Health Care Workers Make Their Case On Payment Reform

In advance of Gov. Deval Patrick's much-anticipated speech Thursday on controlling health care costs, the state's biggest health care workers union sent out a letter to legislators detailing its priorities. We asked the union to explain its position:

By Veronica Turner, Executive Vice President, 1199SEIU United Healthcare Workers East

Every single legislator on Beacon Hill received a letter from me today on behalf of the 40,000 healthcare workers in Massachusetts represented by 1199SEIU.

When upcoming payment reform legislation changes how hospitals and other providers get paid by insurers and the state, it is going to have a profound impact on the floors of the medical facilities where the work of healing and caring for patients actually gets done:

-- Procedures will be improved and protocols will be revised.

--Healthcare workers will be adapting to new roles intended to heighten coordination of patient services, strengthen patient communication, and bolster preventative care efforts, among others.

--Hospital management and labor will be challenged to come together and engineer new solutions to healthcare delivery challenges and work to usher in the next level of care quality and cost savings.

It is good news that policymakers on Beacon Hill and healthcare stakeholders are having real conversations about reducing healthcare costs and improving the coordination, delivery, and efficiency of care. As the conversation moves forward, the legislature should heed the voices of the healthcare workers who will ultimately be responsible for the hands-on implementation of these noble goals.

In our letter to lawmakers, we present some principles that we think it is essential for legislators to keep in mind as they work towards final legislation to curb costs and reform the healthcare payment system.

Implementation should be executed gradually over time and should include pilot programs and incentives for early adopters. In other words, we should test out newly proposed regulations and approaches within select hospitals and networks before exporting them to the entire healthcare delivery system. Such pilot programs will allow regulators, providers, caregivers, and other stakeholders to get a stronger assessment of what’s working and what isn’t – and identify ways to improve the system before it’s applied statewide. Other issues addressed in the letter include:

Medicaid Rates: We said efforts to stabilize Medicaid rates should be prioritized. The rate at which hospitals are reimbursed for Medicaid patient care has decreased from 82% of the cost of care to only 70% of the cost in just the last five years. Further destabilization of those rates could create access inequities for Medicaid patients and lower income communities. Further destabilization of Medicaid rates could also thwart efforts at controlling the cost of private insurance – since private insurance consumers are eventually forced to make up the difference for inadequate Medicaid rates. In policy terms, you may sometimes hear this cost-driving pattern referred to as “cross-subsidization.”

Worker Voice in Oversight: We believe any oversight system created by lawmakers should include representation for all stakeholders, especially for the workers actually providing services and adapting to the changes on the frontline. Particularly in healthcare, the value of input from the people doing the work in real life and in real time should never be underestimated. As frontline healthcare workers, we offer a unique perspective informed by practical experience and know-how.

Cooperative Efforts: Lastly, we feel that joint labor-management work and training to ensure quality improvements and a smooth transition between systems should be incentivized. Having formal opportunities and an open process for dialogue between healthcare workers and management will become even more crucial as these reforms roll out. Workers will require training and education opportunities to fill new roles and meet the goals set out by payment reform legislation. Healthcare employers, legislators, and labor groups must work together to ensure those training opportunities are expanded, targeted, and prioritized in order to fulfill long-term cost reduction and quality benchmarks.

We will be watching and engaged in the payment reform debate, and advocating for the final legislation to measure up to these principles. I hope this post provides a new perspective on what can often be a very jargon-laden debate around payment reform. In keeping with the tagline of this blog, our jobs are literally where reform and reality come together, and we appreciate WBUR seeking a perspective from the frontline healthcare workforce.