"Can We Reach an Agreement that Will Save Time and Money on Billing?" by James Roosevelt, Jr.

Here we are in late July and the question is being asked with greater urgency, “Is health care reform going to be successful?” I believe the short answer is “yes.” The only folks I hear saying that it is not working are from other states, and tend to be opponents of the model agreed to by all the stakeholders in Massachusetts. I am confident that in a few years’ time, we will look back with pride on what was accomplished when we all came together to support life changing public policy. But as this is a process that is happening in real time, it will continue to evolve and be affected by both politics and the marketplace.

A perfect example of proposed legislation that could have profound implications on health care reform is Senate Bill 697, which calls for standardized coding, a numerical method used by health plans to define medical treatments for billing purposes. At first glance, this certainly appears reasonable. Who wouldn’t support a national coding system that is already used by hospitals for Medicare?

However, the reality is that this is much more complex than a quick glance would indicate, with major ramifications on payment policy and premiums. In brief, the scope of technology changes necessary would require the resource investment of tens, possibly hundreds, of millions of dollars to support either reconfiguring existing technology systems or purchasing new systems.

While Massachusetts’ not-for-profit health plans currently have the lowest administrative costs in the nation, it is no leap to assume that if S.697 passed in its current form, health care costs would increase, and ultimately undermine the goals of health care reform by raising premiums for all consumers, including those who are just now benefiting from coverage. My colleague, Eric Schultz, president and chief executive officer of Fallon Community Health Plan, told the State House News Service that the bill would “do a lot of harm in dismantling health care processes.” He was not overstating the issue.

It wasn’t that long ago when hospitals and health plans were brought together by the Massachusetts Health Data Consortium to discuss the technical solutions necessary for the Health Insurance Portability and Accountability Act of 1996. The outcome of that collaboration is simplified administrative processes, which translate into reduced costs for health plans, providers, and members.

But there is always room for improvement. To that end, it is my recommendation, which has the support of the Massachusetts Association of Health Plans, that hospitals and health plans reconvene with the Massachusetts Health Data Consortium to find common ground on this complicated and expensive, though well-intentioned bill. No one wants to see the gains we’ve recently achieved with health care reform become once again out of reach.

James Roosevelt, Jr. is the President and CEO of Tufts Health Plan