View Full Version : Has Massachusetts Finally 'Cracked the Code' On Health Care Costs?
A follow up to this post, which all came to pass:
https://www.m4carbine.net/showthread.php?t=44150&highlight=obama
I live in MA, and the "universal health" care put into law by none other than our one time Gov. Romney known as "Romney Care" has been a financial DISASTER for MA.
Complex reasons but to sum up why: no cost containment. I could see that a
mile away, why couldn't they?
Now Gov. Patrick is supposedly gonna fix that problem (after the costs of insurance went up 50% for some making then unable to afford insurance in a state that says you have to have it by law...). Give you an idea, my insurance went from $350 per month to $465 with increased co pays, increased deductible, etc... I hope this new law helps...
Obama health care plan is modeled strongly on "Romney Care" model and MA held up as a model state for the concept. Morons all.
Romney has *ZERO* reason to bash Obama on "Obama Care" and Obama is nuts for thinking MA has been a success.
What F-ing balance books is he looking at or citizens asked who's insurance, cost of services, co pays, etc, etc sky rocketed after passing "Romney Care?" to support MA as a success?
Big Pharma, insurance companies, and hospitals will lobby (read pay off) their way out of true cost containment, so the bill will be passed onto you and I.
I'm not against universal health care as a concept per se, but like many ideas, they look much better on paper, and the playing field not even.
Has Massachusetts Finally 'Cracked the Code' On Health Care Costs?
This week, Massachusetts Governor, Devall Patrick, signed into existence a sweeping law designed to gain control over the spiraling costs of healthcare in Massachusetts—the home of the universal healthcare program now known as “Romneycare.”
The new law aims to save Massachusetts $200 billion over the next fifteen years by tying the growth of healthcare spending to the growth of the state’s economy."
It works like this—staring in 2013 and continuing through 2017, medical costs in Massachusetts will be permitted to rise at just one-half the rate of the state’s economic growth. For the five years that follow, spending will be further limited by an additional one half of a percentage point.
Massachusetts medical spending has seen an increase of about 7 percent each year over the past few years while the state’s economy has grown at a rate of approximately 3.7 percent. Using these rates of growth, health care spending would now be required to be cut by about ½ of the current rate of annual increase, greatly lowering the costs of care in the state.
To make this happen, the law has taken dramatic steps to change the way hospitals and physicians are paid—moving away from the fee per service model to one where providers are paid based on the overall care of a patient rather than how many tests are done, procedures performed, etc.
Here are a few of the key provisions of the law intended to bring down costs—
The law creates a new state agency to collect the needed data to establish policy and give effect to the law’s requirements and set permitted growth rates in spending.
The role of physician assistants and nurse practitioners is expanded to allow people licensed to operate in these roles to act as primary care providers where appropriate.
The law encourages the creation of ACOs (medical home approach) so as to achieve better coordination between physicians treating a patient, which has been shown to lead to the avoidance of repeated medical tests and procedures.
The creation of a wellness tax credit for businesses that adopt programs to combat preventable chronic diseases.
Modifications to the medical malpractice rules in the state, requiring a mandatory, 182-day “cooling off-settlement negotiation period” before a lawsuit can proceed.
The law bans the use of mandatory overtime for nurses in hospitals except in emergency situations.
Cont:
http://www.forbes.com/sites/rickungar/2012/08/09/has-massachusetts-finally-cracked-the-code-on-health-care-costs/
montanadave
08-09-12, 09:29
FWIW, my wife and I have our health insurance through her employer, a regional medical center. And our insurance costs have steadily risen by around 15-20% a year. Last year, we paid over $8K in premiums with her employer picking up another $6K. And it's not a "cadillac" health care plan.
I don't have an answer but health care costs are a runaway train and pose the largest single threat to our financial solvency, whether as individuals or as a nation.
FWIW, my wife and I have our health insurance through her employer, a regional medical center. And our insurance costs have steadily risen by around 15-20% a year. Last year, we paid over $8K in premiums with her employer picking up another $6K. And it's not a "cadillac" health care plan.
I don't have an answer but health care costs are a runaway train and pose the largest single threat to our financial solvency, whether as individuals or as a nation.
Well, the underlying message is that providers are getting a pay cut and/or patients are going to get less treatment. You cannot cut costs without addressing either one or both.
Well, the underlying message is that providers are getting a pay cut and/or patients are going to get less treatment. You cannot cut costs without addressing either one or both.
And here is how it will be done:
...the law has taken dramatic steps to change the way hospitals and physicians are paid—moving away from the fee per service model to one where providers are paid based on the overall care of a patient rather than how many tests are done, procedures performed, etc...The law encourages the creation of ACOs (medical home approach) so as to achieve better coordination between physicians treating a patient, which has been shown to lead to the avoidance of repeated medical tests and procedures.
The idea is that care will be reimbursed in a uniform "lump sum" that is less than the current fragmented payments. For example, a patient getting a hip replacement currently gets billed for the orthopedist, lab, radiologist, hospital bed etc. This bills may vary from patient to patient depending on how long they stay in the hospital, the number of tests that are ordered, unexpected complications, etc. Going forward, look for Medicare, private insurance, and state agencies to pay for a single flat rate for such a procedure regardless of the number of tests that are ordered or any unexpected complications that may arise. The idea is to reduce the heterogeneity of medical costs across regions and incentivize quality care through best practices.
While it looks goon on paper, there will be some downsides. For example, expect holy war as providers and institutions fight for their share of the pie. I kinda liken it to throwing a top sirloin in a group of starving masses and having them settle it with knives. Another down side is that a patient's healthcare experience will become less "individualized." For example, expect your wife to be "push" out of the hospital after her c-section on post-operative day 2 rather being allowed to stay the extra 1-2 days to deal with unexpected pain, constipation, anorexia, etc.
When you have a fee-per-service model, the incentive is for providers to offer/mandate more services, and generate more fees to maximize profits.
When you have a one-price model, the incentive changes to providing as little service as possible for the fee, in order to maximize profits.
Guess what's not going to change?
The government controlling the cost/pricing model will yield poor results, in either case.
The government controlling the cost/pricing model will yield poor results, in either case.
Either through unintended consequences of tinkering with a complex and interwoven system, or through outright cronyism...
When you have a fee-per-service model, the incentive is for providers to offer/mandate more services, and generate more fees to maximize profits.
When you have a one-price model, the incentive changes to providing as little service as possible for the fee, in order to maximize profits.
Guess what's not going to change?
Exactly. That is what happens in my c-section example from an earlier post. Expect providers to hustle you out the door as fast as possible to minimize costs.
montanadave
08-09-12, 16:32
Exactly. That is what happens in my c-section example from an earlier post. Expect providers to hustle you out the door as fast as possible to minimize costs.
But isn't that what insurers are doing right now, with an ongoing battle between the insurer's utilization review staff and providers?
"The law creates a new state agency..."
oh boy, more bureaucracy. Why, that's bound to help! :rolleyes::D
oh boy, more bureaucracy. Why, that's bound to help! :rolleyes::D
C'mon now,everybody knows more govt, is better! How's the saying go?We're from the Govt, and we're here to help!! :D
Government regulation to "control costs" leads to:
- Less service, longer wait times for care
- Fewer doctors and nurses, and degradation of qualifications (smart people will go elsewhere to make money with their talents and skills)
- an ever increasing percentage of "health care" dollars spent going to compliance rather than care
- Ever more bureaucracy to "fix" the previous regulations, rinse and repeat
You cannot provide unlimited, ever more complicated and long lasting care on a finite budget. There is not enough money in the world to provide everyone a high level of the most advanced treatment and care. Face it, our bodies are not perfect and are programmed to degrade and eventually quit functioning, and most have some level of physiological defects. Each family should be responsible for deciding how much of their home budget is allocated to their own health care and then providing for it.
As soon as someone realizes that someone else is picking up the tab (taxpayers) their "need" for services will have no limit. Govt meddling only complicates the industry and adds ever more overhead costs. A symptom of how sick the industry has become is that most physicians either cannot, or will not, give you proactive cost estimates and discuss options based on affordability. If they are fee for service then they don;t want you to know, just get treated and bear the financial burden later. If they are flat fee plan then they don;t want you to know what could be done, only what they are willing to provide within their cost/profit structure.
Why does anyone think that government regulated or operated healthcare is any less stupid than govt regulated and operated education, or revenue collection, or postal service, or motor vehicle and driver licensing (biggest source of fake ID data in Oregon for meth heads has got to be our own DMV via corrupt workers selling it)?
The more the govt is involved, the more of your money will go to govt and industry bureaucrats and the less of it to doctors and nurses.
Belmont31R
08-09-12, 18:42
Government creates problem...leads to more problems...government solves those problems....leads to more problems...government solves those and we have single payer under Pelosi's control.
Building a house would be very expensive too if the government mandated that all contractors had to hold doctorates in engineering and only employees with a masters in hammering assistance could bang nails in.
Building a house would be very expensive too if the government mandated that all contractors had to hold doctorates in engineering and only employees with a masters in hammering assistance could bang nails in.
In MA they do! :D
The easy way to control costs would be less coverage by insurance plans. Covering only needed surgeries and and inpatient stays. Regular office visits, physical therapy, etc paid directly from your pocket would cut costs because there's no employees needed to cut through all the buerocracy of the paperwork for billing to insurance company x, y and z.
But isn't that what insurers are doing right now, with an ongoing battle between the insurer's utilization review staff and providers?
To some extent, yes. But, there is a big difference between private insurers negotiating with healthcare providers, and Big Sis (Center for Medicare Services) setting the rules of the game and the prizes.
http://www.forbes.com/sites/aroy/2011/08/19/how-obamacare-is-destroying-accountable-care-organizations/2/
On a different note, it may be a little premature to blame all of Massachusetts' problems with cost containment on Romneycare. The merger between Brigham and Mass General (2 Harvard flagships) did not help.
http://www.forbes.com/sites/aroy/2011/08/22/hospital-monopolies-the-biggest-driver-of-health-costs-that-nobody-talks-about/
Don't get me wrong, I'm not a fan of Romneycare - I just want a full accounting if the facts.
Found this article:
Seriously? Doctors say they're underpaid.
http://thechart.blogs.cnn.com/2012/05/01/seriously-doctors-say-theyre-underpaid/
From halfway down the comments section posted by a someone screen-named "ERDoc":
As a senior ER resident I make about $50k. In a year, I'll make significantly more. On a normal shift I work about 10 hours, during which time I rarely eat, drink, or use the bathroom and I see somewhere between 12-20 patients with an unlimited number of complaints. I work between 20-23 shifts a month, not including administrative time, studying, and academic projects that I am required to complete. I can agree that healthcare costs have ballooned., but doctors are not making the vast majority of this money. What we pay for, as a society, is maintenance of our hospitals and technology. You come to an ER with "the worst headache ever" and you're gonna get a CT scan and an interpretation of your findings. Now you get to pay for the hospital, the CT scanner maintenance, the physical space, the nurses, the EMR fees, radiology technician, transportation services, environmental services, registration, and of course your ER doc and radiologist. There's also static costs like the water bill, electricity, air conditioning etc. I will likely never see the huge salaries that are mentioned here, and even if I did the money would be heavily taxed and much of what is left (at least early in my career) will go to my $200k in student loans and the $95K I owe on my 840sq/ft condo. I will almost certainly drive my Sentra well into this decade and my ailing water heater will ensure that I take lukewarm showers for the rest of residency because I have neither the time nor money to invest in repairing it. Do most people spend too much at the doctor? Yes. Do I get paid enough for what I do? No. Do I love my job? Absolutely. I do my job because I love what I do, not to get rich. All I really want is adequate reimbursement for my time and effort, and a little bit of respect ... and even the respect is negotiable. If I ever struggle to make ends meet as a physician, I will simply change careers to a consultant or administrative position and the US will be down another clinician. Please, stop this nonsense about blaming doctors for the woes of society. The problem is all of ours, not doctors alone.
I know nothing about the inner workings of an ER. Lanesmith (err... Sensei) does what was written make sense to you?
Purely as anecdote, but I recently paid an orthopedic surgeon significantly less for the same procedure I had done, at the same facility, 6 years ago.
The hospital charges, however, had nearly doubled.
Found this article:
Seriously? Doctors say they're underpaid.
http://thechart.blogs.cnn.com/2012/05/01/seriously-doctors-say-theyre-underpaid/
From halfway down the comments section posted by a someone screen-named "ERDoc":
I know nothing about the inner workings of an ER. Lanesmith (err... Sensei) does what was written make sense to you?
Most of what he says is technically accurate. The salaries of physicians who are in training (i.e. residency) is between $40-60k and funded in part by the govt. The work hours in residency were once insane with some rotations averaging 110-120 hrs/week. However, they have recently been limited to no more than 80 hrs / week by regulatory authorities. Once a physician completes residency, things generally improve significantly. How much so depends greatly on the speciality. Surgeons in my region generally work about 60 hrs per week (including overnight call 1 day per week) and bring home about $250K per year with the possibility of added healthcare benefits, 401K, profit sharing etc. While this may seem like a lot of cash, keep in mind that surgeons completed 4 years of undergrad, 4 years of med school, and at least 5 year of residency where most of the hours were >100/week.
Board certified ER docs make similar money, but we work fewer total hours due to the large number of night, weekend, and Holiday shifts. If I had to put a number on it, ER docs in my region make about $125 / hr plus benefits (healthcare, business expense, malpractice, etc.)
We are not starving, but we probably make a little less than we could if the govt would extricate itself from healthcare and allow the market to dictate prices and salaries.
FWIW, I'm leaving clinical practice in a few months to pursue a totally different career in govt service. It's a big pay cut, but I'll get to work with a good group of people. I'll do just enough medicine on the side to keep my credentials so that I can supplement my salary and have a backup plan.
montanadave
08-10-12, 09:18
FWIW, I'm leaving clinical practice in a few months to pursue a totally different career in govt service. It's a big pay cut, but I'll get to work with a good group of people. I'll do just enough medicine on the side to keep my credentials so that I can supplement my salary and have a backup plan.
Great Honk! You're going over to the enemy! :blink:
Just kidding. Good luck in your new endeavors. Despite what some folks may dream about, government isn't going away (and has a legitimate role to play, IMHO) and the more well-trained and educated professionals they can get on board, the more effectively it will function and the better off all of us "citizen-consumers" of government services will be.
CarlosDJackal
08-10-12, 09:27
IMHO, this is all a moot point because the cost healthcare will never be brought under control unless the number of unpaid accounts and the cost of Malpractice Insurance are brought under control.
Whenever someone skips on their bill, we all end up sharing the burden. Let's face it, most hospitals and healthcare providers might have been founded on the idea that they want to help their communities. But they cannot stay open unless they make enough money to offset costs. The only exceptions tot his are those healthcare facilities that are run by charitable organizations - most of whom are religion oriented.
This is one of the second and third order effects of obamacare that people overlook. If the abortion and birth control mandate is upheld and forced unto everyone; these institutions that bear a huge chunk of the unpaid accounts could end up closing their doors. Once they close we will either experience a shortage of healthcare or more for-profit versions (to fill the void).
The result will be that we will be bearing even larger amounts that these organizations will have to pass on or risk closing their doors as well.
As far as Malpractice Insurance is concerned, I find it ridiculous that the premiums for Shock Trauma Surgeons are so outrageous. This is because Shock Trauma hospitals experience more losses than most other hospitals for obvious reasons. Most of the cases that they see involve cases where the patient is guaranteed to die if they do not get to the Surgeons in time and will probably die even if they do get to the Surgeons in time.
Suing a Shock Trauma Surgeon is like suing your Body and Fender mechanic because the car you crashed at 100-mph is declared "Totalled". I understand that there are probably legitimate malpractice cases against SHock Trauma Surgeons. But I am willing to bet that most of their cases involve patients who would have died had they not taken any action whatsoever.
Every evening I see multiple law firms soliciting for clients who may have had some adverse reaction to some drug, treatment, or joint replacement. The fact that their advertisements are always on late night TV should be a clue just how seedy these guys are.
IMHO, we should consider adopting some of the British policy when it comes to Civil Suits where the losing side has to pay the cost of the trial. I bet this would reduce the amount of frivolous lawsuits. The other side to this is it would also probably curb legitimate lawsuits due to the threat of further financial burden should the other side have the better counsel (which ultimately determines your success or failure in a court of law).
But that's JM2CW.
montanadave
08-10-12, 09:43
IMHO, we should consider adopting some of the British policy when it comes to Civil Suits where the losing side has to pay the cost of the trial. I bet this would reduce the amount of frivolous lawsuits. The other side to this is it would also probably curb legitimate lawsuits due to the threat of further financial burden should the other side have the better counsel (which ultimately determines your success or failure in a court of law).
And there's the rub.
FromMyColdDeadHand
08-10-12, 09:50
Building a house would be very expensive too if the government mandated that all contractors had to hold doctorates in engineering and only employees with a masters in hammering assistance could bang nails in.
Are you comparing the complexity of the human body with a 2x4 and a bit of steel designed in the iron age?
IMHO, this is all a moot point because the cost healthcare will never be brought under control unless the number of unpaid accounts and the cost of Malpractice Insurance are brought under control.
And it's not even really the insurance costs that are the real dollar driver, it is the tests that get run- even though the outcome is pretty well known- because if you don't have that bit of data if you get sued, there is no way you'll prevail in court. That is the real cost driver.
Which leads me to the real reform we need. If we are going to socialize medicine, why not socialize lawyer services too?
Service is going to suck, technology will not be updated and care will be rationed in all kinds of ways.
The real revolution in Obama care is that you have to be healthy and not use it to stand a chance of surviving.
montanadave
08-10-12, 10:01
The real revolution in Obama care is that you have to be healthy and not use it to stand a chance of surviving.
Hey, wait a minute. If I understand correctly a lot of the rhetoric coming from the small-gov conservatives/libertarians, there is a strong undercurrent of social darwinism at work (i.e. big government makes people weak and dependent; be reducing government programs people would be forced to "sink or swim").
So if Obamacare results in only the strong surviving, haven't we achieved the stated goal?
(please note: tongue is planted firmly in cheek)
Most of what he says is technically accurate. The salaries of physicians who are in training (i.e. residency) is between $40-60k and funded in part by the govt. The work hours in residency were once insane with some rotations averaging 110-120 hrs/week. However, they have recently been limited to no more than 80 hrs / week by regulatory authorities. Once a physician completes residency, things generally improve significantly. How much so depends greatly on the speciality. Surgeons in my region generally work about 60 hrs per week (including overnight call 1 day per week) and bring home about $250K per year with the possibility of added healthcare benefits, 401K, profit sharing etc. While this may seem like a lot of cash, keep in mind that surgeons completed 4 years of undergrad, 4 years of med school, and at least 5 year of residency where most of the hours were >100/week.
Board certified ER docs make similar money, but we work fewer total hours due to the large number of night, weekend, and Holiday shifts. If I had to put a number on it, ER docs in my region make about $125 / hr plus benefits (healthcare, business expense, malpractice, etc.)
We are not starving, but we probably make a little less than we could if the govt would extricate itself from healthcare and allow the market to dictate prices and salaries.
FWIW, I'm leaving clinical practice in a few months to pursue a totally different career in govt service. It's a big pay cut, but I'll get to work with a good group of people. I'll do just enough medicine on the side to keep my credentials so that I can supplement my salary and have a backup plan.
All the docs I know work damn hard for their money, and factoring as you mentioned the time and huge $$$ spent on education, and other factors, I do not begrudge at all what most docs make. Their salaries are (a) generally well earned and (b) not a true factor to our health care issues.
Even the truly insane salaries of CEOs in insurance, pharma, etc, although difficult to justify (in my opinion, your mileage may vary) in relation to their performance and worth, wouldn't make a fraction of where the $$$ goes in terms of health care.
Pharma spends far more on marketing now than they do on R&D (yet claim the huge costs of drugs is their trying to recoup $$$ spent on R&D, etc) and taking an old drug that's cheap to produce and R&D costs recouped decades ago, changing the name, and charging a fortune for it, pharma tricks of the trade that gets passed onto everyone as their profits continue to grow as the rest of the economy sucks.
And going tad OT, pharma has had some serious QC issues - some of them found intentional and criminal - to cut corners and improve profits while potentially endangering end users of their products.
I wrote an article on that which just scratches the surface:
Poor Quality Control In The Pharmaceutical Industry: A Report (http://www.brinkzone.com/articles/poor-quality-control-in-the-pharmaceutical-industry-a-report/)
I once thought that "defensive medicine" (i.e. ordering tests to curb legal risk) was a major driver of healthcare costs. Unfortunately, I've recently learned that it plays a much smaller role in cost than I once thought. Look at TX as an example of a state that enacted very agressive malpractice reforms. They changed the standards for negligence and capped damages just like the medical special interest asked. However, the result was rather unexpected. While malpractice costs decline, overall healthcare spending has INCREASED in TX with these reforms. When you delve deeper in the numbers, you will also see that malpractice reform had no effect on the number of tests ordered by physicians or any other metric of resource utilization. This was very discouraging to those of us who had hoped to have TX as a shining example of malpractice reform serving as a limitation on cost.
However, it is not all that surprising to people with a good understanding of physician behavior and training. Med schools teach us to form exaustive lists of potential causes of an ailment called a differential diagnosis, and then "rule out" each causes with an over-reliance on testing rather than clinical accumen. In addition, we are generally paid more for diagnosing conditions with tests as opposed to less expensive alternatives such as observation (i.e. rather than get a CT scan to test for appendicitis, come back and see me in 12 hrs and we'll see if your condition has progressed). Finally, many of us in medicine are pompous, prick, assholes who don't like to be wrong. Thus, if there is a test that validates suspicions and strokes our egos, then you can bet your bottom dollar that we will order it.
Finally, there is an increasing tendency for patients to expect a test for every ailment. For example, many are visibly upset when told that they have a virus and the doctor does not "prove" that it's not strep throat with a test. They also want an ultrasound for every bruise on their leg or varicose vein because someone on the Internet said that it could be a "blood clot." While some are reasonable and just need a good explanation and reassurance, a vocal significant minority seem to drive physician behavior.
montanadave
08-10-12, 12:22
^ Testify!
I feel very fortunate to have a PCP/internist who is firmly in the "if it ain't broke, don't fix it" camp who is far more focused on treating the patient rather than treating the test.
Plus he saved my life 11 years ago by admitting me to the hospital overnight when everybody else voted to send me home. Turned out I had 85% occlusion of my LAD. Give me a conservative doc with excellent diagnostic skills who follows his hunches.
Like so many components in our society, the problems in healthcare and its costs have been purposely made so compounded and convoluted that there is no simple solution that will ever be implemented. It will limp along along until we hit the breaking point and then probably collapse into a shambles. Only then will the populace be open to a simpler, cheaper healthcare system (that is, when cheap credit and enforced cost sharing are no longer available).
It would be nice to have a system in which some docs could decide to run a simple practice to care for the day to day things and are paid mostly in cash and are free of nearly all regulatory and insurance burden. This would be low cost and basic.
For more complicated cases the patient could be referred to a hospital if they have private insurance to cover it.
At some point we have to accept than some people will not be able to afford much care and will suffer and sometimes die as a result. That is life. I think also that charitable doctors/hospitals ought to be freed of govt oversight and costs so they can offer care at no/low cost if the patient so chooses such care as better than nothing. Mother Theresa once tried to open a free hospice place for the destitute dying but NYC demanded the donated building be upgraded with elevators at a cost of millions. Mother Theresa passed on the project so now NYC has one less place for the most poor to receive care and comfort in their last days.
When govt gets involved it is always to the benefit of the largest corps., and always to the detriment or elimination of the smallest operators who generally provide a lower cost alternative.
I once worked on a project with a team from Andersen Consulting (back when they existed before Enron, etc.). The Andersen manager happed to have a father in the top tier fo govt healthcare. When Washington State tried to get universal healthcare passed he and his consulting company were nearly orgasmic with anticipation. When I asked him why he said it would drive out all the little care providers and leave just the five or six largest providers, which makes those companies much richer and able to afford more consulting services. Big govt and Big business are kissing cousins, not enemies.
In fact, I would submit that the very purpose of big govt is to create a financial and regulatory environment that eliminates small business competition and consolidates wealth to a few multinationals. Big govt is always at the expense of the liberty and wealth of the individuals and small businesses. Socialized medicine is the same thing.
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