Saturday, July 31, 2010

Way to go, legislators!

It is one of the enjoyable mysteries of legislative politics that last-minute bills often accomplish things that people have been talking about for months and even years. The MA Legislature goes out of session later today, and it is prepared to take an up-or-down vote on a comprehensive bill regarding health care costs, insurance premiums, and the like. I have just read the conference report. I can't say that I fully understand all the provisions, but there are some that are in the knock-your-socks-off category for those of us who care about transparency of rates, costs, and clinical outcomes. It is clear from these and other sections that the Attorney General's report on payment disparities among the various providers issued earlier this year had a major impact on the structure and scope of the bill.

Congratulations to the Senate and House leadership for moving things along and reaching this agreement!

[Saturday night addition: The bill later passed the Senate unanimously, 40-0, and likewise the House, 153-0.]

A recitation of a few sections:


Public reporting of relative prices -- Notwithstanding any special or general law to the contrary, the division of health care finance and policy, in consultation with the division of insurance, shall promulgate regulations on or before October 1, 2010 to establish uniform methodology for calculating and reporting relative prices paid to hospitals, physician groups, other health care providers licensed under chapter 112 of the General Laws, freestanding surgical centers by each private and public health care payer under section 6 of chapter 118G of the General Laws. The uniform methodology for calculating and reporting relative prices under this section shall, at a minimum: (i) specify a method for basing the calculation on a uniform mix of products and services by payer that is case mix neutral; (ii) specify a uniform method for including in the calculation all non­claims related payments to providers, including supplemental payments of any type, such as pay-­for­-performance, care management payments, infrastructure payments, grants, surplus payments, lump sum settlements, signing bonuses, and government payer shortfall payments; (iii) permit reporting of relative price in the aggregate for all physician groups whose price equals the payer’s standard fee schedule rates; and (vi) designate and annually update the comprehensive list of physician groups for which payers shall report relative prices.

Establishing uniform methodologies for hospital cost reporting -- Notwithstanding any special or general law to the contrary, the division of health care finance and policy, in consultation with the division of insurance, shall promulgate regulations on or before October 1, 2010 to establish uniform methodology for calculating and reporting inpatient and outpatient costs, including direct and indirect costs, for all hospitals under section 6 of chapter 118G of the General Laws. The division shall, as necessary and appropriate, promulgate regulations or amendments to its existing regulations to require hospitals to report cost and cost trend information in a uniform manner including, but not limited to, uniform methodologies for reporting the cost and cost trend for categories of direct labor, debt service, depreciation, advertising and marketing, bad debt, stop­loss insurance, malpractice insurance, health information technology, medical management, development, fundraising, research, academic costs, charitable contributions, and operating margins for all commercial business and for all state and federal government business, including but not limited to Medicaid, Medicare, insurance through the group insurance commission and federal Civilian Health and Medical Program of the Uniformed Services.

Outcomes reporting -- The department of public health shall promulgate regulations under section 25P of chapter 111 of the General Laws by December 31, 2010 requiring the uniform reporting of a standard set of health care quality measures for each health care provider facility, medical group, or provider group in the commonwealth hereinafter referred to as the “Standard Quality Measure Set.” The department of public health shall convene a statewide advisory committee which shall recommend to the department by November 1, 2010 the Standard Quality Measure Set. The statewide advisory committee shall consist of the commissioner of health care finance and policy or the commissioner’s designee, who shall serve as the chair; and up to 8 members, including the executive director of the group insurance commission and the Medicaid director, or the directors designees; and up to 6 representatives of organizations to be appointed by the governor including at least 1 representative from an acute care hospital or hospital association, 1 representative from a provider group or medical association or provider association, 1 representative from a medical group, 1 representative from a private health plan or health plan association, 1 representative from an employer association and 1 representative from a health care consumer group.....

At a minimum, the Standard Quality Measure Set shall consist of the following quality measures: (i) the Centers for Medicare and Medicaid Services hospital process measures for acute myocardial infarction, congestive heart failure, pneumonia and surgical infection prevention; (ii) the Hospital Consumer Assessment of Healthcare Providers and Systems survey; (iii) the Healthcare Effectiveness Data and Information Set reported as individual measures and as a weighted aggregate of the individual measures by medical or provider group; and (iv) the Ambulatory Care Experiences Survey.

6 comments:

Barry Carol said...

Does the requirement of uniform methodologies for hospital cost reporting mean that Maryland style all payer rate setting will follow soon after the cost reporting rules take effect? If so, is that a good or a bad thing for hospitals other than those with significant local or regional market power? Also, how would all payer rate setting affect Medicare and Medicaid payment rates, if at all?

Anonymous said...

Also, I see the requirements for uniform reporting of costs and quality measurements, but I do not see the phrase "public reporting" anywhere. To whom does this reporting occur? (or maybe I missed it in the convoluted language).

nonlocal

Paul Levy said...

Sorry that I only have the actual legislative language and not an English summary! That will come soon.

This is is public reporting, as best I understand it.

e-Patient Dave said...

Here's my unofficial human-readable version - Grade 8.3 reading level, vs. the Grade 24.2 of the original!

* By October 1 we’ll have regulations to create rules for reporting what each insurer pays to each healthcare provider. The method used will be openly published for everyone to see.

[Note: it doesn't say when the rules will exist, nor when the data will be published. I imagine that'll be in the regulations.]


* By Oct 1, publish regulations to create rules for reporting hospitals’ costs.

This will let everyone see the reason for increasing costs. (Frequently when hospitals are asked why their prices are so high, the answer is that costs keep rising. This will let that evidence be publicly viewed, putting an end to those questions.)

The costs will be reported by category, so the public will see the impact of health IT, bad debt, etc. etc.

* By year end, regulations to require uniform reporting of outcomes (quality measures). By 11/1 convene an advisory committee to define a Standard Quality Measure Set. At a minimum, this will include

· Medicare’s standard data on heart attack, congestive heart failure, pneumonia and surgical infection

· The HCAHPS patient satisfaction survey (Hooray! Reporting patient satisfaction!)

· the Healthcare Effectiveness Data and Information Set created by NCQA

· the Ambulatory Care Experiences Survey - another patient satisfaction survey!

I'm just dyin' to see who's going to complain about this. :–) What a great law!

Lynn Nicholas said...

Paul, I agree that the compromise bill’s transparency and administrative simplification requirements are a definite step in the right direction. There are other provisions we also support and a number of items of concern to hospitals and other providers in this legislation. I am sure that something as important and complex as this bill may need some fine tuning as it is implemented. But wherever one stands on the issue, we cannot lose sight of the fact that the ultimate goal of all our efforts is comprehensive, long-term reform of the healthcare payment and delivery systems.

Anonymous said...

On that public reporting point, all 4 of the minimum measures mentioned are already reported in MA and freely available to anybody with an internet connection.

The hospital measures are available on the Hospital Compare website.

The ambulatory measures (both HEDIS and ACES) are available from the Massachusetts Health Quality Partners at www.mhqp.org

The legislation does specify a different reporting format for the ambulatory HEDIS measures, but that's about all that's missing...at least until we see what measures are added in November. Hopefully the committee that picks the measures and reporting formats will take advantage of recent research on the statistical use and misuse of these measures.