Enjoy your model, America!
"With profits down, future of Mass. hospitals questioned" by Robert Weisman | Globe Staff, September 08, 2012
As they brace for an era of shrinking government funds and mounting pressure to cut prices for medical services, Massachusetts hospitals face growing financial strains.
Two dozen — more than a third of the state’s total — lost money last year, including rural community hospitals, urban safety net hospitals, and even affiliates of renowned academic medical centers, according to a new report from the Division of Health Care Finance and Policy.
Among the biggest money losers were Boston Medical Center, which posted a $25.1 million deficit, Steward St. Elizabeth’s Medical Center in Brighton, which lost $20.9 million, and Quincy Medical Center, which was $18.5 million in the red.
Related: Boston Medical Center expects profit for 2012
But profits are do.... I think I'm going to be sick.
The industry’s performance was worse than in 2010, when 16 hospitals posted losses, and in 2009, when 13 were unprofitable. Overall, profit margins for the state’s 65 acute care hospitals fell to a razor thin 2.1 percent in 2011, compared with 2.6 percent the prior year, the state report said.
Those numbers provide a financial snapshot of a health care market that was scrambling to adjust to rapid changes even before the Massachusetts Legislature passed a law this summer designed to rein in soaring medical costs.
With the state’s intensified focus on affordable care and additional cuts projected for Medicaid and Medicare, the government health insurance programs for low-income residents and seniors, the future of many hospitals across the state is uncertain. In some cases, their survival may be in doubt....
Get 'em to inten$ive care, $tat!
But unlike an earlier period of consolidation in the 1980s and early 1990s — when dozens of small hospitals were shuttered — Massachusetts health care leaders say a more likely scenario this time will be for hospitals to specialize in some services, abandon others, and join integrated networks to strengthen their financial foundations....
Smaller medical centers have fewer resources and less clout in negotiating payments with insurers. Some are buckling under the weight of mounting pension liabilities.
Nothing about excess executive and administrative salaries.
In addition, hospitals are being pressured by state government and commercial health plans to reduce costs by conducting fewer imaging tests and lowering the number of patients treated in emergency rooms. Under the traditional fee-for-service payment contracts many hospitals still have with insurers, however, they aren’t rewarded for those money-saving steps....
But the biggest economic factor for many hospitals, especially those serving low-income communities, is Medicaid funding cuts....
Oh, government subsidizes the bottom line?
--more--"
I know $omeone is making a profit:
"Partners’ financial health turns on complex plans; Investments, debt key to results" by Beth Healy | Globe Staff, October 10, 2012
When Partners HealthCare, the big Boston hospital group, announces its financial results each quarter, what often stands out are not the gains and losses for providing medical services. It’s the investment and debt portfolios.
With $7.5 billion in assets under its watch — more than at most community banks — Partners feels the swerves of the stock market in a big way. And there’s another significant factor in the quarterly swings: a complex hedging strategy on Partners’ debt. Together, these are often the tail that wags the dog....
Oh, the BANKERS at the BOTTOM of ANOTHER American institution? I think somebody better call me an ambulance.
In the first three months of 2012, a $127 million gain on financial instruments helped offset a big write-off for old computer systems that nearly wiped out all the operating earnings.
There are two components of Partners’ large quarterly swings: the investments and a separate category called swaps. These are like insurance on the hospital group’s $3 billion in long-term debt, to guard against rising interest rates. Partners uses swaps to hedge about one-quarter of its debt — bonds it sells to borrow money for new facilities and to renovate medical buildings.
Is that really a healthy business strategy?
Swaps became hugely popular among hospitals, universities, and other big borrowers in the mid-2000s. They offered a way for institutions to take advantage of historically low variable-rate debt, without taking on too much risk. In one instance, Partners says, it locked in a low variable rate, and even with the cost of the hedge is paying 4.6 percent on the debt, versus the 5.5 percent it would have paid on fixed-rate bonds.
Related: Massachusetts Democrats Keep Making the Same Mistakes
See what swaps can do to you? See who $old them to you?
“This was a very popular strategy,’’ said Moody’s hospital analyst Daniel Steingart. But it has dropped off significantly since the financial crisis, when swaps backfired and proved costly for the likes of Harvard University.
UPDATE:
"Partners HealthCare lost $57 million on investments in interest rate swaps"
Yeah, but, you know.... it's fine for the financial health of an insurance company.
They were costly mainly for those who sold, much like selling a stock at the bottom of the market. For those who have held on, like Partners, there have been paper losses but not permanent ones.
There is a difference?
In a way, the statement is quite fascinating. It's the reporter admitting that the monetary system is really a piece of shit. The only reason it is not permanent is because Partners charges 3x the cost of services than other insurers due to its market $hare and clout with the $tate.
But with interest rates falling in a struggling economy, there has been a cost to owning these instruments. Partners has had to post collateral on the swaps from time to time, essentially handing to the bank, for safekeeping, the sum it would owe if it did have to terminate the swaps early. Partners had $116 million in collateral posted on Sept. 30, and it has at times been higher than that since 2008.
Do you feel safe with your money in any bank these days, American?
And the bank gets to play with the money, huh?
But even with $1 billion in swaps, Steingart said, Partners is within the norm for hospital groups of its size....
Yeah, everything is just fine.
--more--"
Remember that article the next time Partners calls for service cuts and fee increases, and then check their portfolio.
Related: Mass. approves Partners, Neighborhood Health deal
Partners earnings rose more than 33 percent in 2012
I know it makes me feel good that a healthcare institution is in the stock market and hedges debt.
Of coure, as a non-profit Partners pays no taxes.
"Investments, donations put Partners in black" by Steven Syre | Globe Staff, February 15, 2013
Partners HealthCare Systems Inc. of Boston earned $84 million in its most recent fiscal quarter despite a large one-time expense for reimbursements to the federal government.
On an operating basis Partners posted a $12 million loss over the last three months of 2012, but offset that with gains from its investment portfolio and philanthropy to end the period positively.
However....
What, Boston Globe?
--more--"
What financial pressures are they complaining about?
Of coure, as a non-profit Partners pays no taxes.
"Investments, donations put Partners in black" by Steven Syre | Globe Staff, February 15, 2013
Partners HealthCare Systems Inc. of Boston earned $84 million in its most recent fiscal quarter despite a large one-time expense for reimbursements to the federal government.
On an operating basis Partners posted a $12 million loss over the last three months of 2012, but offset that with gains from its investment portfolio and philanthropy to end the period positively.
However....
What, Boston Globe?
--more--"
What financial pressures are they complaining about?
Someone else suffering:
"Medical debt still problem in Mass.; Scant change since passage of ’06 health law" by Chelsea Conaboy | Globe Staff, September 10, 2012
Architects of the pioneering 2006 Massachusetts health law, which required most residents to have insurance, expected it would reduce families’ medical debt. But the most recent data suggest the scope of medical debt has remained largely unchanged.
Why am I not $urpri$ed at that diagnosis?
Temporary lapses in insurance coverage and increasingly common plans with high deductibles and copayments have contributed to medical debt, leaving some people struggling to pay bills for hospitals, doctors, and ambulance companies. Rising health costs and the recession also probably played a role.
Translation: the health corporations moved costs to you.
Why am I not $urpri$ed at that diagnosis?
Temporary lapses in insurance coverage and increasingly common plans with high deductibles and copayments have contributed to medical debt, leaving some people struggling to pay bills for hospitals, doctors, and ambulance companies. Rising health costs and the recession also probably played a role.
Translation: the health corporations moved costs to you.
Although the law has failed to cut medical debt, some analysts say it may have prevented an increase in Massachusetts....
Not for long, if it ever did. That argument above is akin to Obama's nonsense about the stimuloot mitigating the effects of the Grand Depression.
Not for long, if it ever did. That argument above is akin to Obama's nonsense about the stimuloot mitigating the effects of the Grand Depression.
Consumer advocates say the state’s experience points to the need for even stronger patient protections if the national law, the Affordable Care Act, is going to reduce burdensome health debt, as intended.
Turns out the Massachusetts model really sucks.
“The 2006 law didn’t eliminate medical debt by a long shot,” said Matt Selig, executive director of Health Law Advocates in Boston, whose office has worked in recent years with hundreds of Massachusetts residents with medical debt. “It’s an underappreciated problem.”
Not when you are the one looking at the bill after opening the envelope.
Turns out the Massachusetts model really sucks.
“The 2006 law didn’t eliminate medical debt by a long shot,” said Matt Selig, executive director of Health Law Advocates in Boston, whose office has worked in recent years with hundreds of Massachusetts residents with medical debt. “It’s an underappreciated problem.”
Not when you are the one looking at the bill after opening the envelope.
--more--"
Nobody buying hungry me a free meal.
And a visit to the doctor's office cost how much?
"A hospital fee, minus the hospital" by Liz Kowalczyk | Globe Staff, January 27, 2013
This practice is common and has become more widespread in the past several years as hospitals across the United States buy up physician practices in the community. Now, facility fees for off-site care are drawing scrutiny from Medicare, some insurers, and consumers, who say that they are unfair and that hospitals are collecting more revenue and driving up health care costs.
“We’re trying to save money in our system and now we’re generating additional costs to the consumer,’’ said Dr. Paul Hattis, a member of the Health Policy Commission that oversees implementation of Massachusetts’ new health cost-control law. He said the panel should examine the issue.
That's Massachusetts!
That's Massachusetts!
The federal Medicare program, which covers 47 million people and is under pressure to cut costs, is taking a look at the practice. An independent agency that advises Congress concluded last year that the charging of facility fees at hospital-owned medical practices is costing Medicare millions of dollars a year. For a 15-minute office visit, for example, the federal health insurance program paid $44 more at a hospital-owned office in 2011 than at an independent office. Medicare patients pay more too: Their share of the bill for this standard visit was $11 more when they went to a hospital-owned office.
The facility fee can cause an even larger difference for some procedures, the Medicare Payment Advisory Commission found. Laser eye surgery, for instance, costs Medicare 90 percent more — $738 — in a hospital-owned facility than in an independent doctor’s office.
The advisory panel is recommending changes that would require Medicare to pay a single rate for a variety of medical procedures performed by doctors and for basic office visits, regardless of the site.
David Spackman, Lahey’s general counsel, pointed out that Medicare permits hospitals to bill facility charges for care in a physician’s office as long as they inform patients in advance....
Health care and insurance is nothing more than a big cash cow, folks.
Many doctors’ practices are losing money and would be forced to close if a hospital did not step in to support them, said Timothy Gens, general counsel for the Massachusetts Hospital Association. “One of the greatest challenges for hospitals is to find the resources to subsidize physician practices so they stay in their communities,’’ he said, explaining that facility fees help pay for technology and staff and meeting regulatory requirements in these offices.
Maybe they should make some investments in debt swaps and stuff.
Insurers have long paid facility fees for care that occurs in a hospital to help cover overhead costs. Eliminating these fees for hospital-owned off-campus practices can be hard, because hospitals do the billing and often do not indicate where the patient was treated. Insurers — and consumers — also are charged facility fees for care at outpatient surgery and urgent care centers that are in hospital-owned networks. Partners HealthCare and Steward Health Care, two large hospital networks, said they charge facility fees at some doctors’ offices....
Why does that not surprise me?
Health care and insurance is nothing more than a big cash cow, folks.
Many doctors’ practices are losing money and would be forced to close if a hospital did not step in to support them, said Timothy Gens, general counsel for the Massachusetts Hospital Association. “One of the greatest challenges for hospitals is to find the resources to subsidize physician practices so they stay in their communities,’’ he said, explaining that facility fees help pay for technology and staff and meeting regulatory requirements in these offices.
Maybe they should make some investments in debt swaps and stuff.
Insurers have long paid facility fees for care that occurs in a hospital to help cover overhead costs. Eliminating these fees for hospital-owned off-campus practices can be hard, because hospitals do the billing and often do not indicate where the patient was treated. Insurers — and consumers — also are charged facility fees for care at outpatient surgery and urgent care centers that are in hospital-owned networks. Partners HealthCare and Steward Health Care, two large hospital networks, said they charge facility fees at some doctors’ offices....
Why does that not surprise me?
Consumers should at least know ahead of time if they are going to have to pay a facility fee, said Eric Linzer, spokesman for the Massachusetts Association of Health Plans. Eventually providers and insurers will have to make detailed price information, including facility fees, available to consumers under the state’s new cost-control law....
I have to tell you, a sick person doesn't want to be bothered with all that s***. Why can't you just go and get the operation or whatever like all the other countries with a good, decent, single-payer system that actually cares about people and not profits?
I have to tell you, a sick person doesn't want to be bothered with all that s***. Why can't you just go and get the operation or whatever like all the other countries with a good, decent, single-payer system that actually cares about people and not profits?
--more--"
"Insurers say health spending on rise in Mass." by Robert Weisman | Globe Staff, February 08, 2013
WALTHAM — Despite more modest increases in recent years and a state push to hold down costs, the message from health insurance executives gathered here Thursday for a market outlook seminar was clear: Massachusetts health spending is heading up in 2013.
Representatives from the state’s nonprofit health plans as well as national for-profit insurers doing business in Massachusetts estimated the “medical cost trend,” a key industry measure, will climb between 6 and 12 percent this year — higher than last year’s cost bump and more than double the 3.6 percent increase set as a target in a state law passed last year.
Medical cost trend is a mix of what doctors and hospitals bill insurers for care and the volume of services and procedures performed. Over the past five years, health care providers have come under pressure from payers and state officials to charge less, while many people have postponed elective surgeries and other care in a weak economy.
That's me.
The new projections of accelerating costs are a sobering sign those moderating trends may be fading. The market outlook was discussed at an event hosted by the New England Employee Benefits Council, a trade group for insurance brokers and company benefits managers.
Premium rates charged by insurers to employers and individuals can sometimes be lower than the overall cost trend, especially when businesses shift costs to workers through higher deductibles or copays. But generally, the cost trend and premiums run in tandem.
“If trends are going up, premiums are going up,” said Eric Swain, vice president of sales and account management for UnitedHealthcare of New England.
Among the cost drivers cited by executives were an improving economy where more people have insurance and can afford to pay for care, the influenza outbreak in Massachusetts this winter, a continuing rise in obesity, the impact of new taxes and rules under President Obama’s health care overhaul, and anticipated further cuts in Medicaid and Medicare, the government health insurance program for low-income and older residents.
Yup, you are driving up the cost of care by accessing it, so don't! As for the other things, maybe it's all true; however, I am sick of s*** excuses. I'll bet none of those guys are hurting for health care or worrying about the bill.
Speakers at Thursday’s event weren’t in complete agreement. While all said costs will be climbing this year, Massachusetts nonprofit executives said they expected a 6 to 8 percent boost in the trend, while the national carriers said the increase would range from 7 to 12 percent.
But the outlook was not completely grim. Speakers said alternative payment models, which give providers fixed budgets for patient care rather than paying them for each visit and procedure, are becoming a larger part of their businesses — and helping them to better manage expenses.
It's also known as RATIONING, something you were told wouldn't be part of the treatment.
“These aren’t pilots,” said Dennis Charland Jr., executive director of national accounts at Blue Cross Blue Shield of Massachusetts, the state’s largest health insurer, which pioneered an “alternative quality contract” meant to rein in costs and reward healthy outcomes. “These are fully launched product, and they’re having an impact in the marketplace.”
A fancy way of saying rationing.
Insurers also have been launching more limited and tiered network products, traditionally rare in Massachusetts, which save their members money but restrict which doctors and hospitals they can use or force them to pay more for expensive medical care providers.
“We’ve seen a strong migration into our limited network and tiered products,” said Kevin Grozio, vice president of underwriting and actuarial services at Fallon Community Health Plan....
Another way of saying rationing.
Going forward, insurers face mounting challenges in a market some said is changing slower than they would like.
Not making enough profit?
“Volume is still largely rewarded, not value,” said Anthony Cali, vice president of network and total medical cost management for Cigna’s New England markets. “The care is still fragmented. The payment system varies widely across geographies.”
While health care use is growing more slowly in Massachusetts than in most other states, the Bay State remains among the most expensive for health care, said Duncan Stuart, director of sales for the New England region for Aetna Inc. But he said Massachusetts also has “the largest spread in terms of savings if you drive utilization away from expensive hospitals.”
Insurance executives said alternative payment contracts are gradually shifting risk from the health plans to doctors and hospitals. Insurers, meanwhile, are evolving into health information organizations that, among other things, supply providers with data they need to manage risk....
Yes, the insurance institutions that are more about capital accumulation for their own health are the heros of the health system.
--more--"
What kept you on life support this long:
"Rule providing a windfall for Mass. hospitals targeted" by Tracy Jan | Globe Staff, February 07, 2013
WASHINGTON — The “Bay State boondoggle,” as a Medicare windfall to Massachusetts hospitals has come to be known by critics, may be seeing its last days.
Senator Tom Coburn, an Oklahoma Republican, and Senator Claire McCaskill, a Missouri Democrat, have introduced a bill that seeks to reverse a provision inserted into the 2009 health care reform law that benefitted Massachusetts hospitals to the tune of more than $250 million a year.
The Coburn-McCaskill bill was filed last week following a Boston Globe story about arcane Medicare reimbursement rules that allow one tiny island hospital in Massachusetts, Nantucket Cottage Hospital, to raise the Medicare payment rates of the state’s 81 other hospitals at the expense of hospitals in most other states.
Related: Sunday Globe Special: The Nantucket Effect
The bill takes aim at an amendment filed by then-Senator John Kerry, a Massachusetts Democrat, and Senator Robert Menendez, a New Jersey Democrat, that required Medicare reimbursements for hospital wages to come from a national pool of money instead of from a state pool. That meant Massachusetts’ gain would come at the expense of most other states.
“This provision unfairly benefits some states to the disadvantage of others, like Missouri,” said McCaskill in a statement issued last week. “It’s inefficient, and I’m happy to work in a bipartisan way to improve the health care reform law by repealing the provision.”
Since Kerry’s departure to head the State Department last week, it is uncertain whether Massachusetts has the legislative clout to defeat the bill. Freshman Senator Elizabeth Warren opposes the bill, according to her staff.
And Senator William “Mo” Cowan, who was just sworn in Thursday afternoon after being appointed to fill Kerry’s seat pending a special election, has already been in touch with Massachusetts hospitals to express his opposition and will vigorously fight its passage during upcoming debt negotiations, said an aide.
The Kerry-Menendez amendment did not single out Massachusetts by name, but the Bay State emerged a winner, along with eight others, because of another Medicare rule saying a state’s urban hospitals must be reimbursed for wages at a rate no lower than its rural hospitals.
Given that Nantucket Cottage is the only rural hospital in Massachusetts, and because wages on the island are high due to its remote location and expensive cost of living, the rest of the state’s hospitals reap an annual bonus of between $256.6 million and $367 million, far exceeding any other state that also wins under this system.
Herb Kuhn, president of the Missouri Hospital Association, had previously told the Globe that Missouri hospitals lose $15.6 million a year as a result of the Kerry-Menendez amendment. Other states like Texas, New York, and Florida lose tens of millions each year in Medicare reimbursement funds.
Coburn called the policy a “payment earmark” and said his bill would “sunset this unjust provision.”
Following the Globe story in January, a coalition of 20 state hospital associations wrote to President Obama asking him to fix the provision in his health reform law that leads to the windfall for Massachusetts hospitals because of one island hospital’s outsized impact on national Medicare reimbursements.
Under the Coburn-McCaskill bill, states such as Massachusetts will be responsible for shouldering the expense of their own increased wages based on the rural rule, instead of draining the reimbursements of other states. A similar bill is expected to be filed in the House.
The Massachusetts Hospital Association and the state’s congressional delegation have said the Kerry-Menendez legislation corrected previous Medicare rule changes that cost Massachusetts hospitals hundreds of millions of dollars. The hospital association has said it is not opposed to reform, but the entire reimbursement system needs to be fixed — not just this one issue.
“The bill put forth by Senators Coburn and McCaskill seeks to unfairly single out one Medicare reimbursement adjustment among the huge number of modifications that are currently in place,” said Tim Gens, executive vice president of the Massachusetts Hospital Association, on Thursday.
“If this bill were to pass, all other adjustments would continue to be funded from a national pool of money that all hospitals across the country pay into, while the rural floor would be treated differently. There are sound reasons to fund adjustments nationally, first and foremost because it’s a more stable and fair basis on which to allocate funding.”
--more--"
Something that literally will make you sick:
"Fecal transplants show promise in infection fights" by Carolyn Y. Johnson | Globe Staff, January 17, 2013
"Insurers say health spending on rise in Mass." by Robert Weisman | Globe Staff, February 08, 2013
WALTHAM — Despite more modest increases in recent years and a state push to hold down costs, the message from health insurance executives gathered here Thursday for a market outlook seminar was clear: Massachusetts health spending is heading up in 2013.
Representatives from the state’s nonprofit health plans as well as national for-profit insurers doing business in Massachusetts estimated the “medical cost trend,” a key industry measure, will climb between 6 and 12 percent this year — higher than last year’s cost bump and more than double the 3.6 percent increase set as a target in a state law passed last year.
Medical cost trend is a mix of what doctors and hospitals bill insurers for care and the volume of services and procedures performed. Over the past five years, health care providers have come under pressure from payers and state officials to charge less, while many people have postponed elective surgeries and other care in a weak economy.
That's me.
The new projections of accelerating costs are a sobering sign those moderating trends may be fading. The market outlook was discussed at an event hosted by the New England Employee Benefits Council, a trade group for insurance brokers and company benefits managers.
Premium rates charged by insurers to employers and individuals can sometimes be lower than the overall cost trend, especially when businesses shift costs to workers through higher deductibles or copays. But generally, the cost trend and premiums run in tandem.
“If trends are going up, premiums are going up,” said Eric Swain, vice president of sales and account management for UnitedHealthcare of New England.
Among the cost drivers cited by executives were an improving economy where more people have insurance and can afford to pay for care, the influenza outbreak in Massachusetts this winter, a continuing rise in obesity, the impact of new taxes and rules under President Obama’s health care overhaul, and anticipated further cuts in Medicaid and Medicare, the government health insurance program for low-income and older residents.
Yup, you are driving up the cost of care by accessing it, so don't! As for the other things, maybe it's all true; however, I am sick of s*** excuses. I'll bet none of those guys are hurting for health care or worrying about the bill.
Speakers at Thursday’s event weren’t in complete agreement. While all said costs will be climbing this year, Massachusetts nonprofit executives said they expected a 6 to 8 percent boost in the trend, while the national carriers said the increase would range from 7 to 12 percent.
But the outlook was not completely grim. Speakers said alternative payment models, which give providers fixed budgets for patient care rather than paying them for each visit and procedure, are becoming a larger part of their businesses — and helping them to better manage expenses.
It's also known as RATIONING, something you were told wouldn't be part of the treatment.
“These aren’t pilots,” said Dennis Charland Jr., executive director of national accounts at Blue Cross Blue Shield of Massachusetts, the state’s largest health insurer, which pioneered an “alternative quality contract” meant to rein in costs and reward healthy outcomes. “These are fully launched product, and they’re having an impact in the marketplace.”
A fancy way of saying rationing.
Insurers also have been launching more limited and tiered network products, traditionally rare in Massachusetts, which save their members money but restrict which doctors and hospitals they can use or force them to pay more for expensive medical care providers.
“We’ve seen a strong migration into our limited network and tiered products,” said Kevin Grozio, vice president of underwriting and actuarial services at Fallon Community Health Plan....
Another way of saying rationing.
Going forward, insurers face mounting challenges in a market some said is changing slower than they would like.
Not making enough profit?
“Volume is still largely rewarded, not value,” said Anthony Cali, vice president of network and total medical cost management for Cigna’s New England markets. “The care is still fragmented. The payment system varies widely across geographies.”
While health care use is growing more slowly in Massachusetts than in most other states, the Bay State remains among the most expensive for health care, said Duncan Stuart, director of sales for the New England region for Aetna Inc. But he said Massachusetts also has “the largest spread in terms of savings if you drive utilization away from expensive hospitals.”
Insurance executives said alternative payment contracts are gradually shifting risk from the health plans to doctors and hospitals. Insurers, meanwhile, are evolving into health information organizations that, among other things, supply providers with data they need to manage risk....
Yes, the insurance institutions that are more about capital accumulation for their own health are the heros of the health system.
--more--"
What kept you on life support this long:
"Rule providing a windfall for Mass. hospitals targeted" by Tracy Jan | Globe Staff, February 07, 2013
WASHINGTON — The “Bay State boondoggle,” as a Medicare windfall to Massachusetts hospitals has come to be known by critics, may be seeing its last days.
Senator Tom Coburn, an Oklahoma Republican, and Senator Claire McCaskill, a Missouri Democrat, have introduced a bill that seeks to reverse a provision inserted into the 2009 health care reform law that benefitted Massachusetts hospitals to the tune of more than $250 million a year.
The Coburn-McCaskill bill was filed last week following a Boston Globe story about arcane Medicare reimbursement rules that allow one tiny island hospital in Massachusetts, Nantucket Cottage Hospital, to raise the Medicare payment rates of the state’s 81 other hospitals at the expense of hospitals in most other states.
Related: Sunday Globe Special: The Nantucket Effect
The bill takes aim at an amendment filed by then-Senator John Kerry, a Massachusetts Democrat, and Senator Robert Menendez, a New Jersey Democrat, that required Medicare reimbursements for hospital wages to come from a national pool of money instead of from a state pool. That meant Massachusetts’ gain would come at the expense of most other states.
“This provision unfairly benefits some states to the disadvantage of others, like Missouri,” said McCaskill in a statement issued last week. “It’s inefficient, and I’m happy to work in a bipartisan way to improve the health care reform law by repealing the provision.”
Since Kerry’s departure to head the State Department last week, it is uncertain whether Massachusetts has the legislative clout to defeat the bill. Freshman Senator Elizabeth Warren opposes the bill, according to her staff.
And Senator William “Mo” Cowan, who was just sworn in Thursday afternoon after being appointed to fill Kerry’s seat pending a special election, has already been in touch with Massachusetts hospitals to express his opposition and will vigorously fight its passage during upcoming debt negotiations, said an aide.
The Kerry-Menendez amendment did not single out Massachusetts by name, but the Bay State emerged a winner, along with eight others, because of another Medicare rule saying a state’s urban hospitals must be reimbursed for wages at a rate no lower than its rural hospitals.
Given that Nantucket Cottage is the only rural hospital in Massachusetts, and because wages on the island are high due to its remote location and expensive cost of living, the rest of the state’s hospitals reap an annual bonus of between $256.6 million and $367 million, far exceeding any other state that also wins under this system.
Herb Kuhn, president of the Missouri Hospital Association, had previously told the Globe that Missouri hospitals lose $15.6 million a year as a result of the Kerry-Menendez amendment. Other states like Texas, New York, and Florida lose tens of millions each year in Medicare reimbursement funds.
Coburn called the policy a “payment earmark” and said his bill would “sunset this unjust provision.”
Following the Globe story in January, a coalition of 20 state hospital associations wrote to President Obama asking him to fix the provision in his health reform law that leads to the windfall for Massachusetts hospitals because of one island hospital’s outsized impact on national Medicare reimbursements.
Under the Coburn-McCaskill bill, states such as Massachusetts will be responsible for shouldering the expense of their own increased wages based on the rural rule, instead of draining the reimbursements of other states. A similar bill is expected to be filed in the House.
The Massachusetts Hospital Association and the state’s congressional delegation have said the Kerry-Menendez legislation corrected previous Medicare rule changes that cost Massachusetts hospitals hundreds of millions of dollars. The hospital association has said it is not opposed to reform, but the entire reimbursement system needs to be fixed — not just this one issue.
“The bill put forth by Senators Coburn and McCaskill seeks to unfairly single out one Medicare reimbursement adjustment among the huge number of modifications that are currently in place,” said Tim Gens, executive vice president of the Massachusetts Hospital Association, on Thursday.
“If this bill were to pass, all other adjustments would continue to be funded from a national pool of money that all hospitals across the country pay into, while the rural floor would be treated differently. There are sound reasons to fund adjustments nationally, first and foremost because it’s a more stable and fair basis on which to allocate funding.”
--more--"
Something that literally will make you sick:
"Fecal transplants show promise in infection fights" by Carolyn Y. Johnson | Globe Staff, January 17, 2013
The half-century old medical procedure has long been a measure of last resort, its mere mention enough to make a room full of doctors wrinkle their noses and laugh like schoolchildren: When a patient suffers from a gastrointestinal infection that keeps coming back, try transplanting someone else’s feces into the gut to restore a normal balance of healthy bacteria.
The scatological treatment may seem more medieval than modern, but over the past decade, doctors have increasingly stopped snickering and started to try it — with promising results. There is now a flurry of new trials at cutting-edge medical centers in Boston and elsewhere, and on Wednesday, a rigorous randomized trial published by Dutch researchers found that most patients with serious, recurrent infections caused by the bacteria C. difficile got better when donor feces were infused into their intestines. That study was halted early because the patients fared so much better than a group given standard antibiotic therapy.
“There’s an aesthetic factor. There’s a gross factor that wigs people out a little bit,” said Dr. George Russell, a pediatric gastroenterologist at Massachusetts General Hospital who did his first fecal transplant in 2010, on a two-year-old child with a relapsing C. difficile infection. “But I think people get over it, and it makes sense to them intuitively.”
--more--"
Let's just hope you don't have a s*** doctor:
"A data gap on Mass. doctors’ troubles; State board lags in posting loss of license, censure" by Chelsea Conaboy | Globe Staff, February 19, 2013
The board that oversees physician discipline in Massachusetts has yet to deliver on its promise to post more information online about doctors who are charged with a crime or who have a history of negligent care.
Now, doctors whose licenses are revoked or allowed to expire as a result of disciplinary actions are absent from the board’s public database. And information about malpractice cases or board actions is removed after 10 years from the profiles of still-licensed physicians.
After The Boston Globe reported last March about the Board of Registration in Medicine’s practice of pulling information about the most troubled doctors from public view, board leaders promised to do better. They worked with state Senator Richard Moore to make a plan for overhauling the database, and the plan was written into last year’s state budget bill.
The new system had been expected to be operating by January. But when the board’s executive director left under pressure in December and Barbara Piselli took over as interim head, board members learned the project was not far enough along to meet that deadline, said Dr. Candace Sloane, the board chairwoman. Sloane said she hopes to begin rolling out the new system this spring....
--more--"
