This week the Massachusetts Health Care Quality and Cost Council (QCC) convened its monthly meeting to discuss approving a plan to improve coordination in health care transitions and to hear summary and analysis from the Division of Health Care Finance and Policy (DHCFP) regarding its recently released Cost Trends Report.
The meeting began with the Council’s various committees reporting back about their individual meetings during the past month. One highlight of the reports was that the advisory committee plans to have a guest speaker this upcoming month about what national health reform means for Massachusetts. Our full report continues below – click on the “more.”
Next, Secretary Bigby went through the overall goals and priorities for the Council in the past and also going forward, in order to highlight the reasons for the Council’s work on transitions. Some of the goals she mentioned included reduction of overall health care costs, increasing patient safety, improving screening/management of chronic illnesses, and eliminating racial and ethnic disparities in health care. She also listed three overarching priorities: 1) creation of a goals scorecard to track the progress of each of the Council’s goals, 2) website expansion, and 3) organization of strategic implementation of the Roadmap to Cost Containment.
Next, the care transitions team explained the transitions plan. They explained that they had gone to 6 different organizations (including the Public Health Council) to get feedback on the plan and then incorporated the feedback into the plan. Most of the feedback had to do with small language alterations and none of the core principles were changed.
After the presentation, various council members asked questions. Dolores Mitchell asked whether there was any part of the plan designed to reduce defensive transfers in nursing homes. She recognized that many transfers happen because nursing home personnel are trying to insulate themselves from liability under the mentality of “it’s better to be safe than sorry.” However, these types of transfers create unnecessary costs and even open the door for unnecessary infections/complications from hospital admissions. Presenter, Alice Bonner, responded that the plan included what she called “interventions to reduce acute care transfers,” which seeks to reduce readmissions and attempts to train nursing home staff as to when it is appropriate to bring residents to hospitals. She noted that the anxiety felt by such staffers often comes from a lack of training they receive on the issue.
Additionally, there are no monetary incentives to keep patients out of hospitals, nor is there any incentive to engage in communication between nursing homes and hospitals. Both parties benefit from transfers, even unnecessary ones; the hospital benefits in the form of revenue, and the nursing home benefits from savings during the time the resident is in the hospital. Thus, in order to fix the issue, we need practice redesign, payment reform, and transparency. Secretary Bigby aptly noted, “how we pay for care informs how care works.” The current transitions report suggests we need payment reform so that we aren’t paying for preventable readmissions. She also noted that the problem is not about incompetence, but more about a lack of organization. The Council then voted to approve the transitions plan.
Next, the Council heard a presentation by a representative from DHCFP regarding the cost trends report released last week. These reports will serve as the basis for hearings (beginning March 16 at 10AM) and development of strategies to address cost drivers. Some highlights of DHCFP’s summary: health care spending in Massachusetts is 15% higher than the national rate, which is mostly due to the cost of nursing homes (Massachusetts has a greater senior population than the nation as a whole) and hospital services; Massachusetts has a higher percentage of premiums going to medical expenses (88% versus 84% nationally); average monthly premiums went up 12% from 2006-2008 and small group rates were generally higher and grew faster than other groups’ rates; from 2006-2008 in the private insurance market, there was a 7.5% increase annually in per capita spending (with price being a key driving force).
In some closing comments, the Council recognized that we should not look at the current necessities of providers and ask what they need to meet their current needs; rather, we should be looking at how we can bring their current costs down so they are operating more efficiently. Dolores Mitchell noted, “what is is not always what should be.” Furthermore, another council member also recognized that part of the problem of high cost in Massachusetts is that people are insulated from said cost so there is no disincentive to going to higher cost providers (namely, the academic medical centers). Thus, we need to find a way to make people change their behaviors and see that utilization of lower cost providers does not necessarily mean lower quality.
The Council then went into executive session to discuss the website data, since the data is not public until the Council votes to make it public.
-April Seligman
