Ten years ago, medical costs skyrocketed, so Massachusetts passed a landmark law to tackle the problem.
The law created the first-of-its-kind oversight body, the Health Policy Board, to monitor rising costs. And set goals to limit spending growth.
Ten years later, this cost control effort has met with mixed success. Although the rate of growth in healthcare spending has slowed, consumers and businesses are still grappling with rising costs each year.
Today, many healthcare industry insiders and observers say progress has stalled. They say the Health Policy Board needs more power to hold the industry accountable for high spending and make health care more affordable for all.
Commission leaders also argue that more powers are needed, including the ability to impose larger fines on providers and insurers that exceed spending targets.
“We have made great strides in slowing the growth of health care costs. One David Seltz said:
“We need to keep the pressure on spending growth in check,” he said. “At the same time, we need to enable health insurers to pass those savings on to consumers in a way that people feel: premiums, copayments, deductibles, and so on.”
From the beginning, the Health Policy Board has used the bully’s pulpit to sound the alarm about hospital mergers and other potentially costly trends. General Brigham’s South After warning that his plan to buy Shore Hospital would be expensive for consumers, Attorney General Maura Healy threatened to sue, and General Brigham (then known as his Partners HealthCare) made a final decision. I stopped trading.
Earlier this year, the committee expressed concern about General Brigham’s plans to build three new ambulatory surgery centers. General Brigham eventually abandoned that plan as well, but he went ahead with other plans to build a new inpatient ward at Massachusetts General Hospital.
In other instances, based on comments from the Health Policy Board, public health regulators forced hospitals to meet certain cost control conditions in order to merge or expand.
Laura Pellegrini, president of the Massachusetts Health Planning Association, which represents insurance companies, said:
Pellegrini said the commission needs more power to deal with high hospital prices and prescription drug prices.
“As time goes on, some people realize that HPC doesn’t have that power,” she said.
“Hospitals and doctors are asking health plans like Blue Cross to significantly increase the prices we pay for their services. And that worries me a lot.”
Andrew Dreyfuss, Massachusetts Blue Cross Blue Shield
Andrew Dreyfuss, chief executive of Blue Cross Blue Shield of Massachusetts, the state’s largest health insurer, also said the commission’s influence appeared to be waning and called for the state to do more. rice field.
“Hospitals and doctors are asking health plans like Blue Cross to significantly raise the prices we pay for their services. And that worries me a lot.” He said, “Because that’s what put us in this position in the first place.
“There is a risk of reversion,” he said.
But some hospital leaders feel unfairly targeted by the committee and are concerned that the committee has already gone too far in shaping the industry.
The COVID pandemic has taken a toll on hospital finances and they are now facing rising costs due to inflation and ongoing labor shortages.
Steve Walsh, president of the Massachusetts Health Hospital Association, said hospitals are trying to balance these rising costs with the need to keep health care affordable.
Walsh, a former lawmaker who worked on the 2012 law, said hospitals will follow the law “It’s unbelievably serious,” he said, but said states need to set more flexible spending targets that take into account historical levels of inflation.
“Suppose the cost of all goods and services offered rises by 10%, keeping the benchmark at 3.6%. [cost increases]it’s just a preparation for failure,” he said.
State law has set a goal of keeping health care cost growth statewide at less than 3.6% annually. The Health Policy Board can require medical institutions that exceed their targets to submit cost-cutting plans.
The Commission has done this only once this year, with General Brigham.
But the fine for non-compliance is $500,000, a small amount for a multi-billion hospital system.
“I think we’re seeing the limits of HPC’s power,” said Paul Hattis, Senior Fellow and former board member of the Lown Institute.
Even the Commission’s supporters agree they have failed to change the fundamental dynamics of the healthcare market.Large hospitals and insurance companies continue to expand and consolidate. The price gap between large teaching hospitals and smaller regional hospitals remains steep. And patients still pay for medical care annually.
According to Amy Rosenthal, executive director of Health Care for All, her consumer advocacy group is constantly receiving voices from people who can’t afford drugs and doctor visits.
“Affordability in healthcare is one thing we hear every day in every language we serve,” she said.
41% of Massachusetts residents say they or a family member had a hard time paying for medical bills in the last year. And many have given up on the care they need, according to a study by the Center for Health Insurance and Analysis (CHIA), a state agency that analyzes health data created by a 2012 law. increase.
Massachusetts spent $62.6 billion on health care in 2020, or about $9,000 per person, according to CHIA’s latest statistics. Spending declined in 2020 as medical facilities closed early in the COVID pandemic, but is expected to rise again more rapidly than in previous years.
Massachusetts has long been a national model for health policy. In his 2006 law signed by then-Governor Mitt Romney, the state extended health insurance coverage to nearly all residents. The second, and more complicated, stage of reform began six years after him, when former governor Deval Patrick signed the Cost Control Act into law.
Several states have seen Massachusetts’ experience and enacted similar cost control measures, sometimes with harsher penalties.
Katherine Biker, dean of the University of Chicago’s Harris School of Public Policy, said states should not only look at how much they spend on health care, but whether that money is being spent on worthy services that help people stay healthy. He said it should be considered.
“You’ll want to make sure the resources are worth the money,” she said.
Ultimately, Massachusetts lawmakers and the next governor will decide whether to give health policy committees more power or try other strategies to make health care more affordable.
House and Senate leaders told WBUR they plan to review healthcare spending in the next legislative session, including a review of the role of the Health Policy Committee and how it is expanded.
““One of the hallmarks of health care reform efforts in Massachusetts is the willingness to evolve based on lessons learned,” said Seltz, who heads the commission. “After his decade, it’s time to rethink and reframe our approach to healthcare cost containment.”