Cost control key for Mass. health reform

Steve LeBlanc

It may be the least sexy buzz-phrase on Beacon Hill, but “cost containment” could make or break the state’s landmark, and oft-scrutinized, health care law.

Soaring enrollment in subsidized health care plans have sent lawmakers scrambling to find more money to keep the law, which requires nearly everyone in Massachusetts be insured, from collapsing.

Gov. Deval Patrick is asking for an extra $153 million to cover rising costs in the current fiscal year, and observers are questioning whether the $869 million budgeted for the subsidized Commonwealth Care program for the new fiscal year, which begins July 1, is enough.

One long-term solution? Cutting the cost of delivering health care without scrimping on quality.

The state Senate recently approved a bill aimed at tightening spending and streamlining services — from developing an electronic records-keeping system to banning gifts to doctors by representatives of pharmaceutical companies.

And last week, a special panel created to look at the cost and quality of health care in Massachusetts released a report also aimed at reining in spending.

The report recommends keeping the annual rise in health care costs from outpacing increases in the growth of the gross domestic product while improving screenings for chronic diseases and eliminating racial and ethnic disparities in health care access.

More spending doesn’t always mean better care, according to Secretary of Health and Human Services Dr. JudyAnn Bigby, who chairs the Health Care Quality and Cost Council, which was created as part of the 2006 health care law.

“The U.S. spends more on health care than any other country, but we don’t necessary live longer or have healthier lives,” Bigby said.

One of the biggest steps the state could take to lower health care costs is to improve the care of those with chronic diseases like diabetes and heart disease, Bigby said.

Helping them stay healthy, and out of hospitals and emergency rooms, not only improves their lives but also cuts costs, she said.

“We spend a lot of money on the higher end care,” she said.

Another relatively easy step would be to cut the number of infections patients get during hospital stays.

Hospital-acquired infections account for up to four percent of all re-admissions and prolong hospital stays, according to Jon Kingsdale, executive director of the Health Insurance Connector Authority, which oversees the landmark law. The cost of hospital-acquired infections total between $200 and $400 million each year.

Other states have dropped the re-admission rate to nearly zero, he said.

The Senate bill, which now heads to the House, also takes steps in curb costs, including:

• Requiring all major health plans to publicly explain the reasons for annual increasing costs;

• Ensuring hospitals and clinics don’t charge for mistakes such as surgery performed on the wrong body part;

• Authorizing the Division of Insurance to investigate the costs of medical malpractice coverage.

Senate President Therese Murray, D-Plymouth, who helped draft the bill, said cutting costs was “crucial to the future vitality of our health care system and our economy.”

The challenge is putting the recommendations and other changes into effect, Bigby said.

Saying the state needs to cut the number of hospital-acquired infections is one thing, but making sure hospitals and clinics adopt the needed protocols — whether that’s more frequent hand-washing or double-checking intravenous lines — is another, she said.

Coming up with a blueprint for turning the recommendations into a reality is the next task before the council, she said.

“The emphasis on quality is just as important [as cutting costs],” she said.

Unless it brings the rising costs under control, the state will have even more trouble making the law work, according to Kingsdale.

The law already has enrolled about 340,000 formerly uninsured Massachusetts residents in insurance programs — or about 5 percent of the state’s population.

“It’s all about increasing financial access [to health care] and the only way we can afford to do that fairly is to also realize some efficiencies and reduce the costs per covered person,” he said.

(Associated Press)