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Changes that would Shake up Health Care Spending

There is a growing consensus that Massachusetts must shift health care spending to reward the quality of care patients receive, not the volume. There is a lot of concern about who will win and lose if/when that shift happens. I'm linking to a few of the blueprints offered at public hearing yesterday hosted by a new state commission looking into payment reform.

Secretary for Health and Human Services JudyAnn Bigby asked the commission to consider a system where private and public insurance programs would pay all doctors, hospitals and other health care providers the same rate for the same service. You can read her testimony here. She talks about payments based on a episode of care...could be a single surgery or a year of treatment for patients with chronic conditions like diabetes. This system assumes that someone would coordinate and be responsible for our "episode." It would be tough for all the docs who practice on their own or in small groups. Bigby suggests that docs in western Mass for example could join some kind of regional center for help with IT and other back office operations.

Lucian Leape from the Harvard School of Public Health also stressed the need for coordinated care to help end waste, errors and uneven care.

His testimony is here. Again in the Q and A I was stuck by the discussion about individual physician practices. Leape says they will have to merge into larger groups on some level if a coordinated payment/care model is going to work.

Closing the gap between what primary care docs and specialists make comes up again and again in this conversation. Alan Sager from the Boston University School of Public Health offered a model for boosting primary care physician payments from about $150,000 now to $250,000 and capping the number of patients at 1,000. This might persuade more medical school students to choose primary care, decrease the oversupply of specialists and thus the tendency to see one when it may not be necessary.

Most of the people who testified agreed that there is enough money in being spent on health care already...the challenge is to redirect it to pay for more preventive care that focuses on keeping people healthy.

Martha Bebinger

This program aired on February 7, 2009. The audio for this program is not available.

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