March 8, 2012 | No Comments
Posted by Frank Ciesla
As commonly discussed, people look to “Romneycare” to see what steps are occurring in Massachusetts and whether or not those steps are precursors to what will happen under “Obamacare” (PPACA). At two speeches I attended last summer in Boston during the American Health Lawyers Association Annual Meeting, the Governor of Massachusetts praised the increased access and availability of health care to the residents of Massachusetts, but avoided discussions as to the growing cost of health care in Massachusetts. A day later in a speech by a Massachusetts Deputy Attorney General, he described the extraordinary steps taken by the State of Massachusetts to obtain information in regard to the cost of health care.
Massachusetts convened a state grand jury with subpoena power to subpoena the records of both insurance companies (payors) as well as the records of hospitals and physician groups (providers) to determine what was being paid to whom, and if possible, why. As a result of the acquisition of what, up to that time, was very confidential information, the Attorney General of Massachusetts was able to issue a report showing the differentials between what is paid to some physicians and physician groups versus other physicians and physician groups for the same procedures as well as similar situations involving hospitals.
One of the major issues currently being debated under both “Romneycare” and “Obamacare” is cost. While both of these approaches initially focus on access, neither of these approaches focus on cost containment. What the activities in the State of Massachusetts shows is that it appears inevitable that the next step under “Obamacare”, will be to focus on costs just as the State of Massachusetts under “Romneycare” is focusing on costs. (http://bostonglobe.com/metro/2012/03/07/speaker-deleo-annual-medical-cost-increases-could-held-percent-containment-bill/1EeY9HCeA9dqB80bO0yxkO/story.html)
What is clear is that the State of Massachusetts is experiencing both the additional cost to the health care delivery system as a result of the increased access to health care under “Romneycare”, as well as the historic increases experienced by the health care system. From a provider point of view, what is disturbing is that the Massachusetts legislators appear to be lumping together the costs associated with increased demand and the increase in costs due to normal economic pressures on the health care delivery system. These normal increases include the cost of benefits to hospital or physician employees, as a simple example.
The Massachusetts situation needs close monitoring so that providers nationwide can see how their reimbursement may be altered and whether or not the increase in access and therefore the increase in costs associated with such demand will be paid for out of reimbursement to providers.