Sanchez, and Senators Fargo and Richard Moore, and will promote healthier food options for close to one million Massachusetts public school students. The law is a strong step in the public health fight against obesity, overweight and chronic disease. Join MPHA, the Massachusetts Health Council, the School Nutrition Association of Massachusetts, American Heart and American Stroke Association, and Children’s Hospital Boston on Friday, July 30th at Noon at the Grand Staircase in the State House to celebrate this victory.
-Mehreen Butt

Dr. Atul Gawande’s latest piece in The New Yorker, “Letting Go,” brought tears to my eyes multiple times. I have not read a lot on end-of-life care, and what I have read so far is often less personal and more theoretical – articles which tend to look at this extremely complicated and emotional topic from either the perspective of the patients and their families, who have to make wrenching decisions, or from the perspective of providers and how they do or do not work well enough with patients and families regarding this decision-making.

This is the first piece I have read that is from both perspectives and gives a genuine and personal sense of the deeply difficult discussions and decisions that are made…difficult for the patients/families and for the providers. Dr. Gawande found a way to communicate a complicated and emotional issue so that the reader almost feels like he or she is there, with that family and patient and with the provider, trying to make sense of everything and figure out what to do. And the reader is made to think about what he or she would do if faced with similar situations and decisions. With all of the talk of “death panels” during the health reform debates, there was a squelching of any conversation outside of health policy wonk circles relating to end-of-life care and decision-making. Dr. Gawande’s article, in a non-policy-wonk magazine, can help start to open the door to having these conversations among the broader public:

Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.”

People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.

The article, like his previous article on health spending, is getting a lot of attention in Washington this week. Our Campaign For Better Care and health quality work is focused on improving the health system to make it responsive to patient needs. Dr. Gawande’s voice expands the debate in a human way that can not be ignored.
-Deborah W. Wachenheim

Rep. Liz Malia Speaks At No On 1 Rally

On Wednesday afternoon, the Committee Against Repeal of Alcohol Tax held the kick-off for its “Vote No on 1” campaign against the repeal of the alcohol tax outside the Massachusetts State House. Passionate speeches and a high energy level highlighted the importance of denying the alcohol industry a sales tax exemption. A question to repeal the alcohol sales tax will be on the State’s ballot on November 2nd.

Senator Tolman, Representative O’Day and Representative Malia and other advocates for the campaign spoke on reasons the alcohol tax is critical to both the financial and public health of the Commonwealth. As the state faces a large budget deficit this year, Massachusetts cannot afford to grant alcohol a special exemption. Alcohol is not a necessity and its sales have only increased since the tax was imposed in 2009, making an alcohol tax cut unnecessary and fiscally detrimental.

The money collected from the tax directly funds substance abuse prevention and treatment programs, helping more than 100,000 people across the state. These programs save lives and keep families together, as several speakers illustrated through emotional personal anecdotes.

Finally, the alcohol tax has been shown by numerous studies to reduce underage drinking. The younger someone is when they first encounter alcohol, the greater the risk of alcoholism later in life. Repealing the alcohol tax would have the negative effects of increasing the number of underage drinkers and potential alcoholics while simultaneously crippling state treatment programs.

Health Care For All is a supporter of the “Vote No on 1” campaign because of the numerous benefits the alcohol tax provides to both individuals and the commonwealth as a whole. For more information, check out the Committee Against Repeal of the Alcohol Tax website: NoOn1MA.com.
-Oliver McClellan

This week is the 20th anniversary of the Americans With Disabilities Act, which mandates equal opportunities for individuals with disabilities in employment, access to public facilities, transportation and telecommunications.

Here in Boston, this important landmark was celebrated with a march and a rally on the Common. However, we should also use this as a reminder that there is still work to be done to truly create equity.

Oral health is central to the health and well being of all people, including those with disabilities. Dental decay is a bacterial infection and can spread to the rest of the body if left untreated. What begins as a cavity can quickly progress into a life-threatening infection. Good oral health reduces long-term health care costs by reducing sources of infection, supporting communication, nutrition, and improving quality of life.

Brushing and flossing alone are not enough- access to dental care is crucial to maintaining overall health. It is especially important for those who may have limited mobility and are unable to brush or floss on their own. Additionally, some people without use of their arms or legs rely on their mouth for day-to-day activities, such as maneuvering by wheelchair, dialing a telephone, turning on a light switch, and typing by manipulating a mouse stick with their mouth.

Recent changes to MassHealth adult dental benefits make it more difficult for people to access critical components of oral health care such as fillings, root canals, treatment for gum disease and dentures. MassHealth no longer covers these services; people must instead try to gain access through a community health center.

So as we celebrate this important anniversary, let’s continue to stand up for oral health. For more information on how to get involved, please contact Christine Keeves at ckeeves@hcfama.org.
-Christine Keeves

HCFA urges the legislature to put patients first and not repeal the drug and device gift ban and disclosure law. Section 105 in the House version of the the Economic Reorganization Bill would repeal Massachusetts’ groundbreaking drug and device marketing gift ban. HCFA urges Massachusetts residents to contact their Senator and Representative and tell them that they do not want pharmaceutical and medical device company marketing practices to come between patients and their doctors.

Currently, the gift ban and disclosure law forbids pharmaceutical representatives from wining-and-dining doctors to convince them to purchase brand name medications. It also requires disclosure of any ‘non-gift’ payments to providers. The gift ban and disclosure law is an essential part of Massachusetts’s efforts to curb health care costs and guarantee the ethical delivery of health services.

The gift ban and disclosure law encourages the drug and device industry to put a limit on the over $6 billion spent annually on direct-to-physician marketing. The logic of restricting the inherent conflict of interest that impacts patient-centered care is perhaps best exemplified by the fact that medical schools like UMass, Boston University and now Harvard have passed their own stringent gift ban and disclosure policies.

Opponents of the gift ban and disclosure law claim that it has forced medical conventions and drug and device manufacturers out of the Commonwealth and has caused a dramatic loss in profits in the restaurant industry. However, not only do medical conventions continue to flourish in Massachusetts, but a large number of drug and device manufacturers have in fact chosen to relocate to the Commonwealth since the gift ban was enacted. Further, it’s clear that the recession, and not the gift ban, is the real reason behind restaurant industry losses, considering that states without a gift ban have experienced similar losses since 2008.

The Senate recently appointed a conference committee to reconcile their economic reorganization bill with the House version. HCFA hopes that the committee responds to Senator Montigny’s (one of the conferees) view that the ban benefits everyone—since “all taxpayers become patients.” Patients need the comfort of know that their doctor is prescribing in the best interests of the patient, free of inappropriate outside influences.
-Devin Cohen

Today’s NY Times includes a column by Dr. Pauline Chen describing the Open Notes study, which allows patients to view their medical records, including doctors’ notes.

The yearlong study, being funded by the Robert Wood Johnson Foundation, involves over 100 primary care physicians and 25,000 patients from three health care centers including Boston’s Beth Israel Deaconess Medical Center. Dr. Chen opens her column by talking about an experience she had in which a patient asked for a copy of Dr. Chen’s notes and, after Dr. Chen mentioned the request to other staff, she received a variety of reactions, including the following from one nurse: “Do you know what’s going to happen if you give them a copy now? They’re going to start calling and e-mailing you with questions about what you wrote.”

While we are often told that providers want to have engaged patients who will play an active role in managing their care, this kind of quote calls that into question. However, the physicians who have signed up to participate in this study are some of those who not only talk the talk but walk the walk. They are willing to allow their patients to view all of their notes for a year with the end result of the study being a better understanding of the impact of Open Notes on patient care and the patient-provider relationship. As one participating doctor says in the article, “In the end, we are all patients-if not now, then someday- and from that perspective it is easy to see the many reasons why this is a step in the right direction.”
-Deborah W. Wachenheim

We’re all mourning the loss of journalism legend Daniel Schorr, who died Friday after an historic career (NPR tribute and links; CBS report).

We also warmly remember his 2006 report on the passage of Massachusetts health reform, reported in this blog. In telling the story of how health reform came to be in Massachusetts, Schorr did not leave out the role played by HCFA and our partners in MassACT!: “supporters of the plan threatened legislative leaders with a petition drive that would put on the ballot a more extensive health plan if they didn’t pass the moderate coalition proposal.”

He concluded that passage with support of both conservatives and liberals evidenced a maturity that was nothing short of a miracle. Watching the partisanship around passage of a similar national plan in 2010 proved him right; miracles are not repeated.

Click on the player above to hear the report.
-Brian Rosman

Justin is a six year old boy with asthma. He stays healthy and out of the hospital as long as he takes his medications. One morning, Justin’s mom called the Health Care For All’s HelpLine in a panic. She went to refill her son’s prescriptions and was told she would have to pay out-of-pocket because her son’s MassHealth coverage was shut off. The medications would cost hundreds of dollars that she did not have. The HCFA HelpLine helped her to reinstate her coverage that was terminated due to a small fluctuation in her income. But it was too late; in the interim Justin had an asthma attack and had to be rushed to the emergency room where he received the same breathing treatment he could have had at home if his MassHealth coverage was continuous.

This is not only Justin’s story. This is the story of thousands of other children. Many families whose income fluctuates close to the 300% of povery level eligibility cut-off find themselves constantly becoming ineligible and then re-eligible for MassHealth and as a result their children are paying the price, by missing doctor’s appointments not being able to get prescriptions filled and ending up in the emergency room.

Now, Massachusetts has a unique opportunity to paint a very different picture and make sure children like Justin have the care they deserve when they need it.

As part of the effort to increase health coverage retention among children, the Massachusetts legislature passed 12-month continuous eligibility for children as an outside section to the budget. Unfortunately Governor Deval Patrick vetoed this language in the budget. We understand the challenges in this fiscal year and the difficulty choices legislators need to make. Now the legislature can make a real improvement for kids’ health by overriding the veto of section 71 and putting this provision back in the FY2011 budget. 12-month continuous eligibility is crucial to make sure children receive the care they need and the 33 states who have successfully implemented this policy are projecting to save administrative costs.

The 12-month continuous eligibility policy allows children under the age of 19 who enroll in Medicaid or CHIP to retain coverage for a full 12 months, regardless of changes in family income over that one year period. This ensures continuous coverage and helps children get their health care needs met on an ongoing basis with fewer disruptions due to administrative barriers.

The Obama Administration has cited 12-month continuous eligibility policy as one of the 8 central measures to simplify Medicaid enrollment and renewal, as well as decrease churning. Why 12 month continuous eligibility is a wise decision?

According to the Office of Medicaid there are about 16,000 children in Massachusetts, whose coverage fluctuates during the year. This means that children become ineligible and fall off of coverage during a particular month due to income fluctuations or paper work and then become eligible again the next month or so. This cycling on and off are detrimental to the health of the child as well as to the State Budget.

Children who experience a coverage gap of any length face substantial barriers to accessing affordable, quality care. Research shows that even brief gaps in health coverage cause people to skip or delay care, while uninterrupted coverage can reduce avoidable hospitalizations for children by 25 percent. Studies also show that children with gaps in health insurance coverage commonly do not seek medical care, including preventive visits, and do not get prescriptions filled.

On the financial side, the Enrollment and Disenrollment in MassHealth and Commonwealth Care report (pdf) by the Center for Health Law and Economics, states that in Massachusetts the administrative costs associated with each enrollment in Medicaid/CHIP are estimated to be about $200 per enrollee, per enrollment cycle. This cost multiplies every time an eligible recipient loses coverage and must be re-enrolled. Therefore, savings for preventing churning for one child is 200 dollars per re-enrollment. Since there are potentially 16,000 children annually who fall off coverage, this means that for one re-enrollment cycle this policy would save the state about 3.2 million dollars in administrative costs, and for two re-enrollment cycles, the state would save 6.4 million dollars.

A report by the Center for Children and Families at Georgetown University’s Health Policy Institute, shows that health costs could decrease as acute episodes are prevented or treated at an earlier stage and the management of chronic conditions is improved. The study shows that payment per child and payment per enrollee per month could drop by about 3 percent. Here’s the details:

A 2007 report from the University of California studied hospitalizations of millions of California Medicaid enrollees from 1998 to 2002, and presented two key findings. First, children with interruptions in Medicaid coverage were far more likely to be hospitalized for “ambulatory-sensitive conditions”— hospital stays that could be avoided with proper ongoing care. Second, when California children’s Medicaid enrollment was increased from six to 12 months in 2001, avoidable hospitalizations fell by 25 percent, enrollment of children increased, and eligible children had fewer gaps in coverage.

(source)

Let’s paint a different picture and color Massachusetts with 12-month continuous eligibility!

A recent report by the Health Commission in Springfield and Green Counties of Missouri made Show Me State headlines last week. The Commission found that dental pain is one of the most common reasons that people visit the emergency room. Local experts explained that this is an access problem, and emphasized that oral health is critically linked to overall health.

The study found that for patients 20 to 39 years old, dental cases make up more than 7 percent of all ER visits in Greene County. They make up 10 percent of all Medicaid visits, and 37 percent of all uninsured visits.

Although the ER can provide temporary relief, St. John’s Emergency Trauma Center Medical Director Ted McMurray stressed that they cannot treat the root of the problem.”A lot of patients who come in with dental needs have really generalized dental disease. It’s not just a tooth that’s the problem,” McMurry said.

These concerns are not isolated to Missouri. As Massachusetts nears the end of its first month of drastic cuts to the MassHealth adult dental program, advocates and health care providers expect to see the rates of dental visits to ERs similarly increase in the Commonwealth. If we want to ensure that Massachusetts can effectively address dental disease, we must speak up to make sure that all residents have access to care outside of our emergency rooms. For more information about getting involved, please visit www.hcfama.org/oralhealth.
-Christine Keeves

The House will vote today on H. 4915, its legislation to address small group and individual health insurance premiums. Representatives filed 53 amendments to the bill. (links: bill text, amendments, pdfs). While time is short to reconcile the House bill with the Senate proposal (S. 2447), we think this should be one of the highest priorities for the legislature this year.

We applaud the House for focusing its efforts to help small businesses and share in the desire to find ways to make health insurance more affordable for small employers and individuals. We hope that final passage of these short-term reforms will lead to the comprehensive payment reforms needed to improve our delivery system and reduce the cost of care (for additional complimentary commentary, see AIM’s blog post).

Health Care For All (HCFA) supports a balanced bill that shares responsibility among carriers, providers and consumers for savings. H. 4915 includes several provisions that impose public accountability for both insurer and provider market activities. We support these provisions and urge the House not to amend them such that their original intent is undermined and savings are not realized for consumers and small businesses.

HCFA, along with the ACT!! Coalition, strongly supports amendment 8, filed by Representative Scibak and cosponsored by Representatives Patrick, O’Day, Canavan, D’Amico, Kulik, Gobi, Kocot, Falzone, Toomey, Brady and Hecht. This amendment clarifies the individual mandate’s affordability schedule so that out-of-pocket costs (such as deductibles and copays) are taken into account when determining the cost of coverage.

HCFA strongly supports amendments 36 and 37, both submitted by Reps. Kaufman, Hecht, Grant, Lewis, and D’Amico, and 45, sponsored by Rep. D’Amico. These amendments allow small businesses to access lower cost health insurance through the Health Connector. The Connector is an important part of the solution to small business and individual health care cost containment. Amendment 45 strikes the provision adding a broker representative to the Connector Board. The broker organization, the Massachusetts Association of Health Underwriters, has been a vocal opponent of health reform. Their President opposes the basic underpinnings of chapter 58, such as the individual mandate, the merger of the small group and individual markets, minimum creditable coverage, and the Connector’s role in offering coverage to small business. The Connector Board has worked hard to find a broad consensus on implementing health reform when faced with difficult issues. The legislature should not upset the balance by inserting a non-constructive person into a well-working process.

HCFA opposes amendments 31 and 41. These amendments would create Association Health Plans and Group Purchasing Cooperatives. Passage of these amendments would undermine important insurance reforms implemented by the Legislature over the last two decades to guarantee availability and renewability of health coverage and the creation of broad insurance rating pools. The result would be higher health insurance premiums for the vast majority of small businesses.

These insurance market reforms are important short-term solutions. We are pleased that the Legislature will soon turn to comprehensive payment reform, which will move our system to rewarding quality care that promotes health and prevention.Payment reform is vital to moving towards lasting affordable coverage.
-Georgia Maheras

The Public Health Council met last Wednesday with an agenda (pdf) that focused on health equity and young worker health and safety.

To help eliminate ethnic and racial disparities within the health care system, the Office of Health Equity recently published “A Guide to Providing Culturally and Linguistically Appropriate Services (CLAS)”.  CLAS standards have been scattered, with some federally mandated and some state and national accrediting agencies requiring compliance with others.  Until now, compliance has been difficult since there has never been a resource to clarify confusing language of the law and increase awareness of the regulations.

The Director of the Office of Health Equity explained that this new guidebook will increase the capacity of the Commonwealth to respond effectively to health care needs of minority populations.  Some of the guidelines for CLAS include providing language assistance and interpreter services, implementing relevant risk reduction and disease prevention programs, and encouraging participation of minority professionals and students in health professions.

Members of the Council agreed that CLAS standards must become part of the DNA of DPH and all other public agencies.  Groups involved in the guide’s pilot program called the book, “manna from heaven” because it provides health care providers with clear guidance on how best to accommodate the health care needs of a diverse populations.  By uniformly removing language and cultural barriers in all realms of health care, CLAS compliance will result in greater individual access to needed services.

One Council member recognized that even though this program addresses many areas in which cultural and language barriers to the health care system increase disparity, there is still room for improvement.  Various sexual preferences and religious affiliations are other significant diversity factors that may adversely affect access to health care and should also be considered.

Another interesting presentation demonstrated that “Young Invincibles”, a term frequently associated with young adults who do not purchase insurance because they consider it unnecessary, are not so invincible in a physically demanding workplace. The highest rates of occupational nonfatal injuries occur among 15-17 year olds, doubling the injury rate of workers 25 years of age and older (a future study will survey injury rates of 18-24 year olds).  Risk factors include job hazards, inexperience, and physical incapability.  Psychosocial underdevelopment may also prevent a young worker from saying “no” to a heavy-lifting task that he or she is incapable of performing.  DPH plans to publish a “Safe Jobs for Youth” manual and institutionalize safety training for young workers to increase awareness and reduce potential hazards in the workplace.
-Elizabeth Arnold

Senator Richard Moore has been elected president of the National Conference of State Legislators (NCSL) for 2010-2011.  Next week, Senator Moore will start his term at the NCSL Summit in Kentucky.

Senator Moore has been a driving force in Massachusetts health reform and is now playing a critical role in our state’s payment reform efforts.  We are confident he will bring the same passion and commitment he shows for these issues to his new role with NCSL.  Congratulations, Senator Moore!
-Suzanne Curry

The Globe reports today that Harvard Medical School (HMS) has approved new conflict-of-interest rules.  In doing so, HMS joins the growing list of top medical schools and teaching hospitals that are enacting strict conflict-of-interest policies in an effort to protect doctors from being turned into (or even being seen as) marketing agents for the drug and device industry.  In the Boston area ,UMass Memorial Medical Center adopted new conflict-of-interest rules in 2008; Partners HealthCare did so in 2009; and Boston University School of Medicine is currently revising its own, already strong, conflict policy.

HMS’s new policy forbids its 11,000 faculty from accepting personal gifts, meals, or travel and from giving promotional talks for drug and medical device companies.  It also includes strong disclosure requirements: it mandates public reporting on a HMS website when faculty receive payments over $5,000 from drug and device companies for consulting of working on boards.

Although the HMS is not the first to implement such rules, Dr. Steven Nissen, head of cardiovascular medicine at Cleveland Clinic Foundation, explained to the Globe that Harvard’s new policy “will influence others” to revise their own policies because it “is a closely watched institution.”   Policies like those at HMS are clearly the way of the future and Massachusetts should support its institutions through its laws.  We should not take a step backwards  in healthcare reform by repealing the Commonwealth’s historic gift ban and disclosure law.

- Rosemary B. Guiltinan

In the July 14th issue of the Journal of the American Medical Association (JAMA), Dr. Peter J. Pronovost looks at the role of physicians and hospital leadership in improving health care quality.  He writes that teamwork failures are often contributors to negative patient outcomes.

Pronovost explains that there is not a lot of empirical evidence in the effort to improve patient safety, but he looks at one exception to this rule – central line-associated bloodstream infection (CLABSI.)  He uses CLABSI as example of an infection that can be prevented with interventions that include checklists of prevention practices, measurement of infection rates, and tools to improve teamwork in a hospital.  However, hospitals across the country have been slow to adopt these interventions for a variety of reasons.

Pronovost concludes that CLABSI and other negative patient outcomes can be reduced if clinicians and hospital leaders work together as a team and hold themselves accountable.  Pronovost also emphasizes the need for public reporting of infection rates, financial incentives from insurers, and sanctions from hospitals in order to hold physicians accountable for patient outcomes.

Massachusetts is already taking some of these steps toward reducing infections: the first statewide hospital-specific public report on infections came out in April (this will be an annual report), a section of last year’s state budget mandated that hospitals not be reimbursed for care needed following the occurrence of a preventable infection (the regulations for implementation still need to be written and approved), and a number of Massachusetts hospitals are currently participating in statewide initiatives, under the leadership of the MA Coalition for the Prevention of Medical Errors, the MA Hospital Association, and the MA Department of Public Health, to reduce CLABSI and other infections, using the tools that Dr. Pronovost describes in the article.

Read more about Dr. Pronovost’s article and his work on the Running a Hospital blog.

-Emma Smizik

UPDATE: HCFA also supports the provisions that restrict unfair contracting practices (those enumerated in s. 36 of the bill) and simplify the administration of health benefits.

Controlling the growth in health care costs is the most important challenge facing Massachusetts. It is critical to balancing our state budget and stabilizing local budgets. Increasing insurance premiums are breaking the budgets of small businesses and stifling employers’ abilities to increase wages, hire new workers and expand our state’s economy. For individuals, the galloping cost of coverage prices too many out of the market for insurance.

On Tuesday the House released its version of legislation to ease health care premium growth for small businesses and individuals. Amendments will be filed on Wednesday, the bill is scheduled for debate on Thursday.  These short-term actions are important first steps. We hope this legislation brings us one step closer to comprehensive payment reform. Only by reorienting our health payment and delivery system around patient needs, rewarding wellness and prevention, can we achieve real savings and improve quality.

HCFA supports the initiatives in the House bill that strengthen accountability for costs at the provider and the insurer level.  We applaud the establishment of wellness programs similar to that being implemented by the GIC under the authority of the Connector and the Department of Public Health, oversight of provider rates so that payments are more equitable, and increased reporting on quality so that we can begin to link payments to health care outcomes. HCFA also supports the provisions that restrict unfair contracting practices and simplify the administration of health benefits.

HCFA strongly opposes sections 38, 40 and 41, which would increase prices for small businesses by weakening the Health Connector Authority.  These provisions would add a broker representative to the Connector Board (section 38), would not allow the Connector to require carriers in the individual market to participate in the Connector’s group market (section 40), and would prohibit the Connector from working with DOR to promote its products (section 41). The Health Connector is a critical part of the solution to small business and individual health care cost containment. The Health Connector Board has worked hard to find a broad consensus when faced with difficulty issues. The current board is fairly balanced, and the legislature should not upset a well-working agency.

HCFA also strongly opposes sections 14-16, the so-called “drug coupon” provisions.  This only facilitates expensive brand-drug marketing, raising costs for through increased utilization of new to market, higher cost prescription drugs.

Small group insurance market reforms are important short-term solutions.  However, they are just the beginning of the discussion on health care cost containment.  Next session must include work on comprehensive payment reform, which will move our system to rewarding quality care that promotes health and prevention. We believe payment reform is vital to moving towards lasting affordable coverage.

-Georgia Maheras