"A healthcare system badly out of balance; Call it the 'Partners Effect:' Elite hospitals are paid much more for care that is often no better than average. It is the best kept secret in Massachusetts medicine
This story was reported by Globe Spotlight Team members Scott Allen, Marcella Bombardieri, Michael Rezendes, and editor Thomas Farragher, as well as Liz Kowalczyk and Jeffrey Krasner of the Globe staff. It was written by Allen and Bombardieri.
.... Call it the best-kept secret in Massachusetts medicine: Health insurance companies pay a handful of hospitals far more for the same work even when there is no evidence that the higher-priced care produces healthier patients....
They are the SPECIAL INTERESTS Dr,. Paul talks about!!!
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This payment pattern has become a driving force in the state's galloping healthcare costs, and it raises hard questions about why certain hospitals and physicians receive premium pay for care that is no better than that of their competitors. Until now, the growing pay gap has not been subject to public scrutiny because contracts between insurers and hospitals typically include confidentiality agreements. But an ongoing Spotlight Team investigation of healthcare in this state found scores of payment disparities for routine procedures in which there is no obvious difference in quality....
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The dramatic payment gaps have emerged over the last decade as hospitals pushed, with varying levels of success, to offset federal budget cuts by boosting their income from insurance companies, health executives say. The resulting wide range of payments for the same services reflects a healthcare system in which deregulation and lax government oversight have allowed the hospitals with the most clout to extract big increases from insurers while everyone else falls behind....
Maybe it is time to DUMP the DAMN PROFIT MOTIVE in MEDICINE, huh?
Health insurance premiums paid by the average Massachusetts family have jumped 78 percent since 2000, and Charles Baker, president of the state's second-largest health insurer, Harvard Pilgrim Health Care, believes that a significant portion of the rise has been driven by hefty insurance payment increases to dominant providers, who use the extra income to install the latest technology and expand, often on rivals' turf.
At the same time, the pay gap undermines less powerful hospitals, whose officials say that they steadily lose doctors to those that can pay more, and that they constantly struggle to keep pace with advances in costly medical technology. For instance, while Mass. General is spending $686 million on the single most expensive hospital expansion in state history, the state's second-largest hospital chain, Caritas Christi, had to borrow money this year to pay for basics, like oxygen tanks....
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A powerful hand
Most patients don't think about the payments their insurance company makes to hospitals and doctors, but they should: Inflation of those payments is the main reason insurance premiums increased by an average of $1,800 per family during this decade. More than 85 cents of every dollar in insurance premiums goes to pay the bills in hospitals, doctors' offices, and other medical facilities.
Which means 15% goes for administration, etc? That's WAY TOO MUCH!!!!
Five years ago, those bills were rising mainly because of growing patient demand for care, Blue Cross data shows, but now the escalating prices that hospitals and doctors charge is far more important. A recent Massachusetts study concludes that the price of inpatient care at hospitals is rising by 10 percent a year, while overall use of hospital beds is declining. The hospitals that are paid at the highest rates all share one trait: They have the bargaining clout to demand higher insurance payments. Often, that clout is based on a powerful brand name and elite reputation....
The other source of bargaining power is geographical isolation. Sturdy Memorial Hospital in Attleboro, for example, commands high insurance payments for outpatient procedures because local residents have no convenient alternative, insurance executives say.
But no company has thrived more in this sharply competitive world - or has had more impact on the cost of medicine here - than Partners HealthCare, a company formed in 1994 to fight back against what its founders saw as the stinginess and lopsided power of insurance companies, which had brought many hospitals to their knees. By bringing together two of the most prestigious hospitals in Boston - the Brigham and Mass. General - Partners became what some called the "800-pound gorilla" of Massachusetts healthcare, able to bend insurers to its will.
Almost from the start, Partners played its powerful hand with conspicuous - rivals would say relentless - aggression and skill. No other city can boast two of the top 10 hospitals on US News and World Report's honor roll, and every insurance company is vividly aware that its members want access to their famed halls.
Partners' dominance became clear in 2000, when executives of Tufts Health Plan had the temerity to refuse Partners' demand for a substantial rate increase. Partners countered by declaring it would no longer accept Tufts insurance at its hospitals. Within days, as thousands of Tufts customers threatened to change insurance rather than lose the right to treatment at the two famous hospitals, Tufts gave in to Partners' demands. Since then, Partners has negotiated one big pay increase after another from insurance companies fearful of a similar humiliation....
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That willingness to get tough turned Partners' main insurance contracts from money losers a decade ago to the company's largest source of profit, Partners officials say. Extrapolating from Partners' internal tally of its insurance revenues, the Brigham and Mass. General receive at least $500 million a year more from the three biggest insurers than if they were paid at the lower rates typical of their rivals.... Altogether, those higher rates add up to at least $800 million more for Partners hospitals and doctors than if they were paid at rates similar to competitors, based on Partners' insurance income....
Take the damn profit out! They don't care about the patients; they care about how much loot they can EXTORT!
Partners officials reject the idea that their insurance payments have driven up healthcare costs significantly, arguing that costs in Massachusetts are part of a national problem and not caused by any one company. They note that insurance premiums here are rising at about the same rate as the national average. "Boston is experiencing the same premium increases as the rest of the country," Partners said in a prepared statement to the Globe....
Yeah, everyone else is a thief, so you might as well be, too, huh?
Partners' favorable insurance contracts have helped the company to reap $1.7 billion in profits since 2004, reflecting a profit rate that is average compared with the nationally known hospitals the company considers its peers. But it's high by Massachusetts standards: Partners collected 35 percent of statewide hospital profits last year, even though it owns only 16 percent of the beds.
Those earnings have allowed Partners to launch a five-year $4 billion construction program that includes the addition at least 180 new hospital beds and several outpatient facilities. Though the current recession is expected to slow expansion considerably, Partners officials say it won't affect projects already underway.
Yup, no credit crisis for them.
While Partners prospers, 24 Massachusetts hospitals are losing money. Many of them would be profitable if they had even a fraction of Partners' contract clout. Caritas Norwood Hospital, for instance, could erase the $242,347 deficit it reported through the third quarter of this fiscal year if the hospital were paid Partners rates for the babies it delivers. Instead, the hospital is losing money and bracing to lose more next year, when Partners opens a new outpatient center at Gillette Stadium in Foxborough.
"Some are able to spend more than others," said Jack Connors, Partners' longtime chairman of the board. "It's our fortune that we're probably in the lead on those investments. And several hospitals aren't able to keep that pace. And that's what I, as a businessman, call market forces, if you will."
Well, let's TAKE the MARKET OUT then!!!!!!
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One reason patients don't shop for care is that, as a practical matter, they can't.... Partners officials say that they don't know exactly how their pay compares to others, though they know they are paid more. That added revenue is going for good purposes, they say, such as research and doctor training. Insurance profits also subsidize unprofitable lines of business, such as psychiatric care and the burn units at the Brigham and Mass. General. In addition, Partners employs 50,000 people, more than any other private company in Massachusetts.
Excuse me, readers. I have to go to the hospital; someone has been blowing smoke up my ass.
Partners officials also say they are building a massive integrated system that could become a model for how to reduce errors and waste. The company's computer networks, for example, will eventually be used to bar-code every single pill, so that each can be double-checked at bedside....
Holy shit!! BAR-CODE the PILLS? Hello, George Orwell!!!!
State health officials have tried to encourage women like Karen Dahl, 31, who lives less than 2 miles from Mount Auburn Hospital in Cambridge, to reconsider their flight to Boston, pointing out in a 2003 study that community hospitals are generally just as reliable as teaching hospitals for normal births. In fact, they had a slightly lower complication rate - and they're a lot cheaper. Dahl's care cost $8,282.14 at the Brigham, while the cost at Mount Auburn would have been about $5,700, according to state insurance data....
But we got money for tv ads and Hollywood and corporations, etc, etc.
Massachusetts patients love brand name medicine, going to teaching hospitals 2.5 times more often than patients across the country, according to a 2005 report for the Massachusetts Council of Community Hospitals. It is a habit that carries a heavy cost: We spend about $1.7 billion more per year than we would using community hospitals at the national rate. Partners' Lee, a cardiologist who still sees patients in addition to his management job, argues that patients are voting with their feet.
"There's a very fair question of can we afford that as a society, but there's no question in our market that people want this," Lee said. "I have people come and see me from New Hampshire and Rhode Island for their blood pressure, and I tell them, 'You don't need to come here,' and they say, 'But I want to,' and I think they're sometimes offended because I'm trying to chase them away."
The growing dominance of Partners - and Children's Hospital for pediatrics - is a microcosm of the national trend in the last 15 years, as government has increasingly allowed the market to decide what healthcare will be available and at what price. Hundreds of unprofitable hospitals closed, while many others merged to gain more negotiating power with insurance companies, which, by the mid-1990s, were aggressively denying claims and shortening hospital stays to hold down costs.
Take a look at what National Helath Care will do for you, America!
The balance of power between insurers and providers did need to shift. But the realignment has had costly side effects: After a decade of stable insurance rates in the 1990s, medical inflation began to soar across the country, something economists attributed partly to the increased clout of merged healthcare systems like Partners. And healthcare specialists agree that the price run-up did not lead to a similar improvement in quality....
Paying MORE for LESS!!!!
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At Caritas Norwood Hospital, where he scrubbed floors as a teenager, Dr. Adam Glasgow said it's unfair that the Brigham and Mass. General make so much more for some procedures, even factoring in the expense of teaching and research. "We're doing the same work," said Glasgow, a surgeon. "It doesn't make any sense for that institution and that physician to be paid more for doing the same work. It just drives up the cost of healthcare. It's unfair, and it's unnecessary." --more--"
But CUI BONO?
Of course, look at how the pro-pharmaceutical treats people who take their care into their own hands:
"Through website, patients creating own drug studies" by Carolyn Y. Johnson, Globe Staff | November 16, 2008
Online social networks, blogs, and homemade videos have, for better or worse, created user-generated upheavals in a variety of industries, propelling information forward ever faster....
What's with the insult, MS? Oh, yeah, the web is kicking your ass!
There are downsides to trying unproven treatments and looking to individual experiences for medical advice. The course of a disease can vary widely between individuals, making it difficult to disentangle the many factors - including a new drug - that might influence its progression. There are also risks to taking drugs when they have not been fully vetted by clinical studies.
You mean like the POISON the FDA APPROVES? Pffft!
Karen Felzer, a seismologist who jointly initiated the online lithium study because her father suffers from the disease, also known as ALS, or amyotrophic lateral sclerosis, for example, said her father stopped taking lithium this summer because it didn't seem to help and had side effects.
Dr. Merit Cudkowicz, ALS clinical director at Massachusetts General Hospital, cites the example of minocycline, an acne drug that some preliminary data had suggested might benefit ALS patients. Later, she said, a study showed that the drug accelerated the disease. "The bottom line is we have to do these studies that have a comparison group - and they do take a long time to start up," Cudkowicz said. "I can see [the frustration], as someone who cares for patients with ALS."
Yeah, but listen to those drug authorities as they try to shovel the shit down your throat!!!!!!
Even so, she said, there are no short cuts. To develop more treatments will require studies in which patients are randomly and blindly assigned to a group taking either treatment or placebo. Cudkowicz and others will soon begin recruiting patients for such a trial of lithium in ALS patients.
But for now, the biggest set of data available on lithium use by ALS patients comes from the reports on PatientsLikeMe.com. So far, the data - which are still being gathered - indicate that the drug is considerably less effective than indicated by the Italian study, published in the journal the Proceedings of the National Academy of Sciences. While that discovery has been disappointing, the online reporting is still useful, say its backers.
Yeah, but SOMEBODY made BUKU $$$$ off it!!!!
A drug such as minocycline was taken for years while patients waited for the clinical trial that eventually showed it could actually harm them, said James Heywood, cofounder of PatientsLikeMe. But less than a year after the Italian lithium study was published, "we now have data in our system on over 100 patients who have been on a drug long enough to demonstrate the hope of that drug was not what was originally assumed - and that means thousands of patients won't take it."
You know what? KEEP YOUR FRIKKIN POISONS and POTIONS, 'kay?!!!
