From today’s State House News:

Senate President Therese Murray, who has been working on legislation to control rising health care costs, will outline her proposal Monday in Worcester. In a media advisory, Murray’s office said her bill will “advance the next phase of health care reform in Massachusetts.” Murray will host a press conference at 11 am at UMass Medical School, where she will be joined by Health Care Financing Committee Co-chairman Sen. Richard Moore (D-Uxbridge), UMass President Jack Wilson, and UMass Medical School Chancellor Michael Collins. Critics of the current system say surging costs threaten to undermine the 2006 law expanding access to health insurance. There have also been increasing calls to promote transparency in health care in an effort to hold health care providers accountable and give consumers more information about choices.

From today’s Berkshire Eagle, previewing tomorrow’s Connector Board meeting where votes are scheduled to be taken on increasing co-pays and premiums for Commonwealth Care enrollees:

Richard Powers, a spokesman for the Commonwealth Connector, said the numbers could still change before tomorrow’s vote.

In addition to coping with increased costs, Powers said, the Connector wants to maintain parity between those on subsidized state plans and those who get insurance through an employer.

“It’s a matter of fairness. It’s not right that someone with private insurance should pay more in premiums and copays than his neighbor who makes the exact same amount of money but qualifies for Commonwealth Care,” Powers said.

“Whether or not Commonwealth Care is even here in two or three years will depend on decisions like the one being made (tomorrow),” he said.

As Sen. Moore indicated in his recent letter to the Connector, there has been a decided lack of transparency by the Connector in their deliberations on this issue. If raising co-pays and premiums by amounts they claim to be trivial is so significant, let’s see the numbers.

On Thursday, the Connector Board will be voting on increases in the Affordability Schedule and raising co-payments and premiums for Commonwealth Care enrollees. Proposed changes include:

• Raising Commonwealth Care premiums by up to 14.3%
• Increasing co-payments, premiums, and out-of-pocket maximums
• Eliminating an out-of-pocket maximum for drugs for Commonwealth Care members in the 200-300% Federal Poverty Level

Click HERE to read a .pdf of the ACT!! Coalition’s concerns about the proposed changes to Commonwealth Care cost-sharing and the 2008 Affordability Schedule.

Click HERE to read stories from consumers with Commonwealth Care.

TAKE ACTION!
There are several actions we can take in the next few days to oppose these proposed changes:
• Click HERE to SEND AN EMAIL TO THE GOVERNOR to voice your opposition against these proposed changes.
• ATTEND THE CONNECTOR BOARD MEETING to demonstrate your opposition to the proposals.
Thursday, February 28, 9am - 12pm
One Ashburton Place, 21st floor conference room
Boston, MA 02108
• TELL US YOUR STORY - If you are currently a Commonwealth Care member, tell us how Commonwealth Care has made a difference in your life and how increasing co-payments and premiums may affect your ability to seek and obtain necessary care.
Please contact Jean Leu at jleu@hcfama.org if you would like to help fight increases in co-payments and premiums.

Thank you for your commitment to assuring quality, affordable health care to all residents of Massachusetts. Please contact Lindsey Tucker, the ACT!! Coalition manager, at (617)275-2904 or ltucker@hcfama.org, with questions or comments.

Letter written by State Senator Richard Moore to Connector Executive Director Jon Kingsdale, sent 2/21/08:

Dear Jon,

I am writing to express my concern with the recent release of the Connector’s premium level increases, and more specifically the Commonwealth Care premium level increases. While I am not pleased with these increases, an even greater concern of mine is the degree of transparency, or lack thereof, which is proffered along with these increases.

Healthcare premiums rise by double-digit numbers annually. Unfortunately, and to the detriment of our residents and businesses, this has become commonplace. However, this serves as no excuse for the Connector to raise Commonwealth Care premiums by 10 to 14 percent, especially in light of the fact that these are exactly the types of premium increases that we are focusing our efforts on trying to combat.

I recognize that an examination of these percentage increases in the context of dollar amounts reveals that it is not what some may refer to as an “exorbitant” increase. The 14 percent increase for the lowest level of subsidized plan is the equivalent of 5 dollars per month. I also recognize that the premium levels set for the first year served as a preliminary trial and that some price adjustments were to be expected. However, the greater challenge that I face in supporting these increases is the total lack of transparency in this process. The only rationale that has been proposed as a justification for the increases is to prevent “overwhelm[ing]” the system. You were quoted in the State House News Service as being concerned about the projections of increased enrollment. My interpretation of this is that the premium increases are being used as a crowd-out mechanism. This is not a viable justification for premium increases. The legislature and, more importantly, the lower income residents who are enrolled in Commonwealth Care, deserve to know where the money is going. How much additional funding is the state, via the Connector, going to be collecting and exactly how does it plan to redistribute it within the Commonwealth Care plans, if at all? If the premium increases are to prevent crowd out, how is the Connector justifying the co-pay increases? These are the kinds of questions that I expect to have answered before I can feel comfortable supporting the decisions of the Connector Board.

We have come to a point in time where it is no longer acceptable to raise premiums without offering a thorough examination and explanation of why these increases are necessary. This is an excellent opportunity for the Connector to set a good example for the rest of the state.

Your careful consideration in this matter, before the next Connector Board vote, is greatly appreciated.

Sincerely,
Senator Richard T. Moore
Senate Chair, Committee on Health Care Financing

Dick Knox, who covered Massachusetts health care for more than two decades as medical editor of the Boston Globe, now covers health care all over the planet for National Public Radio. Today, he offers an update on the MA health reform law — click here – “Mass. Law Uncovers More Uninsured Than Expected” and includes interviews with MA Admin & Finance Sect. Leslie Kirwan, MIT Prof and Connector Board member Jon Gruber, and columnist Bob Kuttner. Also interviewed, a 59 year old hairdresser who recently signed up for Commonwealth Choice.

Some of you have been following the drama over “checklists” since we first posted on this last December. Click here for our most recent posting which has links to all the others.

Apparently, the US Department of Health and Human Services has decided that the use of “checklists” for clinical quality improvement do NOT require explicity compliance with HHS regulations for the protection of human subjects — requirements which make the use of the process unimplementable.

Click here for the US DHHS news release on the matter. We know a lot of folks were weighing in on this matter from a variety of perspectives. Special congrats to Dr. Atul Gawande from Brigham and Women’s who created national awareness of the “checklist’ in his article in the New Yorker, and who brought national attention to the federal blockage in December in the New York Times. Bravo!

“OHRP noted that the Johns Hopkins project has evolved to the point where the intervention, including the checklist, is now being used at certain Michigan hospitals solely for clinical purposes, not medical research or experimentation. Consequently, the regulations that govern human subjects research no longer apply and neither Johns Hopkins nor the Michigan hospitals need the approval of an institutional review board (IRB) to conduct the current phase of the project.”

Score one for common sense!

Now … who in Massachusetts is going to start using them?

To include or not to include cost information on its new website by its launching date — this was the big debate at Wednesday’s Quality & Cost Council’s bimonthly meeting.

The Quality and Cost Council is mandated under MA Law “to disseminate, through a consumer-friendly website and other media, comparative health care cost, quality, and related information for consumers, health care providers, health plans, employers, policy-makers, and the general public.” While comparative quality data are ready for the website, some Council members perceive a need to further massage the cost data.

Council members feel there is “no second chance at making first impression” and will wait to have more solid and meaningful cost data to post on the website in order to present useful and informative cost data to the consumers and not just any data. Council members voiced concern that the data was not user-friendly and will require further work before it can be posted.

The debate will continue on whether or not to publish the cost data on the Council’s website by its first launching date – now set for sometime in March.
Su Yoon

As debate begins on the Governor’s FY 09 budget, some have questioned Gov. Patrick’s proposal to create an Office of Health Equity at the Executive Office of Health & Human Services. The Disparities Action Network responds.

Why does Massachusetts need an Office of Health Equity?
People of color have worse health outcomes than the majority population on nearly every key health indicator in Massachusetts. Despite health access expansion, people of color bear an unequal burden of disease and death that is costly and unconscionable. The proposed Office creates a permanent central place in state government to spearhead efforts to eliminate disparities. There is currently no home for leadership and activity on disparities, despite the wealth of state and national research documenting the pervasiveness of disparities and solutions. The Office would coordinate efforts by state agencies to eliminate disparities, and oversee grant programs to demonstrate best practices. This office can provide direction, technical support and resources for public health commissions, state and local public health departments, and other agencies on disparities, while monitoring and evaluating our progress.

Why should the Office of Health Equity be located in EOHHS?
Health disparities involve many social, economic, and behavioral factors beyond access. Much research demonstrates relationships between social determinants (housing, education, transportation, employment etc.) and poor health. Locating an Office of Health Equity in the Secretariat allows the Office sufficient coordinating impact over a wide range of agencies to ensure that disparities elimination is integrated into all relevant initiatives of state government.

Aren’t there existing councils addressing health disparities issues?
The health care access law, Chapter 58, established two councils with relevance to disparities: the Quality and Cost Council and the Health Disparities Council. The Quality Council’s efforts focus on cost reduction and quality improvement. The reduction of disparities as a quality improvement effort has not been a major focus of the Council amidst a multitude of other quality and cost issues. The Disparities Council has met only once and is just beginning to outline a plan of action. This council can play an important role in advising state efforts, including a new Office of Health Equity, but cannot lead a major effort that coordinates state wide efforts, administers grant programs, and evaluates state progress.
Elmer Freeman, DAN Co-Chair

HCFA is pleased to announce this year’s recipients of our Community Leader Awards. These awards honor leaders make a difference in improving health and health care in their communities through outstanding advocacy, organizing and other means. The awards will be presented at this year’s Policy and Organizing Conference — click here for info and registration.

This year’s Community Leader Award recipients are…

Lisa Vinikoor, Community Organizer for the Greater Boston Interfaith Organization, for her tireless advocacy and organizing, constantly traveling the state to help individuals and families gain a voice in the health care system.

The Disparities Solutions Center for providing essential research, education, and training for the movement for health care equity and for the elimination of racial and ethnic health disparities.

And Lisa Nash, an invaluable and courageous leader in the Consumer Health Quality Council.

Hope you can join us on March 28th.

This morning, the Legislature’s Joint Committtee on Public Health reported favorably our health care quality bill, S. 1277, An Act Promoting Healthcare Transparency and Consumer Provider Partnerships. The bill includes the top priorities of our Consumer Health Quality Council, and members have been working hard all session to move it forward.

We worked closely with Public Health Committee staff to produce a redraft. Thanks to the offices of Chairmen, Rep. Peter Koutoujian and Sen. Susan Fargo. The bill would:

1. Require hospitals to establish Patient and Family Councils
2. Require use of Rapid Response Teams in hospitals
3. Establish public reporting of hospital-acquired infections and set a statutory goal of “zero” for all infections
4. Establish public reporting of “never events” such as wrong site and wrong person surgery
5. Permit providers to apologize for adverse events without the apology being used in malpractice actions

The Committee deleted one provision — requiring all providers to disclose “adverse events” to patients.

At last week’s Public Health Council meeting, DPH Commissioner John Auerbach presented Sen. Moore (the bill’s lead sponsor) and Rep. Koutoujian with “Recognitions of Appreciation for Leadership” for their “bold and effective leadership” in addressing hospital acquired infections and their work to improve quality. With the legislative activity,the DPH work, and the growing groundswell from consumers, providers, and payers, this may be a banner year for health care quality.

We look forward to these reforms moving through the process. Next stop: Sen. Moore and Rep. Walrath’s Health Care Financing Committee.
James Madden

Folks are beginning to believe national health reform will be a real possibility beginning in 2009 with a new president and Congress. And reform proposals are starting to advance. Here’s a Lewin Group analysis of the “Health Care for America” plan to create a new national health insurance pool modeled after Medicare that calls for employers, individuals and the federal government to share responsibility, a national “pay-or-play” model developed by the Economic Policy Institute. From today’s Kaiser Report:

According to the report, the proposal would reduce the number of uninsured U.S. residents by 46.5 million people, or 97.3% of the uninsured. The report also finds the program would control health care spending by limiting provider payment increases, negotiating deeper prescription drug discounts and streamlining administration. The report estimates that under the proposal, total national health spending from 2008 through 2017 would be about $1.04 trillion less than under the current system.

It’s about health, and it’s not about health. Sometimes it’s hard to tell the difference. Anyway, click here for a site that provides the clearest, plainest explanation of social networking, social bookmarking, blogs and wikis you are ever going to see. These are some of the places the internet is going — what it means for health care and everything else — who knows. But enjoy the ride. Thanks to HealthBlawg for the heads up.

Lots and lots of interesting details from this State House News Service account of MA Health & Human Services Sect. JudyAnn Bigby’s testimony this past Friday on the Adminstration’s FY09 budget proposal for Health & Human Services:

FRANKLIN, FEB. 15, 2008…..Reprising Gov. Deval Patrick’s warning to lawmakers of the “cost of inaction,” Health and Human Service Secretary JudyAnn Bigby said on Friday the governor’s budget is a mix of cuts, reforms, efficiencies and targeted investments that lay the groundwork for economic growth.

“Failing to make these targeted investments will weaken the very assets that make Massachusetts a wonderful place to live, work and grow a business,” she told House and Senate budget chiefs at a hearing in Franklin.

Bigby is the overseer of 16 state agencies that take up nearly half of the $28.2 billion budget, at $13.54 billion. That’s a 4.5 percent increase over the allotment in the budget enacted last year, according to state officials. In testimony and prepared remarks, state officials touched on the state’s Medicaid waiver extension, which is pending before the federal government, efforts to curb prison suicides, and being patient in the face of rising health costs.

Highlights from Friday’s public hearing hosted by House and Senate Ways and Means committee members:

– A senator on the budget committee questioned the need to establish a $1 million Office of Health Equity within the health and human services secretariat, as the health care side of Patrick’s budget does. Sen. Karen Spilka (D-Ashland) pointed to the existing Health Care Quality and Cost Council and Health Disparities Council as already tackling the issue of ethnic and racial disparities. “Neither of those entities is responsible for day to day activities that would move us toward eliminating disparities,” said Bigby, who chairs the cost council. The office would coordinate efforts across the agencies and other secretariats, with a director providing staff support to the Health Disparities Council, and provide an annual report card that tracks progress and the effectiveness of programs across the state, according to her testimony. Rep. Byron Rushing (D-Boston) filed a bill last year, with 40 co-sponsors, creating a similar office.

–The state council involved with the cost control side of health care reform, the Health Care Quality and Cost Council, is getting its budget raised to $1.9 million under Gov. Patrick’s fiscal 2009 plan. But the figure falls below the $2.3 million request its executive director urged in December. Requesting specifics on the council, Sen. Karen Spilka noted that the council’s website for consumers has yet to go online, saying this “spring would be nice.” Secretary Bigby appeared reticent to set a firm date, with later this year as a better bet. Bigby said the legislation establishing the council requires it to collect every piece of health care claims data. “You have to realize, this represents millions and millions of pieces of data,” she said. The council has hired a company to go through that process and another company to do focus groups for the future website. Bigby said the council meets next week to discuss how they will contract with a vendor and figure out how to get the data, analyze it and post it on the website. Asked by Rep. Mary Grant (D-Beverly) if a person with a clinical background needs to be added to the council’s make-up, Bigby pointed to the council’s advisory board. “The number of people who can sit on that advisory committee are endless, quite frankly,” she said, adding that she recently made some suggestions to the governor on a few names that could be added.

– State and federal officials are working on an extension to the state’s Medicaid waiver, health care reform’s core financing mechanism, Medicaid officials said Friday. The current three-year, $11 billion waiver ends on June 30, and state officials are seeking an additional three years and upping the number to $13 billion. “I think it’s fair to say we’re solidly in the fact-finding stage with CMS [federal Centers for Medicaid and Medicare Services] about what exactly’s happening in Massachusetts, what we think is going to happen with health care reform moving forward,” Tom Dehner, the state’s Medicaid director, told lawmakers. Gov. Patrick’s budget includes $8.6 billion for MassHealth, the state’s Medicaid program, a 4.4 percent increase over last year’s budget.

– Some members of the state’s business community can breathe a sigh of relief, for now at least: Health officials say they haven’t yet decided whether to increase the $295 per employee charge upon employers that do not make a “fair and reasonable” contribution to their employees’ health plans. “We’re doing a bunch of analyses, looking at that issue,” said Secretary Bigby. “We need more data. I wouldn’t specifically say it’s on the table.” Added Sarah Iselin, commissioner
of the Division of Health Care Finance and Policy: “It’s still early.” Lawmakers pushed health officials to use the reports they’ve been developing. The division is expected to put out a number of important reports in the next few months, including a cost-and-benefit analysis of the health care reform’s various mandates, a biennial survey of Massachusetts employers and their health insurance policies and practices, and the division’s legislatively-mandated list of employers with 50 or more employees using public health assistance each year. The division has reconfigured the methodology for the latter, and it “will support a more accurate count of employees and expenditures than we have been able to capture in prior years,” Iselin said. Lawmakers also voiced concerns that while some businesses are struggling under the weight of the health care law, there are others that have more employees using public health assistance than they’d like to see. Rep. Paul Loscocco (R-Holliston) asked if they were finding any evidence of corporate employers restructuring, possibly setting up two corporations with 10 employees each in a bid to get around the health care law, which applies to employers with 11 employees and over. Bigby said she had spoken with Labor Secretary Suzanne Bump, who can monitor that kind of information and had said that the restructuring costs would amount to too much.

–As lawmakers pressed her and her top aides on rising health care costs in the headlines, Secretary Bigby pleaded for them and others to wait and see the results of the state’s massive health care reform effort. “Massachusetts has to
be patient and make sure we don’t say it’s too expensive before we allow it to work,” she said. Costs will eventually trend downward, she and other health care officials said, pointing to an announcement, reported by the News Service Wednesday, showing that state’s six largest non-profit health plans will hold average premium increases in the Commonwealth Choice program to five percent, rate limits that were accompanied by some benefit changes. “It’s certainly better than 8, 9, 10, percent,” Bigby said.

The Connector Board met today for the first of three meetings during which they will set new affordability standards, and premiums and cost-sharing for Commonwealth Care and Commonwealth Choice (see materials here).

Affordability and cost control generated intense debate. Staff proposals on the affordability schedule and CommCare copays were scrutinized – Board members debated state cost, financial impact on consumers, and the crowd-out threat. The task is tough, and the debate is healthy - it leads to greater transparency and more informed decisions. We look forward to the next six weeks!

Executive Director’s Report
Jon Kingsdale began by emphasizing achievements realized in implementing Health Reform. There have been numerous tests and challenges. And, the Connector implemented a successful CommCare program and prices for non-group coverage have seen a marked decrease, to name a few. The biggest challenge ahead is cost. There are signs of success, such as CommChoice bids that produced below-market premium increases.

CommChoice Seal of Approval
The first issue was CommChoice renewals. Bob Carey presented staff recommendations on FY09 CommChoice plans. The staff evaluated renewal bids on four factors:
• Percent and dollar amount of premium increases
• Affect of proposed benefit changes on out-of-pocket costs
• Affect of proposed benefit changes on the relative plan value
• Potential member disruption created by modifying plans

The average premium increase was 5.1% (from a low of -2.7% to a high of 9.9%, both in the YAP level). This is good news because the average increase in Massachusetts premiums has been double-digit for the last eight years. However, the “savings” won’t be free for consumers. To achieve lower premium increases, two-thirds of the plans changed benefits (including all 6 Gold plans, 5 of 12 Silver plans, 4 of 6 Bronze plans, and 5 of 7 YAPs). The staff didn’t detail changes, saying the majority of changes involved adjustments to cost-sharing, particularly prescription drug cost-sharing, and/or the drug formulary (people now in plans being adjusted can keep coverage as is or move to a new plan). Carey said many plans that include drug deductibles exclude “Tier 1” drugs from the deductible, as the Connector requested. No plans that previously had not offered a select-network Bronze plan opted to offer one in addition to their broad-network plan in the Bronze level, as the Connector requested. Fallon currently offers only a select-network Bronze plan and has opted to offer both that plan and a broad-network Bronze next year.

In response, Lou Malzone expressed concern with the increasing complexity of the offerings, which may result in confusion and administrative costs. He and Dolores Mitchell asked staff to study having all carriers offer a limited set of identical plans. Nancy Turnbull asked staff to report on the premium impact of getting rid of the annual benefit caps in YAPs and how many enrollees are hitting the caps. The board will vote on the final CommChoice contracts with carriers on March 20th.

MMCO Contracts
Next the Board turned to MMCO Contracts. Jamie Katz wasn’t joking when he said he would talk a lot without saying much. Aside from noting a “frank and vigorous” discussion, he gave no details. He offered to take questions and no one took up his offer. The staff anticipates providing information at the next Board meeting (February 28th).

CommCare Enrollee Contributions and the Affordability Schedule
The Board took on proposed changes to the Affordability Schedule and proposals for CommCare enrollee contributions together since the first few tiers of the Affordability Schedule (0-300%FPL) mirror the CommCare premiums. Secretary Kirwan set the stage, emphasizing the goal of balancing affordability and fairness and turned the mike to Patrick Holland and Melissa Boudreault, who presented the goals and data.

A few data sets informed proposed changes. The staff looked at the level of contribution for typical ESI plans, median incomes for Massachusetts residents and premium trends for the CommChoice Bronze plans. Celia Wcislo questioned underlying assumptions with this approach. Wcislo asked why staff hadn’t looked at rates of increases in salaries and cost of living. Turnbull pointed out that the CommCare rungs (up to 300%fpl) experienced an average increase of 14% (the staff proposed raising CommCare contributions from $35 to $40, $70 to $80 and $105 to $120), while the upper end of the schedule increased by 5-10%, making the changes regressive.

Wcislo argued they shouldn’t base what is affordable for low-income groups on small group market rates. She emphasized the new premium and cost-sharing proposal is a significant jump for consumers. Turnbull echoed that, reminding the Board that what we’re talking about is an “affordability” schedule, and coverage offered by employers may not be affordable. The affordability schedule should not be led by an “unaffordable” standard. Wcislo argued the Board should look at all stakeholders to share the financial burden, including insurers and providers.

Boudreault emphasized that the premium payment rate in CommCare is high and demonstrates that current premium levels are indeed affordable.

Kingsdale agreed they need to be mindful of individual situations but reiterated the dangers of crowd-out. He said that 625,000 low-income individuals are taking employer coverage. Enrolling even 1-2% of that population would jeopardize the sustainability of the program.

CommCare Copays
Holland turned to the staff recommendations for new copay structures for CommCare. He outlined next steps in the MMCO bid process, explaining that no vote would be taken today. Delaying the vote allowed time for a robust discussion on these critical decisions. We thank the Connector for continuing to value transparency and process!

Copays in the plans have been raised to move closer to (and sometimes above) small group market standards (detailed info included in the materials). The Board debated this and proposed out-of-pocket maximums, which increased along with the copays in the proposal for plan types II and III. In plan type III, out-of-pocket maximums for drugs were eliminated altogether. Members felt that copays for generics should be maintained as low as possible and that out-of-pocket protections are essential for members.

Similar to concerns raised during the affordability debate, the question of why small group standards were used as benchmarks came up again and Turnbull suggested it is more appropriate to look at cost-sharing in large group plans because most individuals in employer plans are in large groups. Board members requested more data and information to compare the value of the current plans to proposed plans, and several members asked about the amount of savings gained through these changes. The staff will work to gather this data for the next meeting.

Emergency Regulations Approval
Before closing, the Board approved final regulations on Eligibility and Hearing Process for CommCare and Affordability for the Individual Mandate. Katz provided a summary of the changes, most of which were technical clarifications reflecting current practice.

Mr. Katz stated the Connector received testimony and comments from a number of organizations and adopted a few recommendations. He stressed that the majority of requests were substantive and CommCare and the Affordability regulations needs more time and consistency under current standards before major changes can be contemplated.

The excitement continues in two short weeks on February 28th. We’ll be there!
Diana Ong and Lisa Kaplan Howe

Check out this interesting “Health Care ‘08 Poligraph” by clicking here. See where all the presidential candidates stand on six health care issues, and chart your own views graphically in relation to theirs. A little simplistic, but pretty neat.

This morning, the MA Technology Collaborative and New England Healthcare Institute held an event to release a study on implementation in MA of Computerized Physician Order Entry (CPOE) systems. These systems replace the 19th century method of writing prescription orders, automating the order writing function and incorporating clinical decision support to avoid medication errors. They have been in place in many teaching hospitals for over a decade. The study examined how they could be implemented in a representative group of six MA community hospitals.

The findings show that CPOE saves lives and money. One in every 10 patients admitted to a MA community hospital suffers an adverse drug event, and 80% can be prevented by CPOE. The average community hospital would recoup costs of implementing CPOE within 26 months. If all 73 MA hospitals fully implemented CPOE, they could prevent 55,000 adverse drug events per year and save $170 million annually. (See today’s front page Boston Globe coverage.) Click here for access to the full study.

How many hospitals in MA currently have these systems?

Ten.

Six were in this study, and we assume the other four are academic medical centers that have been at this for years. At this morning’s event, EOHHS Sect. JudyAnn Bigby said: “In healthcare we often know the right thing to do but take too long to actually do it.” She talked of her experience as a physician at Brigham & Women’s when they implemented CPOE 15 years ago. Dr. John Halamka describes Beth Israel Deaconess Medical Center’s embrace of CPOE. He offered to share at no cost BIDMC’s protocols with any community hospital to help them implement a robust CPOE system, saying “It’s not about competitive advantage. It’s about patient safety.”

Lynn Nicholas of the MA Hospital Association called for more carrots and fewer sticks in helping hospitals implement this reform. But Senator Dick Moore said: “The legislature now will not be as patient as it was when Oliver Wendell Holmes Jr. called upon doctors to wash their hands between patients, and we are still waiting for them to do it.” The Senator said predicted passage of legislation requiring full implementation of CPOE by every MA hospital by 10/1/2012. Dr. Robert Mandel of Blue Cross announced that Blue Cross will require hospital with which it contracts to have full CPOE by 2012 in order to receive quality incentive payments.

As Dr. Bigby noted, this is a familiar story – reforms proven to save money, protect patients and save lives, yet stymied by the culture. We are happy to see this reform moving forward. No more excuses.
James Madden

Yesterday, Sen. Dianne Wilkerson sponsored a hearing on legislation to create a permanent commission on the status of black men in Massachusetts. The legislation (Senate 2182) was heard by the Joint Committee on Children, Families and persons with Disabilities, with a packed hearing room of advocates, providers, and academics concerned with the issue.

Testimony was delivered by Harvard Law Prof. Charles Ogletree and Schott Foundation Pres. John Jackson, who highlighted disparities in education by race and gender that lead to higher rates of incarceration and violence among young black men. They both called for greater investments into equity-promoting education programs to narrow the gap. Harvard Prof. Brian Gibbs testified on glaring health disparities faced by black men and the need for greater attention to the health needs of this population. Other experts and citizens testified on black male disparities in health care, criminal justice, employment, and housing. They called on the legislature to create the proposed commission as a first step to major policy changes to improve the lives of black men and the Commonwealth.

These equity issues mirror the broader issue of racial and ethnic health disparities. Congrats to Sen. Wilkerson and other legislators for maintaining a commitment to assuring equity and justice for all Massachusetts residents.
Camille Watson

Public reporting of Hospital Acquired Infections (HAI) is a top priority of HCFA’s Consumer Health Quality Council. Today the State Public Health Council approved new regulations to require HAI reporting. The Public Health Council, Commissioner John Auerbach and Dr. Paul Dreyer deserve recognition for their leadership and guidance. The regs will assist DPH in monitoring and surveillance of HAIs, create consumer transparency, and provide data to achieve the goal of eliminating HAIs by 2012. Healthcare facilities will report data through CDC’s National HealthCare Safety Network (NHSN). Some data will be made public on a website to be created in conjunction with the State’s Health Quality and Cost Council.

The Consumer Council testified on these regs at a public hearing in December. We recommended an advisory group to monitor implementation – the final regs create a Technical Advisory Group with three or four consumer members. We recommended DPH consider alternatives to a website to disseminate data – DPH will look at other modes of communications, including materials in languages besides English.

Both these changes happened in part because of compelling testimony by Council member Elizabeth Pell. Thank you, Elizabeth, for making things happen and ensuring that consumer voices are heard. Before the vote, Commissioner Auerbach thanked PHC member Lucilia Prates (also President of the Consumer Health Quality Council) for her commitment to the issue. We second what the Commissioner said — thank you Lucilia.

Commissioner Auerbach recognized Senator Dick Moore and Rep. Peter Koutoujian for their “bold and effective leadership” in addressing HAI and working to improve quality. Dreyer reported steps DPH is taking to eliminate Serious Reportable Events (SRE) as defined by the National Quality Forum. DPH is committed to collecting data and disseminating the data to prevent SRE’s from ever happening.
Mehreen Butt

The Connector has posted the staff-recommended proposal for next year’s Commonwealth Care premiums and copays. As we feared, it’s not pretty.

Here’s our questions: did the Connector consult with any members enrolled in Commonwealth Care before advancing this proposal? Did they consult with health centers and physicians and hospitals seeing Commonwealth Care patients? Is the proposal based on what’s affordable and medically appropriate for members, or is just part of the attempt to find budget savings everywhere possible?

The details

First, premiums (spreadsheet here).

The increases are regressive. The Connector staff is proposing a 14.3% increase for those under 300% of the federal poverty line. For those above 300% of poverty, the proposal calls for a 10% increase in the amount people are expected to pay for coverage to avoid penalties.

Second, copays. In many cases, the copays increase by a whopping 100%. The complete spreadsheet listing the changes is here. Some highlights:

Plan Type II: 100%-200% of poverty

Plan Type III: 200% - 300% of poverty

As with the premiums, the proposal for copays are also regressive; the copays increase at a much higher rate for the lower income levels, in most cases.

What’s worse is the proposal would greatly increase the out-of-pocket maximums facing Commonwealth Care members. Currently, members in plan type II (100%-200% of poverty) are protected against out-of-pocket costs exceeding $250 for hospital copays and $250 for drug copays in any year. This increases to $750 for hospital and other services, and $500 for drugs.

For members in Plan type III (200%-300% of poverty) the total out-of-pocket maximum for hospital and other services doubles from $750 to $1500. The current drug limit, $500, is completely eliminated, leaving no protection at all for members facing extraordinary drug costs. This certainly violates the spirit of the MCC regulations, which require out-of-pocket limits for plans with deductibles or coinsurance.

We have made our position on increases in Commonwealth Care copays and premiums clear (see this post and this one from yesterday). Raising copays and premiums places the burden of financing the increasing costs of coverage on the poorest and sickest residents of the Commonwealth. It’s bad medically (a study concluded “chronically ill people cut their medications between 8 percent and 23 percent when their copayments are doubled”). It’s regressive. It’s unfair.

At tomorrow’s Connector Board meeting, ACT!! members will call on the Connector to go back and “sharpen their pencils.” We hope the Board and staff work cooperatively with all stakeholders to find a way to continue building on the program’s success.
Brian Rosman

This afternoon, the Health Care Financing Committee favorably reported H. 4276, an Act Relative to Children’s Mental Health. Special recognition goes to Rep. Pat Walrath, Sen. Richard Moore, and the staff of the Health Care Financing Committee for their hard work on this legislation while it was in committee. Also, thanks goes to Rep. Ruth Balser, lead sponsor, for her continued leadership on mental health issues.

The need for this bill is significant. Of the 140,000 young people in Massachusetts who need mental health services each year, more than 100,000 are unable to access care. Almost 50% of all children who drop out of school have a mental disorder, and 90% of those who commit suicide have a diagnosable and treatable mental illness.

The time is NOW to reform Massachusetts’ children’s mental health system. Click here to learn more about the Children’s Mental Health Campaign.
Matt Noyes