Friday, October 29, 2010

The Massachusetts Model: Trailblazing Blueprint

I can never read those things.

"Mass. recasting health payments; Officials draft plans for new system to compensate doctors, hospitals" by Liz Kowalczyk, Globe Staff  |  September 27, 2010

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.

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.

“We have more and more reason to want to move away from this system,’’ Bigby said in a phone interview Friday. “It is not going to be able to support the type of health care system we need. Fee for service is about how much revenue you can get for doing a certain thing or a certain number of things. That’s not how we think about providing health care to people.’’

Bigby’s group is developing a specific plan for switching to a new cost-conscious payment system that would essentially put providers on a budget for each patient’s care. 

Related: The Massachusetts Model: Doctors' Diet

The Massachusetts Model: Office Visit 

Also see: The Massachusetts Model: Municipal Health Mess

A Healthy Insult For the American People

Why can't you have one of those plans, American?

The 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.  

Uh-huh.  

Anything with word global in it makes me sick.  Agenda-pushing liars poisoned the term.

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....

Bigby and other health care executives believe the state is now ready to move forward.

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.  

Yeah, God forbid it go to actual care!

“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.’’  

Those are NOT GOOD QUALITIES to 

Despite the setbacks this year, “momentum for payment reform is growing,’’ agreed Andrew Dreyfus, chief executive of Blue Cross Blue Shield of Massachusetts. Bigby’s nine-member group includes six state government leaders, raising the possibility that government programs like Medicaid could be first to change how they pay doctors and hospitals....   

The poor are always the guinea pigs because they have no power or $ay.

Bigby said her goal is to present the Legislature with a plan for the transition by the end of the year to global payments, which lawmakers could then use to draft legislation....

Rossman said Health Care for All favors the model currently used to oversee the state’s mandatory health insurance law. The Health Connector, which oversees that program, does not include insurance company executives, doctors, or hospital executives, all of whom have a financial interest in the health care system. “That will have to be hashed out,’’ he said.  

That is what is wrong with the system: the PROFIT motive!

Another major issue, said James Roosevelt, president of Tufts Health Plan and a member of Bigby’s group, is how “are we going to deal with the fact that there are providers in the system who are very much the haves and those who are very much the have-nots. Are we going to agree on something that redresses these great differences?’’

Earlier this year, Attorney General Martha Coakley issued a report finding that some hospitals and doctors with market clout are paid twice as much money as others for essentially the same patient care.

Related: The Massachusetts Model: The AG's Amnesia

Looks like the Globe has a touch of it, too.

Bigby said she believes that the future oversight board should “establish a mechanism for addressing’’ the inequalities, but that it should include a way to compensate costly teaching hospitals for expenses such as educating new doctors and keeping burn units on standby.

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Also see: How You Will Pay For Your Medicine
  
Return of the HMOs