Our last number for the week is $144.8 million. That’s how much in hospital costs were billed to the Uncompensated Care Pool for October-December 2006, according to the latest report just issued by the Division of Health Care Finance and Policy (not yet online).

That’s down from $168.8 million from April-June 2006, before health reform started. The hospital costs of low-income uninsured are down over 14% from that high point though the first 6 months of health reform.

This is one of the key early markers to assess health reform. As more people enroll in MassHealth and Commonwealth Care, we would expect Pool costs to decrease. That was the experience following the MassHealth expansions in 1996 and 1997.

The period covered by this report catches just the beginning of CommCare enrollment, which continues to accelerate. During this period, Pool caseload dropped by 9% from the previous year, as did inpatient discharges, and outpatient visits dropped by 13%.

These results will also be encouraging to federal CMS officials, who have linked continued federal funding with drops in Pool usage. As the administration, providers and advocates hash out the rules for the upcoming Pool year, it’s good to see concrete evidence of the value of expanded coverage.
Brian Rosman

EOHHS has issued a Request for Responses (RFR) to solicit grant proposals from community and consumer-focused public and private nonprofit organizations to reach and enroll potentially eligible residents in MassHealth, Commonwealth Care and Commonwealth Choice.

Details of this notification are on the Comm-PASS website. The document details are: Title: MassHealth, Commonwealth Care and Commonwealth Choice Enrollment Outreach Grants RFR; Document Number: MH082907001; Comm-PASS Category: Professional Services.

To access the document, follow these instructions: 1) Go to Comm-pass.com. 2) Select the “Search for Solicitations” link mid-way down the page. 3) Enter the Document Number listed above in the Document Number field and select “Open” from the Document Status drop-down menu. 4) Select the “Search” button. 5) Near to top of the page, click the link “Solicitations Found that match your search criteria.” 6) Select the “View” icon for the matching record to access all current information.

Continuing our week of statistics on Massachusetts uninsured, today brings the release by the Blue Cross Blue Shield Foundation of what may be the gold standard for analysis of Bay State health coverage.

The survey
The report (13-page summary here; 36-page full report here) is intended to provide a baseline for evaluating the impact of health reform. The Foundation engaged Urban Institute researchers who surveyed 3010 adults between October 2006 and January 2007. The survey “oversampled” low and moderate income residents to get a better picture of those most likely to be uninsured. They worked hard to get responses, including offering $10 to answer the questions, making at least 12 call attempts, and so on. They then adjusted the findings so the age, sex, race/ethnicity, and geographic distribution of the sample is consistent with the distribution of the population in Massachusetts.

The results provide a detailed picture of who was uninsured in Massachusetts just as health reform got underway. They also report on unmet care needs between those with and without coverage, the cost of coverage and out of pocket costs, underinsurance and more.

Some First Impressions
There’s a lot here to digest, but a quick glance provides these early impressions, both relating to the upcoming financing crunch for health reform:

• There’s a lot more uninsured adults than the administration, Connector and the legislature assumed. Like us, the survey warns against direct comparisons of surveys using different methodologies and time periods. But the inescapable conclusions, already borne out by the enrollment numbers, is that the state and federal governments need to budget for substantially more Commonwealth Care eligibles. The Urban survey’s 2006 uninsurance rate is estimated at 13.3% of adults (about 571,000 people), while the state survey used to plan health reform initially indicated a 2006 adult uninsurance rate of 8.7% (adjusted on Monday to 9.2% - about 395,000). That’s roughly 50% more uninsured than the original forecasts assumed.
• The uninsured get substantially less care than those with coverage, and their health suffers because of this. Gov. Romney still uses the point he made frequently while pushing health reform: we’re already paying for the care of the uninsured, so we just need to shift funds from uncompensated care reimbursements to insurance coverage. But in fact, new money will inevitably be needed. The new survey demonstrates that even with our strong safety net, and even after controlling for different needs, uninsured adults get less: “Overall, 52% of uninsured adults reported that they did not get needed health care because of the cost of that care, compared to 12% percent for insured adults. Similar differences are reported for unmet need for doctor care, specialist care, medical tests, treatment or follow-up recommended by a doctor, preventive care screenings, prescription drugs and dental care.” As a result, the uninsured are more likely to report their health status as fair or poor than insured adults.

Next Steps
The researchers will conduct a similar survey this fall, to assess the impact of health reform after one year. Those results won’t be available until summer 2008, though.

We commend the BCBS Foundation for supporting this effort. Please use the comments if you see anything else of interest in the report.
Brian Rosman

Sometime after the new year, we all will have to fill in some numbers on a new Massachusetts tax form - Form HC. The HC stands for Health Care, and it’s the enforcement mechanism for the individual mandate requirement that all adults have health insurance if it’s affordable.

The DOR is out with its revised draft of Form HC, and its draft instructions. The form has gone from 2 to 3 pages, and the instructions (2 pages + 1 page of tables + 1 page to look up your county) include this 94-word gem of a sentence:

If line 1 is less than or equal to: $15,315 if single or married filing a separate return; $20,535 if married filing a joint return with no dependents; or $25,755 if head of household or married filing a joint return with one or more dependents, fill in the No oval in line 6a, skip the remainder of this worksheet and go to the following Schedule HC Worksheet for Lines 6b and 6c, unless your employer offers you free health insurance coverage (your employer’s Benefits Department should be able to provide this information to you).

To be honest, it’s easy to make fun of this but the complexity is a byproduct of fairness - that’s the tradeoff. The question is, how will the general public react? For the vast majority, with insurance, the form is fairly straightforward. But if you get into the affordability determination, it’s pretty tough.

The form is just a draft, and DOR invites feedback. One immediate issue I spotted - there’s a website address for the Connector, but no phone number. DOR has also posted a revised form 1099-HC, which you will need to fill out the Form HC, and other information on its health information page.
Brian Rosman

Just as sure as August 28 follows August 27, so does the federal census uninsured estimate follow the preliminary release of the DHCFP state survey of the uninsured.

The federal numbers get lots of attention, but as statistics they are particularly problematic. The methodology is acknowledged to be flawed, and the delay between data collection and reporting makes them of little use for real-time policy adjustment.

At the state level, the numbers are even more difficult to use. Because of the sample size being small, the census lumps together multiple years when reporting state figures. So the number for Massachusetts that came out today is the 3-year average of 2004 through 2006.

With all that, here are the numbers: Massachusetts uninsured, 2004-2006: 653,000, or 10.3% of the population. Don’t ask us to compare them to the state numbers released yesterday, because there’s no meaningful comparison.

Nationally, the numbers are a bit more important. The headlines:

• Number of uninsured up by 2.2 million, to 47 million.
• Percent without insurance climbed to 15.8 percent in 2006, compared to 15.3 percent in 2005. The percentage without insurance has increased largely because employer-sponsored insurance coverage has continued to erode.
• The uninsurance rate for children rose from 10.9 percent to 11.7 percent. This should add urgency to the SCHIP debate.
• African-Americans (20.5 percent uninsured) and Hispanics (34 percent) are much more likely to be uninsured than non-Hispanic whites (10.8 percent). Both minority uninsurance rates increased in 2006.

The Mass Budget and Policy Center has good summary of the Massachusetts results and the methodological problems, here. The best national instant analysis of the meaning of the numbers is from the Center on Budget and Policy Priorities, here.

This just out this afternoon from the EOHHS Division of Health Care Finance and Policy:

HCFP SURVEY FINDS 40,000 DECREASE IN STATE’S UNINSURED
BOSTON — Due to the ongoing successful implementaiton of health care reform, the number of Massachusetts residents without health insurance has dropped significantly since last year, according to survey results released today by the Massachusetts Division of Health Care Finance and Policy (HCFP).

The survey — conducted between January through July 2007 — found that 355,000, or 5.7 percent of Massachusetts residents, do not have health insurance. This represents a 10 percent decrease from the same period last year.

The overall uninsured rate dropped from 6.4 percent to 5.7 percent, and the number of people without coverage fell from 395,000 to 355,000. The uninsured rate for adults under the age of 65 decreased from 9.2 to 8.2 percent, while there was no statistically significant change in the uninsured rate for children (2.3 percent). …

These findings are based on a survey conducted for HCFP by the Center for Survey Research at UMass-Boston. The Center surveyed nearly 10,500 individuals and more than 4,000 Massachusetts households starting in January 2007.

In the process of analyzing the latest survey results, a methodological issue was identified that has resulted in a restatement of the 2006 survey results. This adjustment corrects for an under-representation of young adults aged 18-30, who are more likely to be uninsured. The likely explanation for this under-representation is the growth in cell-phone only households.

Both the 2006 and 2007 survey results have been adjusted to address this issue. This adjustment yielded a higher estimate of the uninsured in the Commonwelath in 2006 of 6.4 percent or 395,000, compared to 6.0 percent or 372,000, as had been originally reported.

Lots of numbers getting tossed around. Bottom line — the survey confirms a significant drop in the number of uninsured in the Commonwealth. Because these numbers were collected during a pretty volatile period, we believe the actual drop in uninsured is much, much higher. We also think the beginning number of uninsured is probably higher as well. Nonetheless, this is good news, and one more piece of evidence that health reform is making a positive and significant difference.

This is numbers week for the Healthy Blog. Late August is when lots of statistics seem to issue forth from their bureaucratic hiding place.

First up: 1,081,823. That’s the total MassHealth enrollment, as of June 30, 2007. For the first year of health reform, June 30, 2006 to June 30, 2007, MassHealth’s net enrollment growth was 47,378. The increase for kids was 22,873; for adults, 24,505 (including 5,602 disabled adults and 2,349 seniors).

For a historical perspective, see the helpful chart maintained by the Mass Medicaid Policy Institute below (not updated for the latest month)

The program with the largest growth in the past year was kids in the Family Assistance program, which increased its eligibility cap to 300%. Enrollment in the program grew by 18,362 children.

The other significant growth was in MassHealth Essential, which added 9,438 below-poverty long-term unemployed adults. Chapter 58 increased the enrollment cap for the program, which had a waiting list for months prior to July 2006.

MassHealth is one of the pillars of chapter 58. One of the key but often overlooked goals of health reform was getting the already eligible but unenrolled into MassHealth. These new numbers indicate that progress has been made on this front, but more work remains.

CBS Evening News and Katie Couric covered MA health reform in a report on Friday. Nothing new here, just the national attention, for good and bad. The piece was done weeks ago; they held it until they had a good news peg: Romney’s health plan announcement. You can read the script and see the video here.

Better though is the reporter Wyatt Andrews’ blog, commenting on the incongruity of seeing the Connector booth at Fenway. Andrews sums up the situation quite well:

Here’s what’s great about the plan.

1) They are really trying to be universal. More on this in a second.

2) If you can pay, you can’t be turned down.

3) They have reached 170 thousand people who had no insurance last year. And that’s just so far.

4) They have jump started the national debate over how to get this intractable problem, the plight of the uninsured, solved. This isn’t Clinton care; it’s a huge experiment to see whether the private market can work when everyone’s forced to be in it.

Here’s what’s not great, all of which the state admits it’s working on.

1) Thousands of employers complain they can’t afford to do (offer insurance) what the law orders them to do.

2) Tens of thousands of the working poor–or part timers–can’t afford the cheapest plan offered through work.

3) Tens of thousands of middle income folks can’t afford $662 dollars a month, especially when that policy has a huge deductible too.

4) They haven’t persuaded all those young men, men who don’t need or want insurance, that this is a good enough deal. And they badly need these guys paying into the system.

Andrews ends: “And you have to hand it to Massachusetts. It was hilarious to watch that stream of raving Red Sox fans juggling cheese dogs, tankers of beer– and flyers for health insurance. I am not commenting on the total lack of irony there: I was just jealous.”

Our humor category is growing by leaps and bounds. Kudos to Charley on the MTA at Blue Mass Group for catching this spicy tidbit from the Boston Globe’s Primary Source political blog:

Likely Republican voters were asked how familiar they were the healthcare plans of all their candidates, even including non-candidate Fred Thompson. The results? In Nevada 29 percent said they were familiar with Thompson’s healthcare plan. In New Hampshire it was 15 percent, in Iowa 18 percent, in Florida it was 22 percent and in South Carolina had 24 percent with some idea about his plan.

Huh?

Thompson makes no reference to healthcare in his short stump speeches and has yet to even enter the race much less offer a healthcare plan.Nonetheless voters in these states told the pollsters at Woelfel Research, Inc that they were more familiar with Fred Thompson’s healthcare plan than they were of Tommy Thompson, Tom Tancredo, Ron Paul, Duncan Hunter, Mike Huckabee and Sam Brownback.

Wow.

The Kaiser Commission on Medicaid and the Uninsured has released a fact sheet called: “Dental coverage and care for low-income children: The Role of Medicaid and SCHIP.” This paper provides a national view of children’s dental health and the solutions we need to work together to accomplish to ensure that all children have access to health care. Below is an excerpt from this paper.

“Oral health is an integral component of children’s overall health and well-being. Tooth decay is the most common chronic disease, affecting five times more children than asthma. Statistics from the Centers for Disease control and Prevention (CDC) reveal that over two-thirds (68%) of children have decay in their permanent teeth. Oral Diseases have been linked to ear and sinus infections and weakened immune systems, as well as diabetes, and heart and lung disease. Lack of treatment has the potential to affect speech, nutrition, social development, and quality of life, and in the worst cases, can lead to death. Studies have found that children with oral diseases are restricted in their daily activities and miss over 51 million hours of school each year.

Preventive measures such as fluoridated water and sealants, as well as diagnostic dental services, are effective and efficient ways to prevent, detect and treat tooth decay and disease. Children who receive early preventive care have average dental costs that are 40% lower than those of children who do not receive early treatment. The CDC estimates that every dollar invested in fluoridation saves $38 in dental treatment costs.”

The fact sheet discusses the importance of having dental benefits in both the Medicaid and SCHIP programs and makes recommendations for increasing access to dental care for children. These recommendations include “expanding community heath centers in medically underserved areas, providing grants to increase the numbers of pediatric dentists, developing prevention programs for high-risk populations, and improving efforts to track children’s dental health.” Other solutions include increasing provider payment rates and increasing access to parental education.

Overall, we know that oral health is critical to overall health. We also know that while dental disease is the most common infectious disease of childhood, it is also among the most preventable. It is nice to see Kaiser produce a comprehensive fact sheet for national advocates.

To read the fact sheet, click here:
Kate Vaughan

In a stunning admission at a campaign health event in Florida today, Republican Presidential Candidate and former Massachusetts Governor Mitt Romney said that he had been “brainwashed” while serving as governor and agreeing to a big government health expansion scheme.

“Gosh, there was so much blue, so much blue, everywhere, my eyes kind of glazed over and I lost focus,” Romney said, referring to the Massachusetts health reform law known as Chapter 58 which has thus far expanded affordable health insurance coverage to about 175,000 formerly uninsured individuals, mostly through expanded government financing.

“Now that I’ve left that darn state, I’ve seen the light,” Romney admitted, saying he feels a pain in his stomach every time he thinks about the law which requires government, individuals, and employers to make contributions to create a near-universal health care structure.

In the early part of his presidential drive, Romney rarely mentioned Massachusetts or health care. But just last month, rival candidate Rudolph Giuliani advanced his own health reform platform to favorable reviews from conservative analysts. Romney’s new plan, described in today’s New York Times, hews closely to Republican health care orthodoxy, so much that conservative critics of Chapter 58 are offering praise:

“Compared to what Gov. Romney did in Massachusetts, that would be a dramatic improvement,” said Michael F. Cannon, director of health-policy studies at the libertarian Cato Institute, which has blasted Mr. Romney for the state plan. “If it’s geared toward getting government out of people’s health-care decisions by reforming the tax code, wow, that’s fantastic.” — WSJ

“I know people can look at my health law and think, ‘holy Toledo, he’s a big government so and so.’ But, just like Ronald Reagan and Rudy Giuliani changed their minds, well, heck, I’ve changed mine as well,” the candidate noted.

In an unusual move, at the end of the event, the Romney campaign served cherry pie for all reporters and participants.

Deceptive marketing. Deceptive sales to seniors. Illegal exclusions. Failure to cover maternity care and newborn visits. Violation of privacy rights. Illegal membership practices.

AG Martha Coakley has filed a lawsuit against the big, bad, MEGA Life and Health Insurance Company and its corporate parent, HealthMarkets Inc. She’s got the goods, and the bad guys are going down.

The case alleges 8 counts of illegal activities, and the evidence turned up is compelling. Here’s one of the best things they learned: The companies treat consumer complaints and grievances as “agent training opportunities.”

As early as last fall, HLA was providing to the Office of the Attorney General significant evidence that MEGALife had violated the state Consumer Protection Act. The AG’s Office met with HLA and listened to concerns raised by HLA’s clients who were aggrieved by alleged deceptive and misleading sales and marketing practices of Mega Life agents. HLA documented over 37 client complaints and submitted over 100 pages of supporting documentation. HLA is pleased at the AG’s Office response to the issues raised by HLA clients and Massachusetts consumers in general and that the court complaint against Mega Life has now been amended to incorporate these claims. Now, the full force of the state’s powerful Consumer Protection Law, Chapter 93A, can be unleashed to bring justice to Massachusetts consumers allegedly victimized by MegaLife.

This one should be delicious to watch.

The AG’s press statement is here. You can read the full complaint here, and the evidence submitted here.

This morning’s hearing on the Health Safety Net (HSN) Trust Fund, successor to the Uncompensated Care Pool, began with a twist (you can read the State House News Service coverage here; and the Globe’s here). Just before the hearing got underway, the Division of Health Care Finance and Policy handed out a sheet with 17 “clarifications” of the proposed regulations (you can see a scan of the clarifications here, courtesy of MLRI).

The clarifications (some called them tweaks) partially addressed a number of the concerns raised by the ACT Coalition, HCFA and providers. Among the key concerns resolved by the clarifications were waiving cost sharing at hospital-licensed community health centers and allowing secondary “wrap-around” coverage for coinsurance.

However, the majority of the concerns raised by the ACT Coalition remain unresolved, and we will continue to aggressively press for a more fair and workable Health Safety Net.

The hearing opened up with testimony summarizing the proposal and a number of the clarifications from Caroline Minkin, the Division’s Uncompensated Care Pool Policy Manager (read her testimony here)

ACT Panels
The ACT!! Coalition organized three panels; a clergy panel, a policy panel, and a consumer/advocate panel, who presented wide-ranging testimony. The clergy – a Rabbi, Episcopalian Reverend, Greek Orthodox Priest and Catholic monk, all spoke eloquently in moral terms that access to quality, affordable health care is a basic human right.

Neil Cronin, of MLRI, led off the Policy panel. Given the announced revisions in the regulations, Neil apologized in advance if his testimony sounded like Gilda Radner’s Emily Litella. Neil, Carly Burton of MIRA, and Brian Rosman of HCFA spoke to the issues of eligibility, cost sharing and the operational challenges of implementing a complex new system. The ACT!! written testimony can be read here; and the MLRI comments are here.

Autumn Mathias, a case worker for the Boston Center for Refugee Health and Human Rights, kicked off the final ACT!! panel discussing how gaps in coverage and cost sharing negatively affect the population she works with. Two financial counselors from UMASS Memorial Hospital, Lisa Himenes-Burbo and Nancy Timm, spoke of their experiences working with clients who already deal with gaps in coverage and issues with termination and redetermination in the current system. Erica Marote, a consumer from Coalition Against Poverty, concluded the panels, eloquently sharing her boyfriend’s story of his inability to pay the high deductible for partial care.

Following the ACT panels, speaker after speaker echoed and amplified on these criticisms of the proposal. Representatives from hospitals and health centers pointed out that reductions in HSN eligibility will lead to substantial revenue reductions for safety net providers committed to serving low-income patients. If the accumulated deductible and copays exceed the reimbursement for a service, hospitals won’t receive any payment at all for treating a patient. Health Law Advocates (remarks and testimony) and the Access Project focused on medical debt, presenting case after case of people harmed by uncovered medical costs. The new regulations will exacerbate the problem, including high deductibles for partial care, and incomplete regulations of hospital debt collection processes.

Business Community Support
Michael Widmer of the Mass Taxpayers Foundation and Eileen McAnneny of AIM voiced support for the regulation’s attempt to move people from uncompensated care to coverage (AIM’s testimony). This position was also articulated earlier by Melissa Boudreault, the Connector’s Commonwealth Care manager. She testified in support of the exclusion of CommCare-eligibles from Health Safety Net coverage.

As advocates, we agree with that goal, and the vast majority of users of Health Safety Net services will be people ineligible for MassHealth, Commonwealth Care, or affordable employer coverage. At issue is whether, during our transition as the first state to attempt near-universal coverage, we should lock out altogether people who temporarily drop off of state programs for some reason.

Moore Letter
Our concerns were also raised in a letter submitted by Senator Moore, Senate Chair of the Health Care Financing Committee (read the letter here). Moore wrote that “while the goal of the reform of the safety net is to incentivize people to acquire coverage rather than continue to use the UCP, what must be avoided is placing more of a burden on the hospitals and inadvertently discouraging patients from seeking medical care.”

Bottom Line: 3 Questions
We’ll certainly have more to say about the issue in the coming weeks. The final regulations should appear sometime on or after September 20th. For the Patrick administration, it seems they have 3 key questions for ponder – ones for the poor, for providers and for themselves.

1. For the poor: should the goal of encouraging enrollment in insurance programs use carrots, as in now the case, or should some serious sticks be used that may harm some patients seeking needed care?
2. For providers: is the solution to the limited funding for the new Pool to shift some of those costs onto poor patients and safety net providers?
3. For the administration itself: will the systems be in place to allow for the implementation of the new HSN system by the October start of the regulations?

Vanessa Furtado and Brian Rosman

Please use the comments for any reactions or opinions. And we’d be happy to post links to other testimony if sent to us:
Testimony of Oral Health Advocacy Task Force

Well, here’s a surprise. US Health and Human Services Secretary Mike Leavitt has started a blog. Click here. He writes from the road — Montana and South Africa, for two. And he takes comments — moderated during working hours by DHHS staff. His 8/16/07 posting touches on the SCHIP controversy, but only indirectly. This is unprecented, no? Give the guy credit for putting himself out there like no federal bureaucrat has done before. And let’s give him all the comments we can in support of full SCHIP reauthorization! And sorry Nancy Turnbull — one more health blog!

Tip of the hat to Andrew Sullivan’s always engaging blog for this one. A British Telegraph article (click here), reporting on a new study in the Lancet, shows that the US health care system produces the best cancer survivor rates 22 nations for men and women. Here are some of the numbers for five year post-diagnosis survival rates (for the fans and critics of Canada — sorry, it was not on the list):

FEMALE
1. US — 62.9
2. Iceland — 61.8
3. Sweden — 61.7
4. Belgium — 61.6
5. Finland — 61.1
6. Switzerland — 61.1
9. Germany — 58.8
11. Netherlands — 58.3
16. England — 52.7
17. Ireland — 51.9

MALES
1. US — 66.3
2. Sweden — 60.3
3. Iceland — 57.7
4. Finland — 55.9
5. Austria — 55.4
6. Switzerland — 54.6
9. Germany — 50.0
12. Ireland — 48.1
14. Netherlands — 47.1
15. England — 44.8

Pretty close bunching among females, at least among the top ten or so. The spread in survival rates among males is more eye-popping. These results fit with the prevailing meta-narrative on the US health care system. We do pretty well when you get really sick and need technologically advanced care. It’s all the other stuff where our numbers are mediocre to poor.

Some regular blog readers knock us for only focussing on the negatives in US health care. Here’s a case where the US system looks pretty darn good.
John McDonough

The hearing on the eligibility, cost sharing and services under the Health Safety Net Trust Fund is tomorrow, Wednesday, Aug. 22, at 9:30 am at 1 Ashburton, 21st floor. Please attend to show your support for a safety net that protects low income residents.

The ACT!! coalition will be testifying, including religious leaders, policy experts, and those with first-hand experience. There will also be testimony from providers, legal groups (including Health Law Advocates) and concerned citizens.

Later in the afternoon, at 1:00, will be the hearing on payments and funding.

We’re pleased that the legislature changed the name from the “Uncompensated Care Pool” to “Health Safety Net.” The new name expresses the goal of the program: providing a safety net of basic hospital and community health center care for poor uninsured and underinsured residents.

But we’re concerned that the regulations don’t fully live up to the program’s name. While the details can be dense, the basic points are fairly simple:

1. Under the proposed regulations, some low-income residents would be without any medical safety net.
2. The new costs, particularly the $420 annual deductible, would be an inequitable burden on low-income uninsured people, leading to delayed enrollment and delayed care, harming patients.
3. Our already overloaded systems are not equipped to handle the complex new eligibility and cost sharing rules. Changes should not be made until systems are in place to implement the process.

We will be calling for the DHCFP to reexamine the proposals. Please come and support our efforts.

For contrary views on yesterday’s post on the new Medicare payment rules — see the new blog, The Physician Executive, and see Paul Levy’s blog entry from Sunday, especially the followup discussion and comments — click here for that.

Tonight, we hosted a quality of care discussion in Framingham for folks from the Metrowest region. Linda Campbell, Director of Quality and Patient Safety at Metrowest Medical Center told me two facts I had missed in all the discussion: 1. the rule takes effect on 10/1/08 giving hospitals about 13 months to prepare, and 2. the full rule runs about 2,000 pages. Yikes!

I appreciate the concerns about the difficulties hospitals will face implementing this new structure, and recognize that some degree of gaming is inevitable and will undermine the ultimate effectiveness of this rule. At the same time:

1. We know that hospitals around the nation — especially Michigan — have driven their rates of infection down to ZERO. No one says it’s easy, but as Lucian Leape says, the cat’s out of the bag on this one. And he’s been saying that for over two years now.

2. We’ve all seen news accounts of the Pennsylvania hospital chain that is guaranteeing consumers and payers will not have to pay for hospital mistakes.

3. Where else in the American economy is there a sector that derives revenues from its mistakes?

4. If we can’t agree on payment reform around infections and never events, we’ll never be able to agree on any change.

On balance, this is a slam-dunk and CMS has done the right thing.

Caveat: my favorite definition of quality — doing the right thing and doing it right. CMS is doing the right thing — the jury’s still out on whether they’re doing it right.
John McDonough

I’m back from two weeks vacation in Utah (what a place!) — with welcome news in today’s NYTimes front page story (click here) that the Medicare program, run by the Centers for Medicare and Medicaid Services, will stop paying for “the extra costs of treating preventable errors, injuries and infections that occur in hospitals…” In the multi-year campaign to raise awareness of and stop hospital acquired infections, this may well be the most significant and impactful step of all. Once Medicare adopts this policy, the bulk of private payers will certainly follow, the only question being how long it will take them. And state Medicaid programs won’t be that far behind either.

Changing the way we pay for medical care services is the most essential step/challenge in getting quality right. HCFA’s cost-control agenda we issued last March — click here for the report and see recommendations B1-7.

There’s been a gathering movement against hospital acquired infections for most of this decade. The real hero in this movement has been the Consumers Union and their Stop Hospital Infections campaign which triggered the passage of public reporting laws in 19 states. HCFA’s quality legislation would require public reporting of hospital acquired infections and so-called “never events,” and direct the Department of Public Health to work with hospitals to reduce infections as close as possible to zero — click here for info on our bill, scheduled for a public hearing on September 12th, 10am, before the Legislature’s Joint Committee on Public Health.

Here’s a sincere question for all the private insurers — in Massachusetts and elsewhere. Information on hospital acquired infections has been publicly available for years now. Have you been unaware of the problem of hospital acquired infections? Is so, how come? If not, what have you done about it before now? If you knew about infections and have not done anything before now, how come? If this issue doesn’t force some hard thinking on the part of our health plans, there’s something wrong:

Susan M. Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group, said, “Private insurers will take a close look at what Medicare is doing, with an eye to adopting similar policies.”

It has taken the consumer/patient voice and now the financing power of the federal government to bring this issue to the fore. The CMS action is the turning of the corner on infections. Time to start thinking about what’s next.
John McDonough

This coming Monday evening, consumers, providers, and advocates will come together for the MetroWest Community Forum on Health Care Quality. This community forum will be an opportunity for anyone who cares about the quality of their health care to express their ideas and concerns, hear from people involved in the patient safety movement, and learn about ways they can be involved in improving the quality of health care in Massachusetts.

The forum will begin with MetroWest consumer health activist Geri Chimera, who will talk about how quality of care issues have impacted her life and how she is involved in pressing for better quality. Geri will be followed by John McDonough, who will discuss Health Care For All’s quality initiative. Finally, Linda Campbell, Director of Quality and Patient Safety at MetroWest Medical Center will inform the group about how their medical center is improving care. The speakers will be followed by an open discussion.

We hope to have a lively conversation about this issue that has deeply touched the lives of about one quarter of Massachusetts residents. The forum will be the first step towards establishing a MetroWest regional chapter of the Consumer Health Quality Council.

The MetroWest Community Forum on Health Care Quality will be this Monday, August 20th from 7:00-8:30 PM. Baypath Elder Services will host the meeting at Chestnut Place, 354 Waverly St. in Framingham. For more information, contact James Madden at jmadden@hcfama.org or 617-275-2940.

EOHHS issued their latest health reform implementation update earlier in the week. It’s not on their website yet, but we got it right here.

(NEW: you can read all of the reports, filed every 60 days, here)

Headlines:

• 105,000 people enrolled in Commonwealth Care as of August 1 (this is not more than expected, just quicker than expected.) Over 90% are paying premiums on time.
• 5,000 enrolled in Commonwealth Choice.
• Outreach grants for next year will likely be only for community groups. The work of the larger “Model B” grants (”comprehensive broad-scale media or grassroots campaigns”) is being filled by the Connector’s media and eduction campaign.
• The elimination of premiums for MassHealth members below 150% fpl reduced premium-paying MassHealth recipients from over 52,000 to below 30,000
• More than 2,500 businesses have signed up with the Connector to allow part-time and contract workers to purchase health insurance on a pre-tax basis.

Also, MSNBC.com has posted a big package on health reform, including a long story, video, interview with Jon Kingsdale, and more. It starts here.