BOSTON — As the Legislature gears up to take another run at making comprehensive reforms to health care, lawmakers and health care executives on Tuesday pitched a variety of ideas they said would help to control the cost of care in Massachusetts.
Among the roughly 30 bills before the Committee on Health Care Financing on Tuesday were a series of bills related to community hospitals, which often serve as lower-cost alternatives to larger institutions. Stabilizing community hospitals was a central focus of the health care reform bill House and Senate lawmakers could not finalize before last session ended.
Community hospitals contend with a gap between the rates paid to large research hospitals and those paid to smaller community providers. The state's larger teaching hospitals often argue that the higher rates they receive are necessary to support their teaching and medical research functions.
"Delivering health care of the same quality, with the same outcomes, is a challenge we meet, for now. We do it in spite of our low health plan rates, and very high exposure to Medicaid. This combination is typical for hospitals in communities like Lawrence, Brockton and Holyoke — high Medicaid volume, low commercial rates," Lawrence General Hospital President and CEO Dianne Anderson told the committee. "Massachusetts is unwittingly, and with no policies to arrest it, building a two-tiered system of health providers — one tier is paid well and serves largely commercially insured patients, and one that is paid poorly that serves a growing proportion of low-income patients."
Anderson — along with Win Brown, CEO of Heywood Hospital in Gardner, Cambridge Health Alliance Chief Medical Officer Dr. Ayyad Sayah and Dan Keenan, vice president of Mercy Hospital in Springfield — testified in favor of a Rep. Frank Moran bill (H 1184) that would increase the price floor to a minimum of 90 percent of the statewide average relative price, similar to an approach adopted last session by the Senate.
"The remedy is affordable," Anderson said. "If health plans paid us and all of the other providers who are paid less than 90 percent of the average relative price, at that level, it would cost a fraction of 1 percent of the total annual commercial health care spend in Massachusetts."
When the Senate considered it last year, the cost of bringing all hospital payment rates up to 90 percent of the statewide relative price was estimated at an additional $180 million each year. The House's approach last session was to authorize $337 million in new assessments to stabilize community hospitals.
"As we take up health care reform again this session, it is clear that community health centers are an imperative part of that discussion," Rep. Thomas Stanley said, testifying in support of a Rep. Kevin Honan bill (H 1165) that would create a Community Health Center Transformation Fund and instruct the state to provide at least $15 million annually to community health centers based on need.
The committee, which is likely to serve as the point of origin for whatever health care reform legislation the House and Senate plan to take up this session, also heard Tuesday about a bill (H 1156) filed by Rep. Ken Gordon to allow patients on MassHealth, the state's Medicaid insurer, to receive care at an urgent care center without having a referral from their primary care physician.
"MassHealth requires a referral in order to treat a patient that comes in without a referral from a PCP, primary care physician. No other insurance company requires such a referral," Gordon said.
Dave Adams, president of Freedom Health Holdings, which oversees six Massachusetts urgent health centers, said the average cost of care at an urgent care center is about five times lower than the cost of the same care at a hospital's emergency department. Because MassHealth patients need a PCP referral to receive care at an urgent care facility, Adams said many instead go to ERs for treatment when their primary care doctor is not available.
"We believe we can lower the cost of health care in the state of Massachusetts by many tens of millions of dollars by allowing us to treat MassHealth patients in our urgent care clinics without a referral so that those patients don't go to ER and use them as a primary care office," he said.
And the committee also heard Tuesday morning about a Medicaid issue that Rep. Tricia Farley-Bouvier said might go unnoticed in most parts of the state. When a resident from her Pittsfield district gets treatment at a hospital in another state, like nearby Vermont or New York, she said it often costs MassHealth more than if that patient received care in Massachusetts.
"Southern Vermont Medical Center is paid the statewide average, which is more than the Western Mass. hospital rate, and so it has created a kind of perverse incentive for Southern Vermont Medical Center to advertise, in particular, in northern Berkshire County to pull patients to them because they get paid more than Berkshire Medical Center and, interestingly, they get paid more for a Berkshire County resident than a Bennington, Vermont, resident," Farley-Bouvier said.
That system has led to "a lot of billboards in Berkshire County for Southern Vermont Medical Center," a hospital which Farley-Bouvier said is about 30 minutes closer to Pittsfield than Baystate Medical Center in Springfield.
Farley-Bouvier proposed legislation (H 1149) under which MassHealth would reimburse out-of-state hospitals at the rate in that state, not at the Massachusetts rate.
"MassHealth would pay the Vermont rate for Vermont, the New York rate for those going to Albany," she said.