A WORKING GROUP of the Massachusetts Senate unveiled health care legislation on Tuesday that promotes the treatment of patients in more cost-effective settings while laying the groundwork for tougher regulatory oversight of hospital readmissions and payments to pharmaceutical manufacturers and hospitals.
The working group, led by Sen. James Welch of Springfield and funded by the Milbank Memorial Fund of New York City, traveled to Minnesota and Vermont while meeting virtually with officials from Oregon, Washington, Texas, and Maryland to learn what those states are doing to improve health care delivery. The group also held a series of roundtables with local stakeholders.
In releasing a report and legislation at a State House press conference, members of the group tended to focus on issues of interest to them. Senate Majority Leader Harriette Chandler of Worcester trumpeted the legislation’s promotion of telemedicine and the use of dental therapists, who could deliver care in settings where dentists routinely don’t go – nursing homes, schools, and rural areas.
Sen. Jason Lewis of Winchester talked about the role of social determinants in health care and Sen. John Keenan of Quincy touted the development of behavioral health urgent care centers so patients could seek out care there rather than going to emergency rooms.
Chandler suggested the Senate legislation could become as important as universal health care, which started in Massachusetts and came to be known as Romneycare before it was known as Obamacare. “I probably shouldn’t be so bold, but I suspect that this could become Bakercare, and I would like to see it become Trumpcare because I think this is what the country needs,” she said.
Sen. Karen Spilka of Ashland, the chairman of the Senate Ways and Means Committee, said the health care legislation would yield savings of $114 million for MassHealth and savings of $475-$525 million in commercial markets by 2020. She said some of the savings could come sooner depending on when the legislation is enacted.
Gov. Charlie Baker has pressed legislative leaders to reduce the number of people on MassHealth or subsidized health plans, but the Senate bill doesn’t do that. Instead, it offers employers enticements to insure workers who would be eligible for MassHealth and tries to shame those who don’t by publishing the names of the 50 employers with the most workers on MassHealth.
The Senate’s bill also, cautiously, lays the groundwork for a more interventionist regulatory strategy by state officials in healthcare markets.
One area of focus is hospital readmissions, trying to reduce the number of patients who are treated and released but end up back in the hospital because of some complication. One recent state report found that 26 percent of inpatient discharges were followed by a return to the emergency room within 30 days.
The Senate’s proposed legislation directs the Health Policy Commission to set a readmission reduction benchmark and over time penalize those health care providers who fail to meet the target.
The legislation also tasks the Health Policy Commission with gathering much more detailed information on pharmaceutical products and their cost. Officials said the information would be used to track spending more closely and also to provide information to caregivers on the efficacy of various drugs. The commission’s work would be funded by fees assessed on pharmaceutical manufacturers who sell products in Massachusetts. “They’re paying to be overseen,” said Welch. “This is a very big first step.”
One other major initiative contained in the legislation is the creation of a Hospital Alignment and Review Council, charged with sorting out the disparity in payments hospitals receive from insurers for providing the same services. The issue has been bandied about for years, but came to a head in 2016 when 1199SEIU, the health care arm of the Service Employees International Union, pushed a ballot question that would have required health insurers to pay hospitals no more than 20 percent above or 10 percent below the “carrier-specific average relative price” for a service.
Proponents of the ballot question said it would have lowered payments to higher-cost providers such as Partners HealthCare by $463 million while putting $196 million into the pockets of struggling community hospitals. State leaders brokered a deal to pull the question off the ballot by promising some concessions to the union, some extra funding for community hospitals, and the creation of a price disparity commission.
The Senate bill addressed the price disparity issue in a cautious manner. The legislation calls for no hospital to be paid less than “90 percent of the statewide commercial relative price,” but leaves it up to the market to determine how that target should be reached. If the market hasn’t brought lower-paid hospitals up to the 90 percent level after three years, Welch said, the Hospital Alignment and Review Council could intervene and start handing out financial penalties to address price disparities. Tyrek Lee, the leader of 1199SEIU, spoke favorably about the legislation at the Senate press conference.
The Hospital Alignment and Review Council would be headed by officials from the Division of Insurance, the Health Policy Commission, and the Center for Health Information and Analysis.