BOSTON Early this year, Gov. Deval Patrick filed his bill to control health care costs and urged the Legislature to take it up right away.
“I’ve challenged you to be bold,” Patrick told members of the Greater Boston Chamber of Commerce in February. “Because what we do today — or fail to do — will matter for a generation to come.”
Now, we have the first glimpse of how the Legislature will tackle this issue. WBUR’s Martha Bebinger joined All Things Considered host Sacha Pfeiffer to discuss legislators’ plans, beginning with comments by Lynn Rep. Steven Walsh, the House chair of the Committee on Health Care Financing.
Sacha Pfeiffer: Walsh agrees with Patrick that changing the way we pay doctors has to be a key part of the state’s plan to control health care costs. The idea is to cut down wasteful spending. The House would have doctors and virtually everyone else who cares for patients move to a global payment system in three years. What would that change look like for doctors and for patients?
Martha Bebinger: For doctors and for hospitals it would mean that they would have to budget for a patient’s care. For patients it would mean that most of us would need to have a primary care doctor so that there is someone who is coordinating our care.
Walsh, who has been spending a lot of time at Children’s Hospital lately with his infant son, doesn’t minimize how difficult or major these changes are, but he says they have to be done.
None of us will get the quality care that I’m receiving right now in 2021 and beyond if we don’t change the way we pay for health care. It’s a system that, as good as we have it here, is absolutely broken and won’t survive without major changes.
Walsh’s goal is to hold health care spending increases, after three years, to just under 4 percent a year, which is about half of what we have now. This can happen, he argues, by cutting out tests that aren’t necessary and other wasteful care, and shifting the focus to keeping people healthy so they don’t need hospitalization.
The House is also talking about accelerating the transition to electronic medical records and moving most of the state’s health care agencies under one large authority. Give us a few of the other points of this draft House bill.
There are seven areas. One deals with changing the workforce so that there’s a lot more emphasis on prevention. Under global payments, we’d need more primary care doctors, we’d need more people doing preventive care. We’d need clear information about costs so we know how much we are spending. We’d need medical malpractice reform so that doctors don’t feel like they have to order a test to protect themselves. And we’d need a lot of patient education about what this all means.
These are some big changes for patients, doctors and for everyone who pays for health care. I imagine there are people pushing back on this?
There are people pushing back, although I’m hearing less than I expected. Many hospitals are already moving to insurance contracts that include global payments. There is a sense that this is where we’re headed among hospital management and they’ve decided to be part of that change.
Even if you hear less opposition, there is, just out from the Massachusetts Medical Society, a survey of doctors that says fewer than half of them are likely to voluntarily move to global payments. That leaves the impression that it’s going to be difficult to persuade doctors to make this change.
There’s no question there is a lot of trepidation among physicians about starting to a manage a budget for their patient’s care and being held responsible if they go over budget. So Lynda Young, president of the Massachusetts Medical Society, says moving to global payments in three years is too fast.
The unintended negative consequences that may occur would be very difficult to justify, if things are put into place that aren’t working because they’ve moved too quickly on this.
Consumers have very little idea of what this change would mean for them and advocates say global payments will have to include money for patient education. Health Care for All Director Amy Whitcomb Slemmer says global payments show great promise for “more-integrated, less-fragmented care that puts patients at the center of the health care system.” But it’s hard to gauge at this stage how much pushback we’d see from patients.
What’s not in this proposal that you expected to see?
We don’t yet see a plan to close the gap between what high-cost and lower-cost hospitals are paid. Rep. Ron Mariano, D-Quincy, has filed a bill that would close that gap, so we’ll see if it moves as a separate bill. We’re not sure yet how the House will deal with mental health and substance abuse.
Everyone who cares for patients would move into comprehensive health care organizations (accountable care organizations, or ACOs). Would the state limit how big these could get to avoid monopolies that could demand whatever price they want? There are many unanswered questions. Walsh and the Senate chair of Health Care Financing, Richard Moore, D-Uxbridge, are out touring hospitals and meeting with dozens of groups, so call or email them if you want to weigh in.
What about the Senate? What are leaders there proposing, and when?
Senate leaders have told health care groups they hope to have a bill out in November, but it may get pushed to February. The Senate shares many of the House’s priorities regarding electronic medical records, boosting primary care and more public information about costs and quality. The Senate is considering slower movement toward global payments, taking five years instead of three, as the House suggests, and with more incremental steps.