Hospital closures: “Survival of the fattest”

No. Grove St. Today. Note street sign.


Some say the health care system could stand to shrink a bit. Here, Alan Sager of BU uses the sudden closure of North Adams Regional Hospital to argue that the wrong hospitals are closing.  Hidden on the Globe letters page:

Over half of the Massachusetts hospitals open when John F. Kennedy was elected president have now closed. Not one that closed was a major teaching hospital. Heavy reliance on teaching hospitals helps explain our state’s extraordinarily high hospital costs. The pattern of closings may be partly responsible for that reliance.

Some might suppose that a functioning free market protects needed and well-run hospitals while closing unneeded and inefficient ones. Sadly, that pattern seldom prevails. Low-cost, efficient hospitals are not likelier to survive. But hospitals in wealthier places, with more patients insured by higher-paying insurers, rarely close. Some call this survival of the fattest.

More good work from the Globe health desk here:

 Are cardiologists refusing to follow new cholesterol recommendations?

Good morning Denver: Health writers meeting this weekend #AHCJ14

ahcj-logo-topNot much of a Boston presence at the Association of Health Care Journalists meeting this weekend, but we take note anyway.

Even if you are not a writer, the meeting offers much clear-eyed insight into the health care system. And these days, tools we use to probe quality and costs are available to anyone who knows how to sort a spread sheet. Still, journalists and consumers alike need to know how to surf the ongoing tsunami of health care data.

So, follow #ahcj14 on Twitter for tips and the occasional link.

Globe, Times on some of the the 3 million newly insured

globe-ssWith the uproar about computer glitches with the new health insurance exchanges, you would never know that millions of people were about the get coverage at a reasonable cost.

Today, The Boston Globe’s  Chelsea Conaboy offers stories on five of them. The story is  behind the pay wall. You can look at the pictures, go out and buy the Sunday paper or get a digital subscription. 

Much has gone wrong since state and federal health insurance websites created under the Affordable Care Act launched on Oct. 1. Technological glitches have frustrated customers, flustered politicians, and fueled debate about President Obama’s landmark legislation.

Lost amid all the fury, however, have been the success stories.

Many who struggled without insurance are getting it. Others with poor coverage have found better plans. Some whose policies cost a lot, yet covered little, have obtained more comprehensive coverage that — with government subsidies — often costs less.

About 3 million people have signed up for a private health plan through the online insurance exchanges, a senior US health official said Friday. More people are newly enrolled in Medicaid in states expanding that program, which provides coverage to people with low incomes.

Or, check out this story from last week’s New York Times about how the law is having an immediate impact on people who suddenly qualify for Medicaid.

WELCH, W.Va. — Sharon Mills, a disabled nurse, long depended on other people’s kindness to manage her diabetes. She scrounged free samples from doctors’ offices, signed up for drug company discounts and asked for money from her parents and friends. Her church often helped, but last month used its charitable funds to help repair other members’ furnaces.

Ms. Mills, 54, who suffered renal failure last year after having irregular access to medication, said her dependence on others left her feeling helpless and depressed. “I got to the point when I decided I just didn’t want to be here anymore,” she said.

So when a blue slip of paper arrived in the mail this month with a new Medicaid number on it — part of the expanded coverage offered under the Affordable Care Act — Ms. Mills said she felt as if she could breathe again for the first time in years. “The heavy thing that was pressing on me is gone,” she said.


Vertex gets clawed after sales of much-touted hepatitis C drug drop

It sounds kind of hostile, but “clawback” is an economic development term. Instead of using flat-out tax breaks to lure companies that promise new jobs, the Massachusetts Life Science Initiative now holds firms to their promises.  If they don’t generate jobs, companies have to pay back the state.


Boston Redevelopment Authority.

So, Vertex, the Cambridge biotech that just built a $800 million headquarters in the Seaport District, will have to return some of our money.

From the Globe:

With the drug’s sales dropping sharply, Vertex said it is cutting about 17 percent of its total workforce, or 370 jobs — including 175 in Massachusetts — and will return $4.4 million in state tax incentives it received for promising to create jobs.

The company may yet become an anchor of the state biotech sector. But to do so, executives will need to make good on their plans to build a multi-drug pipeline — something few in the high-risk biotech business have done. The first test will be winning approval for a portfolio of cystic fibrosis drugs.

The city of Boston also contributed to the project.

Clawbacks provide taxpayers a way of making sure their investment in development subsidies pays off in the form of real public benefits, and allow governments to recoup their money if it does not. The concept of a clawback may seem like common sense. However, with the way many subsidy deals are currently structured, companies often face no penalties if they fail to deliver on promised jobs or investment. A company’s plan to create public benefits may be regarded by both corporate executives and public officials as more of a goal than an enforceable commitment. Governments often take a “good faith” approach, assuming the company has done and will continue to do its best, and letting it off the hook if it falls short. 

Often, companies will threaten to relocate unless they win tax breaks. Vertex was considering its move at the time the state was setting up its life science subsidy program. From Nature Network Boston:

For Josh Boger, the head of Vertex Pharmaceuticals, the need for incentives from the state is real. “I’m the one who regularly gets detailed reports about how much more favorable things would be if we moved Vertex to another state,” said Boger, who is also the current chair of BIO, the national association of biotechnology companies.

As Vertex looks to expand its headquarters, Boger has been listening to pitches from other states, as well as other countries. “Am I looking at Massachusetts? Yes,” he said. “That doesn’t mean that I’m not looking elsewhere.”

Checking in with this week’s edition of the Health Wonk Review

The new Health Wonk Review is up with a collections of health policy blog posts. Image

This edition includes comments on a Harvard School of Public Health study on “how public and healthcare experts perceive very different reasons for Medicare’s always-impending insolvency.” Also, the latest on the effort to shut down the government in an effort to defund the affordable care act.

With the exchanges coming on line next week, it’s a good time of check in with this crowd.

Beyond the ACA,  local blogger David William takes on those who take on doctor rating programs.

The importance of the hospital patient survey and more policy news

Two local bloggers contribute to the new edition of  Health Wonk Review,  a bi-weekly digest of health policy posts.

masthead-hwrHealthBlawg offers a wrap-up post on the health information technology and health care policy conference in DC earlier this month. The Datapaloozers are looking at data streams from the government and beyond in an effort to manage the health and the health care costs of various populations…policy blog posts.

Why are patient experience surveys crucial to gaining clues for improving patient care and comfort? Many hospitals use them, notes David Williams at Health Business Blog, even though providers may not always be enthusiastic about being rated. They’ve become more important since Medicare began using patient experience as a criterion for reimbursement. 

Does Berwick have a fix for Massachusetts that he didn’t get to try in DC?

berwickIn addition to the rest of the state’s problems, would-be Governor Don Berwick would inherit the post-mandate struggle to contain health care costs. Does he have any solutions for  Massachusetts that he didn’t get a chance to try in DC?

Last summer, the former Medicare chief gave a talk before a film about the failures of U.S.  health care.  Instead of demonizing doctors and drug companies , he said they are just working within the system as it stands.

They’re just doing what makes sense,” he said. “We have to change what makes sense.”

Read full post here. 

For more on Dr. Berwick see:

Gene sequencing and cutting hospitals costs — in the morning papers

There he is again, Harvard geneticist George Church.  Fresh off denying that he was looking for a surrogate to gestate a Neanderthal baby, he’s in the Times business section. He is pictured with his hand laying on the top of a genome sequencing machine a tad bigger than a dorm room refrigerator.  They say the device, made available by a Cambridge company is for researchers and docs, but it costs a lot less than a cottage on Martha’s Vineyard. So who knows?

Over the past few years, the cost of mapping one person’s genome has dropped to around $6,000 from about $250,000, and it is expected to  widget-knome-overview-zerogo far lower. And, as genomic medicine quickly evolves, a powerful computer packed with software has arrived to interpret sequences privately within the walls of a lab, in contrast to systems that use the Internet and distant servers. The software parses variants in DNA, looking for ones that may be important.

The appliance, made by a human-genome interpretation company called Knome, is the size of a file cabinet and costs $125,000. Knome will begin shipping it in coming months to researchers investigating the genetic basis forcancer, rare diseases and drug response, said Jorge Conde, a co-founder of the company along with Dr. George M. Church, a geneticist and professor at Harvard Medical School.

A bit more on Knome here. 

Closer to home, the Globe story on efficiencies  at the Steward Healthcare System stays out of the Cheesecake Factory kitchen. Atul Gawandes’ New Yorker story compared the chain hospitals’ approach to the of the chain restaurant.

Like everything else about for-profit Steward — robotic surgery, fixed-rate insurance contracts, managers working with patients to prevent hospital readmissions — the e-ICU is focused on innovation, efficiency, and finding ways to save money.

It’s a formula that has been reshaping the way business is done in the state’s health care industry ever since Steward was formed by a New York buyout firm in 2010 to take over the struggling Caritas Christi Health Care chain. But whether the makeover will achieve its most important goals — making medical care less expensive in Massachusetts and making a profit for Steward — remains an open question. What is certain is that Steward has become a force in this critical industry.

#mahealthcarecosts: Massachusetts commission meets

  1. More about the chairman. 
  2. HCFA
    Stuart Altman starts w/ a round of introduction. Sec. Bigby talks importance of improving quality of care, not just in cutting cost. #MAHPC
  3. HCFA
    Jean Yang looks forward to next generation of health reform. #MAHPC
  4. HCFA
    Carole Allen, pediatrician, local advocate for children’s health. #MAHPC
  5. HCFA
    More meet the commission: Dr. David Cutler, health economist at Harvard. Marylou Sudders, expert on behavioral health. #MAHPC
  6. HCFA
    Jay Gonzalez, Secretary of Administration & Finance says that controlling health care costs is essential for fiscal health of MA. #MAHPC
  7. HCFA
    Dr. Wendy Everett, president of NEHI, says that the other 49 states are going to be watching us. #MAHPC #mahealthcosts
  8. HealthPolicyHub
    Thinking about health care costs today? Check out @HCFA’s feed – lots of info on MA’s first steps to “crack the cost code” #mapoli
  9. HCFA
    Dr Paul Hattis of @GBinterfaith says statute allows commission to frame, name & if necessary blame & shame to help reduce cost #MAHPC
  10. HCFA
    Rick Lord of AIM and Veronica Turner of @1199mass last to introduce. All the stakeholders working together to lower #mahealthcosts #MAHPC
  11. HCFA
    Chair Stuart Altman says #MAHPC a “sounding board” for the system & not a “one way street.” #mahealthcosts
  12. JC7109
    Groups rally in Lynn against possible cuts to health care – so much for Obamacare #MApoli #tcot

Essay contest — Tell a story about the cost of your health care and win $$$ #hcr #healthreform #aca

Ever feel like your doctor has no sense of the cost of the prescription, treatment or scan he or she is ordering? In an ideal word, doctors shouldn’t take cost into consideration when choosing care.

But the health care system doesn’t operate in the real world and often that scan doesn’t represent the best care. And, even insured pateints are in for huge copays and deductibles.

Costs of Care is a Boston group that dares to give “patients and their caregivers information they need to deflate medical bills, while expanding the national discourse on the role of care providers in responsible resource stewardship.”

 Their effort is part of a new push for transparency in health care pricing.

So, you’re thinking – that sounds familiar? Why didn’t my doc explain the difference in costs when he asked me which hospitals I wanted to go to form my surgery?

 Now’s your chance to share that story. The folks at Costs of Care is sponsoring their third annual essay project and they are looking to stories “that best demonstrate the importance of cost-awareness in medicine. Examples may include a time a patient tried to find out what a test or treatment would cost but was unable to do so, a time that caring for a patient generated an unexpectedly a high medical bill, or a time a patient and care provider figured out a way to save money while still delivering high-value care.”

 Check out last year’s winners here: Entries are due November 15 and all “qualifying submissions” appear on the group’s website. The prize –$4,000.

Note that the contest is sponsored by a slew of insurance companies and Beth Israel Deaconess Medical Center. We note that Partners – famous for its high cost care — is not a sponsor.

The group notes that the stories have been used by “the major media and have been used by leading healthcare organizations such as the New England Journal of Medicine and the Institute of Medicine.”

So best not to sign up if you are shy. For more info click here or go to Or, check out their Facebook page.


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