Next Step in HCR (Just Maybe)

The Boston Globe reports that Massachusetts “… Officials draft plans for new system to compensate doctors, hospitals“:

Governor Deval Patrick’s administration is reviving the state’s ambitious plan to change how doctors and hospitals are paid, aiming to hand the Legislature a specific proposal by Jan. 1 and end months of disagreement over how to control health care spending.
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Dr. JudyAnn Bigby, secretary of health and human services, convened a small group of state officials and health care executives earlier this month to draft a first-in-the-nation blueprint for scrapping the current payment system, in which doctors and hospitals are typically paid a negotiated fee for every procedure and visit. This system, called fee for service, is widely viewed as lacking coordination and encouraging unnecessary tests and procedures…
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The [new] system, called global payments, would require doctors, hospitals, and other providers to band together into groups called accountable care organizations that would split the payments and better coordinate patient care, thereby improving quality. These provider groups generally would get a flat per-patient fee, along with incentives for high-quality care, hopefully eliminating the incentive for unnecessary tests and procedures, and encouraging greater focus on preventing serious health problems from developing in the first place.
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But the group, the Committee on the Status of Payment Reform Legislation, will have to agree on a number of contentious issues, such as how much power state regulators will have over the prices paid to providers, the rules for forming accountable care organizations, and whether providers — many of whom profit from the fee-for-service system — will have seats on the board that eventually oversees the potential dismantling of that system…
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Since the summer, the federal government has made it clear that changing how providers are paid is a priority. Medicare next year will give out $10 billion to 100 to 300 sites in the US to test new payment models, and many Massachusetts providers plan to vie for this seed money.
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“What I’ve been hearing from the administration is a bit of a pride issue,’’ said Brian Rossman, research director for Health Care for All, a Boston-based patient advocacy group. “They’re saying, ‘We ought to be the first state to do this.’ They know other states are moving forward as well. But we have always been the pioneer on these issues and we should be first.’’

There are many arguments to be made, millions of words yet to be written, for and against the idea of accountable care organizations. But the giant stinking maggot in the ointment, right now, is that Democratic governor Deval Patrick (aka ‘Obama Lite’) is running against Charlie Baker, aka ‘Mitt Romney Heavy’ — a smiling legacy-GOP glibertarian sociopath with just enough pseudo-charm that most normal people wouldn’t automatically hesitate to get into an elevator alone with him. Since the crown jewel in Baker’s slash-and-burn career came when he was given the chance to turn an excellent, therefore perennially financially struggling, HMO into yet another profit mill where both patients and health care professionals are regarded as unpleasant impediments to the proper financial flow, nothing good will happen if he manages to wrest the chair away from the Dems. And given the recent Scotty “Cosmo Boy” Brown unpleasantness, the chance of this happening cannot be dismissed.

12 replies
  1. 1
    Redshift says:

    I remain hopeful that the elements the Dems put in HCR allowing the states to experiment with what works better will win out over the GOP push to empower the states to do worse.

    But then, I’ve always been an optimist.

    (I’d be more hopeful if we were dealing with an opposition that had any regard for facts, and would actually admit when we get it right. The fact that I’m still hearing callers even to frickin’ NPR blathering about how socialized medicine has never worked and how everyone in those other countries hates it is damn depressing.)

  2. 2
    Culture of Truth says:

    “new system to compensate doctors, hospitals“

    What role do chickens play in this process?

  3. 3
    Crashman says:

    I’m getting Baker’s ads confused with one of the New Hampshire senate candidates, the one with him driving in a humble looking pickup truck and talking about no more deficit spending. They’re everywhere. Can’t I watch my brain-dead TV in peace?!

  4. 4
    Pangloss says:

    a smiling legacy-GOP glibertarian sociopath with just enough pseudo-charm that most normal people wouldn’t automatically hesitate to get into an elevator alone with him

    Me likey.

  5. 5
    4tehlulz says:

    So we get to elect an HMO exec and cripple revenues to the state in the same election.

    yay.

  6. 6
    aimai says:

    Ok, now I’m hyperventilating. You are so right, Annie Laurie, but what can we do? I guess I’d better start responding right now to the Deval Patrick pleas for help.

    aimai

  7. 7
    Davis X. Machina says:

    …he was given the chance to turn an excellent, therefore perennially financially struggling, HMO

    I had HCHP back when it really was a community health plan, ca. 1984.

    I would trade my fairly-close-to-goldplated BC/BS for what I had then in a heartbeat, even if the premiums stayed the same.

  8. 8
    Nied says:

    @Crashman:

    I’m getting Baker’s ads confused with one of the New Hampshire senate candidates, the one with him driving in a humble looking pickup truck and talking about no more deficit spending. They’re everywhere. Can’t I watch my brain-dead TV in peace?!
    Reply

    That’s Hodes’ ad, he’s the D running for NH senate. The ubiquitousness of that hokey add (and the one with the hot dog eating contest), and the fact that I have yet to see an add for Ayotte makes me think Hodes just might have a chance in that race. Now granted I don’t watch very much local TV, but I see that thing at least three or four times whenever I’m watching re-runs of “the Office.”

  9. 9
    JITC says:

    In any system where there are for-profit middle-men (e.g. insurance companies) patients, doctors, hospitals, nurses, et al will LOSE. They are skimming from the system, taking away deserved profits from the people actually providing care and pilfering needed care from patients.

    Quoting Ms. Laurie, ALL insurance companies are

    profit mill[s] where both patients and health care professionals are regarded as unpleasant impediments to the proper financial flow

    There needs to be one single, huge risk pool where risk is actually spread out (even under the MA plan, the risk is divided up across thousands of insurers and then divided up further into internal pools).

    This is inefficient and makes zero economic sense.

  10. 10
    The Raven says:

    “These provider groups generally would get a flat per-patient fee”

    Financial incentive to undertreat. Food!

    But also, this has been tried before. It’s what HMOs do, and it works very badly, though I’m not sure of the details. Maybe Eskow has something on this.

  11. 11
    JCJ says:

    Some of this should be easy. I am a radiation oncologist (radiation treatment of cancer) and I can think of a very clear recent example of how something could be done based on published data. I recently saw an otherwise very healthy 78 year old lady with a recent diagnosis of breast cancer who had undergone a lumpectomy. She was not recommended to take any form of endocrine therapy (tamoxifen or an aromatase inhibitor) due to her overall favorable outlook. Standard treatment from the radiation perspective was thus to treat the breast with radiation to lower the risk of a recurrence in the breast. I recommended a course of treatments with 16 days of treatment. She asked me why afriend of hers who was 81 had 33 treatments. A recent study from Ontario showed no difference in outcome between two different regimens of whole breast radiation when either 16 or 25 treatments. The other 8 treatments were likely a boost dose to the original site of disease. In an 81 year old there would be little if any benefit to this (depending on the surgery done.) As such, a payer could easily make payment for the shorter course only, and then if the doctor or patient felt compelled to pursue the longer course it could still be done. This regimen of 16 treatments cannot be used for every case after breast conserving surgery, but it is certainly an accepted option by leaders in the field of radiation oncology. I get paid less for this, but although I am a whore I am not that bog of a whore.

  12. 12
    lahke says:

    Hey, JITC–

    MA has 3 or four of the best insurance companies in the country (per Consumer Reports), and they’re HMOs with outstanding reps for quality treatment. Add in the fact that in MA they are the only thing standing between you and the voracious maw that is Partners Health Care, and we actually have it pretty good in the Bay state. All our big plans are not-for-profits, we’re getting close to 100% coverage, we’ve had no-recission and no pre-ex condition limit plans for 20 years, and we may actually get to a process that can control costs soon. If we can’t have single payer, this ain’t so bad.

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