Tuesday, March 16, 2010

"But our patients are sicker"

Liz Kowalczyk at the Boston Globe provides a story and the detailed analysis of the rates paid by Harvard Pilgrim Health Care to hospitals and physicians in Massachusetts. Similar charts have now also been filed by Blue Cross Blue Shield and Tufts Health Plan. All this demonstrates again that the health care reimbursement system is broken.


Brenda RN said...

To claim that the patients at MGH and BWH are sicker is just ridiculous! The claim that Children's needs higher reimbursement rates because of the high number of Medicaid patients it serves is more valid, but then using that logic, any hospital with high Medicaid volumes should also command higher rates.

I have worked at three Boston hospitals and I or my family have received care at two others. The care is equally good at all of them, the caregivers are all committed to their patients, and most contribute to medical research and training through their relationships with the local medical schools. I am appalled that the reimbursement rates can differ so significantly.

I am glad the Globe is covering this issue. A recent discussion with some of the nurses at work showed that very few people know that the reimbursement rates vary so much among Boston hospitals. Perhaps now there will be some public support for fixing this outrageous system.

Barry Carol said...

It is encouraging to see this information starting to enter the public domain even though it falls short of my preference for disclosure of actual contract reimbursement rates by procedure and provider. I think there is enormous potential for both employers and labor unions to use this information to begin to educate their members about these differences in rates and why it is in the members’ own self-interest to make more cost-effective choices.

While some employers are already doing it, all employers should be telling their employees exactly how much the employer is paying for health insurance on the employees’ behalf. It should also be made clear that the escalation in these costs is crowding out the employer’s ability to provide adequate wage increases at least sufficient to keep pace with inflation.

Labor unions, including those representing public employees, could be helpful in making members understand that these rate differences are mostly a function of market power and not quality. Since referring doctors, at least until now, have been largely unaware of these rate differences as well, patients need to start asking whether an MRI can be done at an independent, non-hospital owned imaging center instead of at the local community or teaching hospital. ER visits should be limited to emergencies while urgent care clinics or even retail clinics and nurse hotlines should be used for less serious issues when a timely appointment with their regular doctor is not possible.

The bottom line is that both patients and referring doctors need to learn to care about what services, tests, procedures and drugs cost even when insurers are paying. Employers and labor unions can do a lot more to aid in that effort, with or without reform. Both need to step up and soon because the current medical cost trend is unsustainable.

Anonymous said...

Forwarded from a note from Jim Mandell, CEO of Children's Hospital:

These numbers, which show Children’s Hospital Boston and its physicians as among HPHC’s highest cost providers, are misleading at best and downright incorrect in others. We’ve had a long discussion with the Globe reporter to make our points, but want to make sure that you also know the facts.

Check this website for more explanation: