History Repeating: After Changing The Game For Health Care Reform, Massachusetts Levels Paying Field

One might argue Massachusetts is the healthiest place in the country

.

More than 97 percent of its residents have health insurance. The others are covered under Medicare or are exempt from the states historic mandate.

Physicians in Massachusetts, for the most part, are happy there too. Hoards of them who for years saw their waiting rooms morph into hungry paper tigers --- unwittingly in business only to feed the insurance machine --- flocked to the state in search of the simple life. Free to run their businesses without fear of red ink dripping from their ledgers, doctors continue to spring up on street corners more than three years since Massachusetts became a mandatory

health insurance state.

But a funny thing happened on the Road to Reform in Mass. A new numbers game has emerged now that patients have grown accustomed to a model of care where health insurance cards are as common as birth certificates. While Congress debates setting out to do for America what Massachusetts has already done for itself, the next item on the states To-Do list is quality control.

Conventional wisdom says the quality of the product or service you buy is often tied to the amount of money you pay for said product or service. Not always, of course. But the mantra, you get what you pay for, is a strong one. Not so in medicine.

Thats precisely why Massachusetts is evaluating how its health insurance companies reimburse doctors and medical facilities for their services. The state contends that skyrocketing healthcare costs are the result of an artificially inflated fee-for-service business model that doctors and hospitals have propagated for decades.

Massachusetts has established a strong foundation for improving health care quality and reducing health care costs - in short, making health care accountable, writes Mass. Senator Richard Moore in a guest column appearing in the Boston Globe. (Pundits) assert that Massachusetts only addressed access and not quality improvement (with the states mandate).

Blue Cross and Blue Shield of Massachusetts and Bostons Caritas Christi Health Care, a chain of six community hospitals in eastern Massachusetts, have just signed a new five-year contract that, if successful, could be a precursor for how all medical services are paid for in the state.

The contract includes a so-called global payment system in which hospitals will be paid fixed amounts based on the estimated annual costs of patients care instead of the fee-for-service system in which medical providers bill insurers for individual visits and procedures. BCBS Mass will also get incentives to improve the quality and affordability of care at Caritas hospitals. The metrics will be measured under evidence-based, standardized medical benchmarks --- kind of like a patient exit interview combined with number-crunching to determine if the doctor actually increased his patients life spans.

In its struggle to balance its state budget to pay for health reforms, Massachusetts has decided to adopt BCBS Mass. pact with Caritas, preparing to twist the arms of insurers across the state until they deliver more bang for the buck.

Massachusetts has among the highest health care costs in the United States, and while we rank among the best in health care quality, we could do better, said Sarah Iselin, who co-chaired the states Payment Reform Commission. Insurance premiums have increased almost every year for the past two decades at a pace that well exceeds the annual increase in wages and the cost of living.

State officials plan to phase the Global Payments system in over five years; roughly the same amount of time it will take the Federal Government to fully-implement its proposed not-for-profit public health insurance option.

By then, Massachusetts will have plenty of evidence to support or negate the Global Payments business model, Congress will have another PowerPoint slide deck to present to its constituents and insurance companies will be hiring new accountants.

Critics of the Global Payment model say unanticipated patient healthcare costs could pose a huge financial burden on doctors and hospitals and contend that the budget structure of the global payment system would limit patient access to care.

Under the Global Payment structure, individual patients would not be denied treatment if they already have reached their spending quota, with the budget allotted for other patients helping offset those costs. But patients, critics say, would face restrictions if they sought a procedure from doctors outside Massachusetts or outside the network of

healthcare providers designated as responsible for their care.

That is Unless Congress decides to adopt it nationwide. Then, itll be a whole new ball game.

by: Michael Brewer

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