State-wide and National Healthcare Reform Efforts Need "All Hands on Deck"

Lynn Nicholas, President & CEO of the Massachusetts Hospital Association, says the state needs an interim U.S. senator now to protect our interests during the health reform debates, or local hospitals risk losing up to $1 billion annually:

Massachusetts has been on the forefront of America’s current healthcare reform efforts, and the Commonwealth’s hospitals actively support health system reform and continued coverage expansion both state-wide and across the nation. . Our hospitals will continue to provide a unified voice in favor of comprehensive, high-quality and affordable care and we commend our state leaders for their ongoing support and the members of our Congressional delegation for championing this important effort on behalf of all Americans. (See Martha Bebinger's Aug. 4 post on why some hospitals are worried about two particular elements of the national health care reform debate.)

As these healthcare reform efforts continue to unfold, we must ensure that the state’s current focus on controlling costs fairly engages all stakeholders – hospitals, physicians, state government, employers, insurers and patients themselves– and that any federal proposals are not a step backward from the advances we have made here in the Commonwealth.

Massachusetts was founded on a strong sense of social justice and community obligation – just look at the centrally located “commons” found in nearly every Bay State city and town. Our predecessors set aside valuable property to be used for the greater good in Colonial times. Today we should muster our collective will and energy to meet the larger responsibilities posed by healthcare reform. To do this we need “all hands on deck” in our state, which includes immediately filling the temporary vacancy in Massachusetts’ Congressional delegation. (Read the Globe's latest story on filling Kennedy's seat.)

I have worked in healthcare for over 30 years and the volume and pace of reform deliberations is unprecedented in my experience. The national reform proposals currently pending ostensibly affect one-sixth of the nation's economy and are wide-ranging in scope. They could well affect the progress we have made in Massachusetts, including additional insurance coverage for more than 400,000 Massachusetts citizens who didn't have coverage prior to the passage of our state's landmark healthcare reform law. In the months ahead, it will be essential for the Commonwealth to closely monitor the evolving federal plan with a full Congressional delegation to ensure appropriate coordination with the path we have set here in Massachusetts.

There is a great deal of controversy around the pros and cons of filling the Senate vacancy left by the death of Sen. Edward Kennedy; but the potential harm to our citizens and our Commonwealth from underrepresentation in the US Senate trumps every other concern. The intrigue around this issue will last a few months, but the ramifications of decisions being made in Washington will likely impact us for decades.

In particular, some of the health care proposals currently being considered in Congress could severely damage or even destroy key components of the Massachusetts economy. Healthcare and hospitals in particular are an integral and extremely valuable component of the economic infrastructure in the Commonwealth. Our hospitals anchor the health care delivery system in their communities and are among the state’s largest employers, and the number of Massachusetts residents working in direct care, medical industry and research accounts for 15.8 percent of the state’s total employment. Many of these jobs are directly or indirectly supported by the significant federal funds that flow into Massachusetts for Medicare, medical research, education and services.

There are now federal proposals on the table that would change the formula for distributing Medicare funds nationally. One such plan is a "value formula" that would take Medicare dollars from hospitals in higher-cost regions like Massachusetts and transfer them to so-called "efficient" hospitals with lower costs in other parts of the country. If implemented, these geographic payment variation proposals would spell economic disaster for a number of states – including Massachusetts – that have advanced healthcare-centered infrastructures. Their simplistic comparisons of health spending levels disregard underlying demographic and cost‐of‐living differences, overlook added costs from educating the next generation of physicians, and ignore numerous complex nuances and important factors like the condition and socioeconomic status of particular patient populations.

While Bay State hospitals and other providers are already working with Congressman Capuano and the rest of our Congressional House delegation on this issue, it will soon be debated in the Senate. And it will be crucial for Massachusetts to have two senators in place. Without full representation in Congress, this or some similar scheme could cost Massachusetts hospitals between $440 million and $1 billion per year. If not deleted or mitigated, “geographic variation” alone could start the unraveling of our world class medical community.

Massachusetts needs and deserves full involvement and full representation on healthcare reform issues at both the state and national level. We cannot stay the course in these tumultuous times otherwise.