Massachusetts health care executives are lobbying the Patrick administration and legislators to move cautiously before embracing a proposal to transform the way hospitals and doctors are paid - a plan one hospital CEO bluntly said is “irresponsible’’ and “sophomoric’’ in its initial form.
Three months after a state commission proposed the bold plan to control exploding health care costs within five years, many hospital executives and doctors call it unrealistic, and say it could bankrupt some providers and compromise patient care if implemented too quickly and without major changes.
Hospital chiefs and physicians have made a flurry of requests for closed-door meetings with legislators, administration officials, and Governor Deval Patrick in recent weeks to lay out their concerns before final legislation is written.
Translation: They are writing it.
Public hearings on the first-in-the-nation proposal, which would essentially put providers on a budget rather than pay them for each procedure, begin this week....
What public hearings?
Both hospital and physician leaders say they favor changing the way providers are paid, to control costs and improve care. But they feel the changes should unfold gradually, and on a voluntary basis at first, starting with pilot programs that provide incentives for providers to adopt the new payment system. A 10-member commission, which included key legislators and members of Patrick’s administration, recommended in July that private and public insurers largely scrap the current fee-for-service system in which insurers pay doctors and hospitals a negotiated fee for each procedure or visit - a system that is widely viewed as encouraging unnecessary and uncoordinated care.
Instead, the commission recommended that insurers pay providers predetermined, per-patient annual fees, called global payments, which would cover all of a patient’s medical care during the year.
Anything with the WORD GLOBAL IN IT I don't like!!
And WHAT IF YOU ACTUALLY GET SICK and have a COST OVERRUN?
Government just gonna PAY THAT like they do the WAR LOOTERS?
Doctors and hospitals would have to form larger groups, called accountable care organizations, that would provide most of the care for individual patients and divvy up the payments. The change would mean that hospitals and doctors are at greater financial risk if their patients need a lot of expensive medical care - a risk now borne mostly by insurers.
Oh, this is ALL ABOUT INSURING INSURANCE INDUSTRY PROFITS!!!!
There’s also greater risk that patients would be denied necessary but very costly care, as some patients experienced during the early 1990s under a similar payment method called capitation.
So this is NOT EVEN a NEW IDEA, it is a FAILED, OLD IDEA!!!!
Nice work, Massachushitts!
This is your NATIONAL MODEL, readers?
So such a system would need close monitoring, the commission said, as well as ways to reward doctors and hospitals who provide high-quality care. Many health care executives are skeptical, however, whether extra payments for providing superior care will be enough to ensure patients get all needed treatment. The commission wants to make this dramatic change statewide within five years, but it did not agree on the details, leaving legislators to decide key issues this fall, such as whether a transition to global payments would be voluntary or mandatory and whether the state would provide significant financial incentives to doctors to form larger groups. Lawmakers and the administration will need support from providers to make any new system work well....
So WHERE DOES the PUBLIC -- you know, the ones this is SUPPOSED TO BE ABOUT, fit in?
A number of commission members, however, including state Senator Richard Moore, Democrat of Uxbridge, and state Representative Harriett Stanley, Democrat of West Newbury, initially had pushed for quick action, saying that the need to rein in health care costs is urgent, with medical spending growing by more than 8 percent annually.
Single payer. Excise the middleman who does nothing but take profits out of health monies.
Moore said through a spokesman that he did not want to comment on providers’ concerns until after the public hearing on Thursday. Stanley would only say that “it’s still a work in progress.’’
********************
The hospital association wants legislators to include health care providers on the oversight board; shield providers from financial risks they can’t control and don’t have reserves to cover, such as a swine flu outbreak; change insurance plans so that patients are encouraged to stay within their accountable care organizations for all of their medical needs; provide extra compensation for providers who treat low-income patients and for teaching hospitals that have extra costs associated with training residents, research, and 24-hour trauma services; and offer incentives for providers to jump in and test the global payment system....
Sounds like RATIONING to me!
Also see: Partners in Looting
Swapping Partners Good For Health
So the TAXPAYER is going to UNDERWRITE the PRICE-GOUGING INSURANCE COMPANIES PROFITS, 'ey? And this is going to GO NATIONAL?
Another complicating factor for legislators is that there is also disagreement among providers on key issues. Some hospitals, particularly those that belong to the Partners HealthCare system, have been able to negotiate fees that are significantly higher than those paid to their competitors.
Yeah, THAT IS WHY COSTS are WAY, WAY UP!!!!
And THEN they GAMBLED IT AWAY and LOST the MONEY!!!
Related: The Boston Globe Shuts Off Its Spotlight
Yeah, that last link is interesting, isn't it?
Paul Levy, head of Beth Israel Deaconess Medical Center, is worried that those higher fees will merely be transferred to a new system, cementing current inequities. “Everyone should have the same global payment,’’ Levy said. “Otherwise you’ll still have the Partners hospitals making 30 percent more and they’ll be embedded forever.’’
--more--"Why wouldn't the Glob trumpet their award-winning report, readers?
"State plan may place limits on patients’ hospital options" by Liz Kowalczyk, Globe Staff | October 11, 2009
Yup, but WHEN THEY SOLD YOU this RIP-OFF it was DON'T WORRY, you can see who you want, where you want, blah-blah! Turns out it was ONCE AGAIN MSM and GOVERNMENT LYING TO YOU, Bay-Stater!
The state’s ambitious plan to shake up how providers are paid could have a hidden price for patients: Controlling Massachusetts’ soaring medical costs, many health care leaders believe, may require residents to give up their nearly unlimited freedom to go to any hospital and specialist they want.
Doesn't that MAKE YOU ANGRY, Bay Stater?
HOW MANY MORE LIES are you willing to take?
You are being SO RIPPED OFF by this "SUCCESS" of a MODEL!
BEWARE, AmeriKa, the MASSACHUSHITTS MODEL COMES FOR YOU!!!!
Efforts to keep patients in a defined provider network, or direct them to lower-cost hospitals could be unpopular, especially in a state where more than 40 percent of hospital care is provided in expensive academic medical centers and where many insurance policies allow patients access to large numbers of providers.
Ya think? And WE ARE NOT IN A GOOD MOOD to begin with!
But a growing number of hospital officials and physician leaders warn that the new payment system proposed by a state commission would not work without restrictions on where patients receive care - an issue some providers say the commission and the Patrick administration have glossed over....
That is what they do with everything here.
A state commission recommended in July that insurers largely scrap the current fee-for-service system - in which insurers pay doctors, hospitals, and other providers a negotiated fee for each procedure and visit - and instead pay providers a per-patient annual fee to cover all of the patient’s medical care. This new system of “global payments’’ would discourage overuse of expensive medical services, force providers to live within a budget, and improve coordination of care for patients, supporters argue. There is little doubt that the state’s current system of broad choice and sometimes uncoordinated care has helped push Massachusetts health care costs above the national average.
Yeah, because PARTNERS is F***ing us!!
It can lead to unnecessary duplication of medical tests, when patients see multiple providers, each often unaware of what the others have done. And thousands of residents get knee replacement surgery, have babies at teaching hospitals, or other care, when often a less-expensive hospital would be more economical and provide good-quality care....
The Massachusetts proposal would involve a more ambitious restructuring of health care than any of the cost-cutting ideas being discussed in Washington. Under a global payment system, doctors, hospitals, nursing homes, and other providers would form large networks, called accountable care organizations, that would provide most of the care for individual patients and divvy up the payments. Doctors would try to coordinate patients’ care within these networks, which would share electronic medical records and treatment plans. And to manage costs, they would try to direct patients to the hospital within the network that could provide good-quality care at the lowest cost, while generally using teaching hospitals for advanced care.
Translation: The RICH and WELL-CONNECTED will GET the BEST CARE and YOU will be shuttled of for more "low-cost" care, average person.
The release of the report sparked a lobbying campaign by Massachusetts health care executives, who are urging Governor Deval Patrick’s administration and state legislators to move cautiously because they fear a new payment system could bankrupt some providers and compromise patient care. Many changes recommended by the commission would have to be approved by the Legislature before being put in place. In its report, the commission, which includes high-ranking Patrick administration officials and legislators, said patients wouldn’t necessarily be restricted to providers within their primary care doctor’s accountable care organization. And, during a hearing at the State House Thursday, Dr. JudyAnn Bigby, secretary of Health and Human Services, said “the people benefiting from the new system should not even notice it.’’
This state is something else. Yeah, we don't notice the tax increases and the lootings. Too busy eating liberal government and MSM s***.
Writing in the New England Journal of Medicine last month, staff writer Dr. Robert Steinbrook said the state commission failed to address the choice issue head-on. Global payments would save money only if networks “limited the volume of services, and denied certain requests from patients and providers,’’ among other measures, he wrote. “Since patient choice is such a sensitive issue, the commission waffled.’’
But Sarah Iselin, head of the state Division of Health Care Finance and Policy and cochair of the payment commission, said the panel understood the importance of addressing the effect of its recommendations on patient choice, but “felt these issues could be figured out’’ later by a board that would be created to oversee the transition to a new payment system.
That is HOW WE GOT INTO this MESS!!!!
The commission recommended that all residents choose a primary care doctor, because many patients will listen to their doctor’s recommendations about where to get care, she said. Under global payments, those doctors would have an incentive to refer patients within their organization. And, she said, educating patients about low-cost, high-quality providers also will play a major role, and may preclude the need for forced restrictions on choice. “Over time, patients may very well be inclined to go there all by themselves,’’ Iselin said. Even if patients continue to seek basic care at teaching hospitals and go outside their doctors’ networks, she said, global payments have the potential to save money in other ways. The state estimates, for example, that reducing preventable hospital stays and emergency room visits would save $1 billion a year.
By REIGNING IN PARTNER'S OVERCHARGES?
But Lynn Nicholas, president of the Massachusetts Hospital Association, pointed out that even saving money in these areas requires more coordinated care. One way to address the issue and still give people choices, she said, is for insurers to offer plans that charge higher premiums for unlimited access to providers, and lower premiums for members willing to stay within a defined network.
You know what?
See: No Choice But Single Payer
PICK a COUNTRY and PICK a PLAN!!!!!
Many insurers offer these types of limited networks now - premiums are about 15 percent lower than in plans with unlimited access - but they haven’t been popular among employers and employees. Nicholas said that may be because the financial incentives to join plans with limited networks aren’t strong enough. She wants providers, insurers, and employers to work together to develop benefit programs that will encourage patients to stay within limited networks.
Feels like FASCISM to me!
Another way to cut the cost of academic medical centers is to reduce the prices they are paid. In an analysis done for the state this summer, the RAND Corporation estimated Massachusetts could save $1.3 billion to as much as $18 billion over 10 years if teaching hospital payments for certain conditions were set at average community hospital rates, depending on how many conditions are included.
Do we HAVE a PARTNER there, Glob?
It’s unclear whether the Legislature or the board that would oversee the new payment system would embrace such a controversial change. But the payment commission recommended that the board address in some way the issue of hospitals being paid vastly different amounts for similar care.
Why is that SPOTLIGHT OFF, Glob?
During her testimony, Bigby, the state Health and Human Services secretary, said that in the transition to global payments, “we must be careful . . . not to enshrine the inequities that exist in the current system.’’
Don't want it then.
--more--"
Well, at least they are protecting your privacy....
The largest health insurer in Massachusetts is warning roughly 39,000 physicians and other health care providers in the state that personal information, including Social Security numbers, may have been compromised after a laptop containing the data was stolen in August from an employee of the Blue Cross and Blue Shield Association’s national headquarters in Chicago....
Blue Cross-Blue Shield affiliates across the country typically feed updated personal information about health care providers weekly to the Chicago headquarters for a national database that helps patients locate a provider outside their local health plan’s service area. It is information used to build this database that was stolen....
Yup, they NEVER MET a DATABASE they didn't like.
--more--"
Related:
- The Massachusetts Model: Working Or Not?
- The Massachusetts Model: Comes At a Premium
- The Massachusetts Model: Screwing Small Business
- The Massachusetts Model: Going Out of Business
- The Massachusetts Model: Crazy Coverage
- The Massachusetts Model: Immigrant Insult
- The Massachusetts Model: Profit and the Paycheck
- The Massachusetts Model: Doctors' Diet
- The Massachusetts Model: By the Numbers
- The Massachusetts Model: Treasurer's Assessment
- The Massachusetts Model: Care-Keeping Costs
- The Massachusetts Model: Mass. Hospitality
- The Massachusetts Model: Lessons Learned
- The Massachusetts Model: Non-Compliant Complacency
