What Held Up Payment Reform? Top 5 List #1

As the new and expanded CommonHealth gets rolling, we’ll be asking people with their fingers on the pulse of Massachusetts health care reform about the current state of play — and what comes next. Pulse-wise, Brian Rosman, research director at the advocacy group Health Care for All, is an advanced oximeter (that high-tech clothespin they clip on your finger.)

His top five picks for why the state legislature ended its session this summer without the promised advances on changing the payment system:

1: Time simply ran out. General state issues took more time than expected, particularly the casino question and a budget that was more complex than usual.
2: Shorter-term cost controls demanded too much attention. Efforts to provide fast rate relief to small businesses and individuals tended to dominate. But everyone knows payment reform must come. At the signing for the insurance bill, which would normally have been a time for self-congratulation, everyone was saying instead that it was not enough. Senate President Therese Murray promised that payment reform would be her top priority next session. Ronald Mariano, assistant majority leader of the House of Representatives, declared, “The days of fee-for-service are over."
3. Lack of consensus: Historically, Massachusetts has passed its groundbreaking health care reforms with the agreement of a broad consensus of politicians, employers and medical providers. On payment reform, no such consensus exists yet, and forging one will take serious time and effort.
4. Uncertainty over the effects of national health reform. The national reform bill sets up a "Center for Medicare and Medicaid Innovation" that will let states try out reform models, but the center won't start up until January. Its role will affect what states do.
5.Disagreement about oversight and accountability. How much power will the state have over the rates charged by insurers and providers?

Coming up on CommonHealth: More Top Five lists of payment reform sticking points, and possible ways past them.

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Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



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