Tuesday, August 02, 2011

Chutzpah, timidity, prediction, policy

What do you call it when a hospital and physician system gets to collect an extra, say, $200 million per year in insurance payments for a decade and a half?  What do you call it when that system promises a one-time donation of $40 million towards a crisis in individual and small business insurance premiums, but then says, "We didn't necessarily mean cash" -- but preferably a negotiated offset to a previously unspecified and unknowable level of future rates?


What do you call it when the Commonwealth has the legal authority to publicize the data it has already collected and to take actions to moderate the payments made by insurance companies to this hospital and physician system, but chooses not to?


What do you call this?

The parties agree to experiment with bundled payments for certain diseases and procedures, staying far away, though, from a full system of capitation. The parties agree to a general rate increase of just a few percent. Together, they will say, this will "bend the cost curve" for this large group of doctors and hospitals. There won't be much talk about the fact that the base upon which the bundled payments and other fee-for-service payments is set remains far above market.

End result: Continued use of market power as the prime determinant in setting reimbursement rates.

A pretty accurate prediction.

What do you call it when all this is happening before our eyes?

Massachusetts health care policy.


Unknown said...

Paul - if you were in charge of strategy what would be your first step to fundamentally transform the current system?

Anonymous said...

The ongoing saga of Partners Health Care, which I had only known heretofore as the "iconic" Massachusetts General of national reputation, has been eye-opening to an outside community doctor, to say the least. Thanks for shining a spotlight on the darkest corners in the hallowed halls of academic medical centers. It is a sad commentary.

nonlocal MD

Barry Carol said...

Why won’t the folks at the Healthcare Quality and Cost Council release the data that they’ve already collected regarding payment rate variance among hospitals, doctors and other healthcare providers? What are they afraid of? Aren’t they interested in bending the medical cost growth curve? From my outsider, out of state perspective, it’s outrageous.

Jeff said...

From Facebook:

Sadly, business as usual, eh Paul?

@Gienna said...

From Twitter:

Healthcare reimbursement is almost never this interesting.