Seltz dissects Mass. health care market

Massachusetts health care costs are expected to actually drop this year because of a decline in non-COVID care, but the executive director of the state’s Health Policy Commission says many of the underlying drivers of spending haven’t changed.

David Seltz, speaking on The Codcast with John McDonough of Harvard’s T.H. Chan School of Public Health and Paul Hattis, a retired associate professor at Tufts University Medical School, said the clout of larger health care providers remains undiminished and health insurance rates are already scheduled to rise next year.

Seltz said one of the disconnects in the state’s health care system – that larger hospital systems receive higher payments for many procedures without providing any qualitative difference in care – has remained unchanged over the last eight years.

“It does not appear to be an issue that fixes itself and policy solutions are difficult to find consensus on,” he said.

Seltz said he expects more consolidation in the health care industry in the wake of COVID. And he said he would not be surprised to see larger hospital systems use their clout in the marketplace to negotiate higher rates next year to recover their COVID losses.

“Will these precious dollars go to the biggest systems or will they go to the smaller hospitals?” Seltz asked. “Will we actually see a greater divergence in these payment rates when the pressure is on and the pie is only getting smaller?”

 

Health insurers seem to be preparing for much higher costs next year. Even though health care spending is declining this year, health insurers have already won approval from state regulators to raise their rates an average of 8 percent next year. Some insurers are projecting double-digit rate increases.

“The numbers are troubling,” Seltz said. “It raises a lot of questions for you and the public because we know there will be financial windfalls for many health plans in the current fiscal year.”

He said health insurance plans are probably trying to be conservative, guessing that pent-up demand for health care services, including a COVID-19 vaccine, will drive up costs substantially. Still, Seltz said, it’s hard to defend a big rate increase at a time when costs are falling.

“That’s a hard story to tell the public, and rightfully so,” he said.

Seltz, in an interview that covered a wide range of issues just prior to his agency’s annual cost-trend hearing, made clear the Health Policy Commission will remain focused on old and new priorities to rein in health care spending.

In the category of old priorities, Seltz said the commission recently examined prior authorization rules of eight health insurance plans for 26 orthopedic procedures. Seltz said the commission found no consistency in the rules among the health plans for any of the procedures, which puts health providers in a tough spot as they navigate the insurance industry bureaucracy.

“It’s so incredibly confusing and so incredibly burdensome,” he said. “That doesn’t seem to be providing very much value on a systemwide basis. … We’re talking about billions of dollars of just added expense.”

One of the commission’s new priorities relates to pharmaceutical costs. A new state law authorizes MassHealth, which administers Medicaid, to negotiate directly with pharmaceutical manufacturers for drug rebates. If those efforts are unsuccessful, state officials can refer the drug to the Health Policy Commission for an evaluation of whether the drug’s value matches its price.

Seltz said no drugs have been referred to the commission yet, but he said the agency is educating itself and preparing for that eventuality. “We’re really trying to build a transparent process,” he said.

BRUCE MOHL

FROM COMMONWEALTH

Gov. Charlie Baker unveils a $171 million package to deal with the end of the state eviction ban, but critics say it isn’t enough, even with a federal eviction ban remaining in place through the end of December.

The Massachusetts Republican Party comes out against Question 2 on ranked choice voting.

MassDOT spreadsheet on I-90 Allston interchange throat options raises questions of bias.

Secretary of State William Galvin tones down his name-dropping in the state’s voter guide.

Opinion: Happy Indigenous Peoples’ Day, say Reps. Jack Patrick Lewis and Lindsay Sabadosa….The era of Columbus is over, says Jim Aloisi….Professor Lawrence Friedman of New England Law says voters should weigh the tradeoffs of Question 1….Michael Quinn, John Tourtelotte, and Chris Warren urge much greater support for vocational schools….Veena Dharmaraj of the Sierra Club and Staci Rubin of the Conservation Law Foundation press the Legislature to pass electrification bills….Steve Pollock of DentaQuest and Joanne Peterson of Learn to Cope remind us that the pandemic has not erased the opioid epidemic….Gabriel Gomez and Evan Falchuk urge a yes vote on Question 2, ranked-choice voting.

FROM AROUND THE WEB             

 

BEACON HILL

A legislative oversight hearing looking into the coronavirus outbreak at Holyoke Soldiers’ Home will hear from families at an Oct. 20 hearing. (MassLive)

Roxbury activist Dominigos DaRosa, who placed a pile of used syringes from Boston’s troubled Mass. Ave. and Melnea Cass Blvd. crossroads on the sidewalk outside Gov. Charlie Baker’s home in Swampscott to call for more action to clean up the area, is now under a court order to stay at least 100 yards away from the governor’s house. (Boston Herald)

MUNICIPAL MATTERS

GBH News Center for Investigative Reporting says it could not locate any evidence that the City of Boston has ever issued a formal sanction under an ordinance that requires construction projects in the city to meet minimum standards for hiring Boston residents, minorities, and women.

Residents gather in Sandwich to protest a machine gun range proposed at Camp Edwards on the Joint Base Cape Cod. (Cape Cod Times) 

HEALTH/HEALTH CARE

Johnson & Johnson suspends its COVID-19 vaccine trials as a patient emerges with an unexplained illness. (Wall Street Journal)

Kevin Churchwell, the longtime No. 2 official at Boston Children’s Hospital, has been tapped to be the hospital’s new CEO, making him one of the most prominent black executives in Boston. (Boston Globe)

Scientists confirm a Nevada man caught COVID-19 twice, and was sicker the second time, raising questions about immunity claims. (NPR)

WASHINGTON/NATIONAL/INTERNATIONAL

The Senate Judiciary Committee holds its second day of hearings today on the contentious nomination of Judge Amy Coney Barrett to the Supreme Court. (Washington Post)

ELECTIONS

Joe Biden is dialing up his pitch to moderate voters in swing states, telling them President Trump has let them down. (Washington Post) Meanwhile, Trump returned to the campaign trail in Florida for his first rally since being diagnosed with COVID-19. (New York Times)

Candidates who run on third party tickets, rather than as Democrats or Republicans, say they hope a switch to ranked-choice voting will give them a chance to break into what has traditionally been a two-party system. (The Salem News) The Boston Globe urges a yes vote on Question 2 to bring ranked-choice voting to the state.

The Globe backs Question 1 — the “right to repair” question on the November ballot — but says the Legislature should also tweak the law to address security and privacy concerns.

Early voting begins this coming weekend, and 1.35 million mail-in ballots have already been sent to voters, according to Secretary of State William Galvin. (MassLive)

Holiday Brook Farm in Dalton created a display out of hay bales to support Joe Biden for president, and a Dalton man is arrested for setting the display on fire. (MassLive) The farm owner promptly recreated the display with a new message on the bales reading, “Love, Unity, Vote, Respect.” (Boston Globe)

BUSINESS/ECONOMY

Worcester’s DCU Center finished the last fiscal year with a $1 million deficit, and is seeking financial help from the city to stem another expected $1.2 million loss by the end of 2020. The convention center closed in March due to COVID-19 and expects to remain closed through December. (Telegram & Gazette)

The Wall Street Journal reported on Friday that Red Sox owner John Henry is in talks to take public Fenway Sports Group, the umbrella company that owns the team.

MGM Resorts seeks to raise $750 million in cash — essentially by borrowing money — as it anticipates a continuing negative impact from COVID-19. (MassLive)

EDUCATION

Public schools band together and, with the help of the Broad Institute, provide their own testing for COVID-19. (WBUR)

ARTS/CULTURE

Debate breaks out in Worcester over how and if to celebrate Columbus Day and whether to revive the city’s Columbus Day parade next year. (Telegram & Gazette)

Indigenous leaders are lobbying lawmakers to change the state flag and seal, which they feel is racist toward Native Americans. (MassLive)

Cape Codders launch a campaign to get Revolutionary War era political writer Mercy Otis Warren commemorated on a stamp. (Cape Cod Times)

TRANSPORTATION

Mary Connaughton of Pioneer Institute and former state transportation secretary Jim Aloisi, a member of the TransitMatters board, say the state must maintain six lanes of roadway and two rail tracks in service at all times during the upcoming reconfiguration of the I-90 “throat” in Allston. (Boston Globe)

CRIMINAL JUSTICE/COURTS

Manslaughter charges brought last month against a Reading police officer are the first time in nearly 30 years that a Massachusetts officer has faced charges for an on-duty killing. (Boston Globe) CommonWealth probed this same issue in 2014, reviewing all 73 on-duty killings by police in the state over the previous 12 years, none of which resulted in charges.

The Globe surveys the varying approaches of the state’s district attorneys to maintaining and releasing lists of problem police officers whose credibility as witnesses in cases could be suspect.

Prosecutors will seek a jail sentence for a former Lawrence court officer who was convicted of evidence tampering, but acquitted of raping a prisoner. (Eagle-Tribune)

Inmates at the Plymouth County jail facing federal charges have dropped a potential class action lawsuit that sought to release some detainees because of coronavirus concerns at the facility. (Patriot Ledger) 

MEDIA

The New Yorker Festival, digital this year, is selling more tickets than the in-person version of past years, albeit at a lower ticket price. (Digiday)

PASSINGS

Donald Comb, the founder of New England Biolabs and a pioneer in the biotech industry, dies at 93. (Gloucester Daily Times)