As 2016 kicks off in earnest with a traditional New England cold front, MHA's member hospitals, health systems, physician groups and caregivers can reflect on the many accomplishments and challenges we have faced in the past year, and anticipate our ongoing and future efforts to make healthcare even more safe, high-quality and cost-effective in the future.
The latest Health Policy Commission (HPC) 2015 Cost Trends Report provides an important look at our state’s healthcare landscape. It reveals progress and challenges across the board, but I was particularly pleased to note some of the outstanding progress Massachusetts hospitals have made in bending the cost increase trend.
The HPC report specifically notes that commercial hospital and physician spending grew just 1% per capita in 2014, significantly below the state's cost growth benchmark of 3.6%.
Hospitals and physician groups are leading the way in reducing the growth in healthcare spending, even in the face of government underpayment for care provided to those enrolled in state and federal healthcare programs like Medicare and MassHealth. They deserve recognition for these efforts.
This continued reduction in the cost trend for hospital-related services is the result of numerous proactive efforts large and small. I believe the best way to advance this success is to escalate the movement to alternative payment models.
More transparency and a rigorous conversation are also in order regarding prescription drug prices as a driver of healthcare trends. Providers are limited in what they can do to mitigate cost escalation in this area, but it is clear that reducing total healthcare spending requires attention to all components of the overall cost trend. Just think what the cost trend would have looked like had we not had such significant increases in drug costs.
To use a cold-weather analogy, we have to be careful not to focus too much on individual threads when we should be looking at the entire sweater. The sooner the market can move to alternative payment in all delivery settings, the sooner we will get more comprehensive connected care, better quality and, as a byproduct, lower expenditures.
Looking ahead, there are two particular challenges that will engage hospitals and care providers in the New Year.
First is an onerous ballot initiative that seeks to regulate hospital pricing at the ballot box. This proposal is seriously flawed, overly simplistic and could potentially move Massachusetts healthcare reform in the wrong direction after years of real progress.
MHA's board of trustees, which represents hospitals of all types and sizes across the commonwealth, voted unanimously to oppose this "regulation from the ballot box" proposal. We already tried healthcare price regulation and ultimately rejected it as inflexible and fraught with unintended consequences. Instead we have moved to a hybrid system that involves both government and the market; there is great wisdom in having a balanced approach. We should be extremely cautious about attempts to essentially go back to the past to adopt a system that couldn't adapt to the comparatively simple healthcare system of the 1980s. Given the rapidly changing healthcare payment system of today, we need a different approach.
Current reforms—namely the healthcare cost containment law, Chapter 224 – haven't been fully implemented. Alternative payment models are expanding, there is greater integration of care, healthcare information technology is improving, and greater transparency will bring information to the public and policy makers that will promote better care and efficiency. The status quo isn't perfect, but it has helped drive progress at a macro level. Meanwhile, concerns have been raised about how the market system has been operating and the resulting variation in prices for individual providers. Such issues can be examined and resolved without engaging in the charged environment of a political campaign.
Perhaps most importantly, the ballot initiative doesn't address one of the greatest contributors to hospitals' financial challenges: low government reimbursement. For hospitals that are under financial stress, a common denominator is government underpayment for the cost of care. For the many hospitals that are overwhelmingly reliant upon government reimbursement, the real solution is adequate government reimbursement.
The second long-term challenge is confronting and defeating the opioid addiction crisis in our commonwealth.
The hospital community appreciates the leadership that the Governor, House Speaker, and Senate President have brought to this crisis. We are committed to promoting proposals that recognize that any solution has to call for action from all the key stakeholders: providers, insurers, government, law enforcement, and communities.
As hospitals we recognize our special responsibility to identify and implement solutions. The priority remains our patients. Hospitals must effectively use their resources and skills to both prevent and treat substance use disorders. Hospitals should be accountable for the care they provide, but they must also be allowed to use their best clinical judgment to meet the needs of each patient suffering from, or in danger of suffering from, an addiction, without disadvantaging other patients who have pressing medical needs such as managing chronic pain.
Hospitals are open to changing how addiction is addressed as a matter of urgent public concern. But any limitations on the clinical judgment of physicians should be done in a way that recognizes that caring for patients, especially in an emergency situation, is not a simple "either or" decision. Not all patients and situations are equal, therefore some level of professional discretion is necessary and in the best interest of patients; but at the same time there should be transparency and accountability to address any individual providers or circumstances that may be contributing to the problem.
And collectively we must work to ensure that preventive resources are widely available across the state so that there is less need to turn to hospital emergency departments to treat addictions. Rather than being housed in hospital emergency departments, those in need of on-going care and support should have a place to turn to in their local communities.
MHA has been working for months with member hospitals across the state to galvanize efforts within the hospital community to address the opioid crisis. Our Task Force on Substance Use Disorder Prevention and Treatment has already produced a first-in-the-nation standardized guidance for hospital Emergency Departments and is now working on guidance for other hospital departments and facilities. Progress is being made, but so much more needs to be done before the affliction of substance abuse is no longer ruining and ending lives within our communities.
We see the bills now working their way through the state legislature as further opportunities to collaborate and identify creative, compassionate, and flexible solutions to address this intractable problem. We are all united in our common goal to help, in the most effective manner, patients and families suffering through this terrible crisis.
May 2016 be the year we achieve these goals.