Tuesday, December 04, 2007

Piling On

Someone at the health insurance plan associated with Boston Medical Center did something wrong. As reported by Alice Dembner in today's Boston Globe, BMC gave the impression in a letter to 2600 people that they would lose their ability to be treated at BMC if they didn't sign up with the hospital's insurance plan.

Now, let's all agree that this was a wrong and bad thing to do. (I think most of us would believe that it was the result of some lower level staff person writing a letter poorly rather than some dastardly plot to force 2600 people to use the hospital.) But what is the right response and the right remedy?

BMC immediately apologized and said they would take steps to make sure this doesn't happen again. Seems like enough to me.

But, no, first they get accused of "losing sight" of the purposes of the MA health reform legislation. Someone else asserts that BMC's actions are "all about money and not about health." Then, they have an investigation by the Attorney General to see if they violated the state's consumer protection law? What's next: Financial damages?

Folks, they made a mistake. This is the hospital that has stood tall for care of the indigent for years. If we make (perhaps literally) a federal case about every glitch and error that occurs in implementing a highly complex state law, we only succeed in generating cynicism and ill will that will ultimately undermine this noble experiment.


Anonymous said...

i agree for the most part... but i'm betting that somehow if the hospital in question were partners or caregroup or some other institution that has more of a monopoly or is perceived as being more powerful, people would expect an investigation like this. why not treat all hospitals the same way? it seems only fair to set a precedent.

Anonymous said...

Paul, I don't want to pile on, but I guarantee you that this was very much about keeping 2,600 patients. You see, under the new health reform law, the $$$ follow the patient -- not the institution. Patient enrollment dictates $$$. Senior executives lose sleep over enrollment, so you cannot attribute this to staff error.

BMC -- correctly -- is extremely anxious about this health reform experiment. So competition among the MassHealth Managed Care Organizations (NHP, Network Health, HealthNet)for every single enrollee has been FIERCE. It is sad that protecting the safety net has come to this.

Anonymous said...

Hi Paul,

I feel for BMC. As a hospital administrator when I see the end product of a project, I wish the folks being effected could see the months of planning and testing that goes into it. Many of the projects I work on seem fairly simple on the surface, but the amount of detail can be staggering. It's too bad that all that work is tainted for one small (and important) detail mistake.

Anonymous said...

I read your blog today, OK. I took a break, read the Globe story, and OUTRAGE!! Boston Medical Center -- Boston's premier safety net provider -- refuses to accept patients who are covered by Cambridge Health Alliance's health plan, Network Health? (Isn't that what it means when you don't have a contract??)

That is an outrage and brings shame to our safety net.

But check out the other MCOs too --can CHA's Network Health patients get their elective care at Boston Medical Center or its affiliated health centers? at BIDMC? at Partners?

Is Codman Square Health Center accepting patients from all the MCOs? or just their affiliate's BMC HealthNet plan?

I hope the Attorney General finds out.

Anonymous said...

Sorry, can't agree.

It needs to be investigated. You're assuming it was a mistake. What is the basis for that assumption? Wishful thinking?

This is about big money. I just found out my insurance next year is going up 51%. Fifty. One. It's now my single biggest expense. Bigger than my property tax. Bigger than my mortgage.

When you're talking about that kind of money, I, for one, am not willing to accept an "oops, my bad" and forget it.

Anonymous said...

Paul, I am surprised, as a regular reader of your blog, that you have not published my comment on this post, which I sent to you earlier this am, long before these other comments. If you didn't receive it, I'll be happy to send it again. If you did, I'd love to know why you haven't published it. Makes me wonder about your editorial policy...


Anonymous said...

Peter, I don't believe I received it, as I published every comment that came through. Please try again.

Anonymous said...


Sending again from yesterday:

I think you don't know the full story here, particularly the history of competition among the Medicaid health plans. The BMC health plan (and the Cambridge plan too) has had an unfair competitive advantage for years in terms of gobs of extra money it's gotten from Medicaid, which has allowed it to compete in unfair (and very expensive ways to the state and feds) against NHP and Fallon. Many people belive that that the BMC plan engaged in predatory pricing for Commonwealth Care, so that the BMC plan would be auto-assigned the CommCare members who didn't pick a health plan. This latest event demonstrates vividly the potential problems of having hospitals/providers control health plans: it creates too many temptations/opportunities for hospitals to further their own business interests at the expense of patients/consumers. I think you're naive if you think this was just the result of a "lower level" person "writing a letter poorly." Someone had to go into the hospital's patient records, find all the patients who had CommCare coverage through NHP and Network Health, take their personal information (i.e., names and addresses)and send them an untrue and misleading letter. Not just the kind of minor mistake or "glitch" that most of us "lower level staff" people make during the course of our work days. This is serious, is part of a pattern of troubling behavior, and deserves to be treated accordingly.

Anonymous said...

Peter, I have noticed that since the little thingy where you have to type in the (unreadable) letters to thwart robots appeared on Paul's blog, occasional comments of mine have been missed also. Sometimes you get the letters wrong and it makes you type them again; if you miss that the comment doesn't appear.
Paul, I am going to try again with a similar missed comment of mine on the endowment post.

Anonymous said...

I'm wondering why you assumed it was a "lower level staff person writing a letter poorly". Are you implying that lower level staff members do not write as well as upper levels? I'm not sure I would agree.

Anonymous said...

Geez, anon, I wasn't talking about writing ability. I was talking about someone who wrote it poorly, in terms of intent, and then not having it carefully reviewed by someone in authority.

Anonymous said...


Whether it was an unfair advantage or not over the years, the system was specifically designed that way by local, state, and federal officials in pursuit of policy goals that they all agreed to.

By the way, on your larger point --the awkwardness of having health plans and providers under the same corporate ownership and providing service in the same geographic area -- I agree. It inevitably raises all kinds of concerns and issues.

Anonymous said...

This financing system was not designed by state officials that way--more foisted upon them. I think Medicaid officials at the time, and many policy observers, would argue that the extra money that went to BMC and Cambridge was garnered and kept through bare knuckle politics and not because of any sound policy purposes. The extra money was originally intended to be transitional funding as Medicaid coverage expanded in the late 1990s and it should have phased out. And it was certainly never expected to become such a huge amount, or to enable these two health plans to become the dominant Medicaid plans, and serve mainly members far beyond the service areas of the two safety net hospitals (e.g., Springfield, Worcester). No real policy design here.

On the other point, love to hear your thoughts about the lines/differences between hospitals owning health plans and merely having health plan CEOs on their boards, given recent addition of Charlie Baker to your board. (Peter again, having trouble sending...)

Anonymous said...

Charlie is not on the fiduciary governing body of our hospital and will never be involved in discussions concerning insurance rates, whether about his company or another. I highly value his perspective on lots of other issues, and it will be good for all hospitals for him to learn more about how we try to improve quality and safety. Check out his blog for more discussion on the topic.

On your first point, policy is what the government determines it to be. It is not an abstract concept of what "should" have been or "might" have been. It is what was decided and put in place. Sometimes it is the result of "bare knuckle" politics.

Anonymous said...

If you read Jean Haynes (Ex Dir. of BMC HealthNet) reply to the Corrective Action Plan it directly admits that the letter was written by a health plan employee and then given to the hospital to send out. So, it was not a "low level staff person at the hospital".
I'd also like to understand your thinking as why there is inherent harm, from a public policy perspective, in having provider-sponsored health plans, particularly when the health plans are serving low-income, formerly uninsured populations, and the hospitals are safety-net hospitals.
Finally, if "supplemental payments" were provided to supplement loss of revenue to safety net hospitals and help the hospital systems serve the uninsured, poorest segments of our population, how this against public policy?

Anonymous said...


Thanks, I should have said low level staff person at HealthNet, not the hospital.

On your second point, my thinking is this: As is so evident from the comments received on this post, the existence of an insurance company and a provider under one corporate roof will always raise questions of self-dealing. That conclusion does not relate in any way to the income of the people served. I didn't say it was harmful. I said it was awkward, and "inevitably raises all kinds of concerns and issues".

I don't understand your last question. I don't recall raising that issue at all. As a general matter, I support public payments to safety net hospitals. Is there something I said that would make you think otherwise?

Anonymous said...

Actually, as I re-read what I wrote, I did not say a lower level person from the hospital. I did say someone from the health insurance plan.

Anonymous said...

Does anyone have a copy of Jean Haynes' (HealthNet) reply to the Connector? It is a public document but it has not been posted anywhere that I can find.