Vital Signs September 2013
A Vital Signs Interview with David Seltz, Executive Director of the Health Policy Commission
The newly created Health Policy Commission faces a formidable task: to oversee and implement the ambitious spending limits set forth by Governor Deval Patrick in his 2012 payment reform law.
At the same time, the commission must navigate other uncharted health care waters, namely overseeing the certification of accountable care organizations, and a series of regional hospital improvement grants.
The commission has also broken new ground by electing to review certain large hospital mergers.
For the commission’s executive director, David Seltz, taking over the top post six months ago was a chance to pursue a challenge he called “the next chapter” in Massachusetts health care reform.
“Personally, I have a passion for this. I believe the ongoing health reform here in Massachusetts is worth defending and strengthening, and this coalition around this effort is so important to that,” said Seltz, 32, a former health care advisor to Gov. Patrick and Massachusetts Senate President Therese Murray.
Seltz sat down with Vital Signs to discuss his first several months on the job, the challenges and time pressures his agency faces, and how policymakers should best balance cost controls with economic growth.
The commission won’t be able to change decades of entrenched practices overnight, Seltz said.
“This isn’t going to be solved in one year,” he said. “If we are too focused on the year-to-year [in terms of cost-containment] we are going to lose something in the long term. It’s not just about meeting the benchmark, but also what is driving it and what is happening underneath that.”
Because health care is a top Massachusetts industry and employer, Seltz said he must frequently address concerns from business groups and health care systems that overenthusiastic cost-cutting and patient protections will halt growth.
“We take the job of balance very seriously,” he said. “The vibrancy of the health care industry is so connected to our innovation economy… We wanted to ensure that our actions regarding cost containment would not be a hindrance. Part of this is pushing towards shared goals, but recognizing that change can be destructive sometimes.”
“You could imagine a scenario where we meet the benchmark but see some trends that are very troubling. Part of our role is to identify those [trends] and put forth some policy recommendations to mitigate those,” Seltz said.
The commission, which includes its chair, veteran National Health Advisor and Brandeis University Professor Stuart Altman, Harvard University Health Economist David Cutler, and Carole Allen, M.D., who recently retired as director of pediatrics for Harvard Vanguard Medical Associates, are now grappling with the “difference between writing legislation and implementing legislation.”
The guiding values of the commission are transparency and a collaborative approach, he said.
“We weigh wanting to move quickly with wanting a deliberative process and making sure there is a voice for all the affected stakeholders,” he said. “Ultimately we are focused on the consumer impact of market changes.”
But that does not mean reinventing the health care wheel, he emphasized.
“We can’t pretend [the commission is] going to come in and solve all of these problems on our own; we need to ensure we are tapping into all the resources already here. These efforts around changing [the] health care system have been going on for quite awhile,” he said.
That means frequent “listening sessions” around the state far in advance of any regulatory changes.
Seltz said he is carefully considering issues raised this year by physicians, such as complaints that state regulations and data reporting requirements — sometimes to five or six state agencies per year — is a disincentive for some doctors to remain in private practice.
“The state has set out a vision for the health care industry to be more coordinated and share information, but the state should also be having that same goal,” he said.
Alignment should be a two-way street for physicians and state officials, Seltz said.
“Where appropriate, agencies should share information so we are not asking for another level of data or reporting that is unnecessary. We have definitely heard that message and are striving to minimize the administrative burden,” he said. “Quality indicators are one of those things where physicians have a lot of frustrations, and we have to ask ourselves, are we actually aligning in a way that will drive things in the right direction.”
– Erica Noonan
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MMS Legislative Priorities Included in FY 2014 State Budget PMP and DA&O Programs See Important Changes
Governor Deval Patrick recently approved a $34 billion state FY 2014 budget that made important improvements to the state Prescription Monitoring Program (PMP) and the Disclosure, Apology and Offer (DA&O) program. These issues have been major advocacy priorities for the MMS.
Under the revised PMP rules, physicians would have to check the program only when prescribing a Schedule II or III narcotic to a patient for the first time. As originally written, the law would have required physicians to use the PMP for every new patient, regardless of age, diagnosis, or intent to prescribe a scheduled medication.
The budget also specifies that payments made under the DA&O program will be exempt from inclusion in Board of Registration in Medicine physician profiles.
