tag:blogger.com,1999:blog-32053362.post5681540629949656175..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: Watching the MA laboratory of democracyPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger10125tag:blogger.com,1999:blog-32053362.post-30485923868711715872010-04-11T12:43:50.810-04:002010-04-11T12:43:50.810-04:00MA purchasers of health care may be approaching th...MA purchasers of health care may be approaching the “tipping point.” You note that institutional leaders may be slow to respond but purchasers cannot wait. Self- insured employers can and probably will move the quickest. <br /><br />Health care providers with better cost/pricing structures can appeal to self-insured employers today and start educating patients for the future by publishing their prices on easily understood comparable services, such as the following.<br /><br />CT Neck without Dye<br />MGH. $1,063 to $1,380<br />BIDMC $461 to $734<br /><br />MRI Neck without Dye<br />MGH $2,805 to $3,307<br />BIDMC $1,621 to $1,757 <br /><br />Source: 2009 Aetna fee schedule – facility charge only<br /><br />Price competition on surgery and other sophisticated services probably await much improved quality measurements and "bundled prices per procedure."<br /><br />Small businesses and individuals are likely to see savings large employers are receiving and demand insurers offer plans that do the same for them. Such plans need not be “closed panels.” PPO plans let patients choose any provider they just have to pay more out-of-pocket. <br /><br />The above steps would quickly save money for purchasers/patients and increase market share/cash flow of efficient providers. Meanwhile providers could pursue more challenging, long term initiatives such as: 1) improving quality 2) re-engineering service delivery and 3) managing patients with chronic conditions and 4) preparing for “annual bundled payments." <br /><br />David SempleDavid Semplenoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-15561963406497380462010-04-09T20:49:01.684-04:002010-04-09T20:49:01.684-04:00It's a good idea a third party in the guise of...It's a good idea a third party in the guise of Therese Murray is getting involved.<br /><br />I think this will resolve in the favor of the non-profits with a twist: if the insurers want to impose the rates, they must open their books for review by an independent auditor to see how things are being paid out to the providers. The non-profits that agree and are found to have their rate hikes justified will allow to hike them, otherwise the rejection stays and the non-profits must then decide whether to drop provider groups, reduce payouts, or a mixture of both.<br /><br />On the other hand, the judge could rule in favor of the governor, but allow a much higher cap for hikes than the governor wants. If the governor is mandating a 5% rate hike cap, the judge could raise that to 15%. Then the non-profits could decide to accept the decision, although it would mean paying out less to providers, or reject them, which would result in dropping provider groups.<br /><br />You are correct, though, Paul - Massachusetts will be the test lab in how the new national health care bill works.Cleary Squaredhttps://www.blogger.com/profile/02007132333940534318noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-78718710279810016672010-04-09T19:09:22.504-04:002010-04-09T19:09:22.504-04:00Paul, you point repeatedly recently to DA Coakley&...Paul, you point repeatedly recently to DA Coakley's report (and it is important data), but what's missing from the DA's report that would make it more useful, is a denominator, or more accurately denominators.<br />While it provides a framework for discussions and provides valuable information, what it doesn't provide are the denominators such as quality metrics (Paul you're obviously a big fan of this) or such as the difference between setting a compound fracture and doing so on a high risk diabetic as just two examples (there are many more).<br />Like any good scientific study, comparisons can only be made if the denominators are the same, I would argue they are not or at the very least not defined.Keithhttps://www.blogger.com/profile/10516531106686413155noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-66441628229494923802010-04-09T18:04:46.063-04:002010-04-09T18:04:46.063-04:00As a former CEO in the federal healthcare system, ...As a former CEO in the federal healthcare system, my guess is that ultimately the state will act in the only way they know to respond, with price controls. This will make it challenging for healthcare organizations to sustain financial viability while maintaining quality and scope of services.James Dougherty, MD, MPHhttp://nostrums.blogspot.comnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-85529821842347743312010-04-09T14:57:04.985-04:002010-04-09T14:57:04.985-04:00<>
Because as healthcare providers come up ...<><br /><br />Because as healthcare providers come up with new technologies, expanded programs, new capabilities, and increased capacity, insurers have had to develop programs and add staff to review the effectiveness of those programs, monitor the eligibility of those services for coverage under benefit terms, and review the medical necessity of the services being provided. <br /><br />Otherwise the costs would have gone even further up; it is fairly well-established that program capacity, more than epidemiology or symptomatology, correlates to use of medical services. Reagan may have been wrong about supply side economics as a cure for recession, but he would have been unquestionably, unimpeachably correct were he to apply voo-doo economics only to healthcare service delivery.Interestednoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-2236647262924199652010-04-09T14:18:33.602-04:002010-04-09T14:18:33.602-04:00No doubt there are general things that people can ...No doubt there are general things that people can do to lower the costs that we all hear about, diet, exercise etc. but once you're in a hospital, the pricing is entirely opaque. The patient has no discretion on any matter, nor any insight into what doctors and staff are spending on you. To add insult, once you're back on the street, the hospital makes it as difficult as they can to get a detailed copy of the charges with the $6 aspirin and $4 gauze pads. If people could see what they were being charged they might take a greater interest in holding down costs.Unknownhttps://www.blogger.com/profile/08819425191303615250noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-62441815292228191592010-04-09T13:41:14.154-04:002010-04-09T13:41:14.154-04:00I'm in agreemnt that fracas in our little Mass...I'm in agreemnt that fracas in our little Massachusetts fish bowl portends what we will see on a national level as healthcare reform is implemented. Local healthcare reform was really just insurance reform and the national plan is MA writ large. Nothing save a few demonstration projects even begins to look at the cost of care. In our state we face particular market dynamics driven by academic medical centers and the "Partners Problem". I have to imagine that variations on this theme exist in virtually every state. It is no wonder that the AMA signed on to support reform, they came away virtually unscathed. While correcting the worst behaviors of insurance companies is a socially desirable outcome until we are willing to deal with direct healthcare costs this problem will not go away. Let hope Ms. Murray has something positive to add to the mix.John Greenbaumnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-82055282354646697072010-04-09T12:14:19.933-04:002010-04-09T12:14:19.933-04:00Many good comments in this post.
And while the ot...Many good comments in this post.<br /><br />And while the other 49 states look at MA, perhaps MA should look at the few other countries that have recently tried private multi-payer universal health care. Switzerland and Holland come to mind.<br /><br />They both have a publicly-available fee schedule for medical procedures, as well as an open mechanism to negotiate and determine those rates. I suspect we'll end up with something similar in MA as well.Paolohttps://www.blogger.com/profile/02799018469316530155noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-75502689634207220942010-04-09T09:01:50.397-04:002010-04-09T09:01:50.397-04:00From the perspective of an out-of-stater, the twis...From the perspective of an out-of-stater, the twists and turns of the Mass. debacle make good political theater. However, the lesson I take away is that dramatic public events among insurers and politicians serve only to divert attention from more important influences in health care: providers, meaning hospitals and physicians, and the patient.<br /><br /> The article by Leape et al clearly demonstrates that neither hospitals nor doctors are yet on board with the necessary changes in health care delivery. This view is supported by the many skeptical and even vicious comments on blogs by physicians, who clearly don’t “get” what people like Berwick are trying to do. The hospitals are successfully pursuing business strategies like “kill your competitor” which are typical of companies like Microsoft, instead of taking care of patients. <br /><br />Patients, in the meantime, figure an academic center is the best place to go to have the most routine medical care, apparently especially in Mass. They have no incentive to do otherwise.<br /><br />The people directly on the giving and receiving end of health care are at the root of the issue. Actions by insurers, employers, and government should be directed toward adjusting incentives to shape their behavior - but let’s not let those actions divert our focus from what’s at the bottom of this “root cause analysis.”<br /><br />nonlocal MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-55004305982193439682010-04-09T06:56:56.065-04:002010-04-09T06:56:56.065-04:00I do research for a living but not in healthcare. ...I do research for a living but not in healthcare. I have read the AG's preliminary and final reports and I think the methodology is flawed. I admit that the conclusions (e.g., that MGH can charge more because everyone wants the option to go there) look intuitively correct but in research speak, the sample looks flawed. The AG reports do not appear to be looking at all health care delivery activity. Only what two insurance companies do vis a vis providers. But for example, while that picks up what BCBS pays Fallon Clinic, it does not appear to include what Fallon Community Health Plan pays Fallon Clinic<br /><br />By the way, I care because I am one of those that has been cancelled by my insurer (Fallon) solely I believe because I am an individual, have been told to go to the exchange, but the exchange does not work. This is a perfect example of why you don't want the guys that run the Registry running your healthcare.<br /><br />Good blog by the way!Dennis Byronnoreply@blogger.com