Presented by Lynda Young, M.D. at the MMS Headquarters,
Waltham
This morning, as we begin our Interim Meeting, we stand in the
midst of very challenging times.
In our nation's capital, debt reduction talks have failed. In
divorce court, they would call it irreconcilable differences. In
Washington, it's called politics.
Medicare fees are scheduled to be cut 27 percent at the end of
this month. However, the conventional wisdom is that Congress will
put together another temporary freeze before then, avoiding the
issue until after the next election.
In Massachusetts, there is consolidation and integration
happening everywhere - from east to west, and north to south.
Hospitals are coming together, and physician practices are coming
together. Better clinical integration is going to be a good thing.
But this will uproot some of our colleagues and change how they
make their living.
Meanwhile, the business community, local governments, and state
government are struggling to pay their health care bills. They're
demanding that we cut health care costs, or they will make the cuts
for us.
About a month ago, at our annual State of the State conference,
Susan Dentzer, the editor of Health Affairs, predicted that
hospitals soon will have to learn to live on Medicare fees. You
could debate about whether she will be proven right, or proven
wrong. But I think she got the spirit of the moment just right -
things are changing, and it's happening very, very quickly.
How did we get to this point in time, and what can we do about
it? That's what I will spend the next few minutes talking about
with you. But first, to see where we're going, let's go back a few
years to see where we came from.
You may remember this scene: April 2006 - the Governor, Senator
Ted Kennedy, and the leaders of the Massachusetts Legislature
gathering at Faneuil Hall, to sign our epic health care reform law.
The day was brimming with hope. We established a goal: Provide
health coverage to as many people in Massachusetts as
possible. By any measure, it was a tremendous success.
More than 400,000 people have insurance today who didn't have it
on the morning five years ago. Today, less than 3 percent of the
population is uninsured - exceeding even the most optimistic
predictions. But we left one important issue unaddressed - the cost
of care. It was a deliberate decision, a conscious choice by
everyone involved: Let's address access first - then, let's deal
with costs. This is what we left for later - the relentless rise in
the cost of health care - while the rest of the economy rose at a
much slower rate, if it rose at all.
If you've been to any presentation that Alice, Mario, Bruce or I
have given over the past three years, you're seen this slide
before. We always show this slide, because we can never forget that
we do not live in a vacuum.
Society at large gives us enormous rights and privileges as
doctors. In turn, it behooves us to be respectful and sensitive to
the pressures that society at large is dealing with.
So today, there is an mandate to deal with the cost of health
care. And by "deal with," they often mean "cut." The days when we
could work around the edges of the issue are long gone.
Let's look at how state government has approached the problem -
and where we fit in.
I mentioned Chapter 58 in 2006: Expand access, then deal with
costs. Two years later, in 2008, we got Chapter 305: A sprawling
attempt to get a handle on health care costs. The payment reform
commission came out of that bill … the commission that Alice Coombs
served on … which recommended a steady transition to global
payments for almost everyone. We all remember that part of Chapter
305.
What was less prominent was a section giving the attorney
general the authority to study trends in health care costs, and use
her subpoena power to get the information that was unavailable
previously. The result was a study that identified large
differences in what hospital systems are paid … which could not be
justified by differences in quality. Once that report came out in
March 2010, the political debate changed forever.
A few months later, we got Chapter 288. There were more cost
control measures, designed to help small businesses. It also
created another commission to recommend what to do about those
payment disparities.
So now we come to this year. The great debate continues to
be: How do we control health care costs? For some people in
government, there is only one answer: Rate setting. In other words,
government decides what everyone gets paid.
That was done with hospitals until the early '90s … and then
abandoned, because there was a consensus that hospital rate setting
didn't work, caused distortions in the marketplace, and stifled
innovation.
Because memories are short, that approach has regained favor, at
least in some circles on Beacon Hill. Our approach, from the
beginning, is that rate setting is NOT the way we should go. We
believe that it would fail again … for the same reasons it failed
20 years ago.But we cannot say no, and walk away. Because if we
walk away, we will get rate setting. There's no question about
it.
There's an old saying that applies here: If you're not at
the table, you're on the menu.
This is not an easy conversation. No one likes to participate in
the reduction of your own income.But costs are coming out of health
care, one way or another. The only question is how, and by how
much. That's a conversation that we must be part of.
That's why Alice was an active participant in the payment reform
commission meetings. That's why we have been part of many other
commissions and task forces over the years. It seems to me that I
go to a different commission or task force meeting every week.
Here's a partial list. What did we get out this? More than most
people realize. In the payment reform bill, this is what we asked
for:
- Go slow; proceed carefully.
- One size doesn't fit all - not everyone can do this. And those
who can make a transition will need lots of support.
- Medical malpractice reform is critical to this. Without
malpractice reform, physicians will not be on board.
- Administrative simplification is important too. Wasted time is
just as damaging as wasted money. There's too much paperwork, too
many prior authorization hoops, and too many processes that add no
value.
What did we get in the Governor's payment reform bill?
Almost everything. What will the Legislature proposed when its
version of the bill is released next year? From what we're hearing
today, everything on this list.
But there is one last issue to address, and that's rate
control.
In our view, the government has a role to play - but not that
role. In our view, the better role for government is to set
the goal, and hold everyone accountable for reaching that goal. Let
the people on the front lines decide how to reach that goal, and
hold them accountable for reaching it. Can it work? I think it
already IS working.
A couple of weeks ago, the Commonwealth Fund released a report
showing that Massachusetts health care premiums are no longer the
highest in the nation. Eight years ago, we had the highest premiums
in the country - now, we're only number 9. And since 2003, the rate
of increase in Massachusetts has been strictly in the middle of the
pack. 26 other states saw their premiums rise faster than
Massachusetts. I don't want to minimize the burden of these
increases on families and businesses. But we could be doing
something right, and it's wise to let us keep doing what we're
doing.
Does that let us off the hook? Definitely not - and it
shouldn't. But it suggests that when we make something our
objective, we can achieve it.
So that brings us to my final point - the Medical Society's role
in all of this. As I suggested earlier, we must stay at the table
in all of these discussions. Everyone wants us there, and we're
making a difference. But our presence at the table guarantees
nothing by itself, and we can't make these difficult conversations
go away. We have to address them directly, and develop solutions
that are balanced for everyone involved.
If we help design the measures to hold ourselves
accountable…
… if we work to protect the vital core of what makes health care
special …
… if we continue to prepare our members for the changes that are
coming …
… we will be doing what we're supposed to do - which is promote
a better health care system for everyone.
I know we're up to the challenge, and I invite you to join
us.
Mr. Speaker, that concludes my report.
