Health reform and cancer: Mass can’t get either one right?

Fortune/CNN jumps all over Mass health reform

 …(T)he plans offer lavish subsidies that swell the demand for health care, they do nothing to increase the supply of medical services in a market suffering from shortages of everything from family doctors to nurses to hospital beds. Two years after enacting health-care reform to rein in costs, Massachusetts strengthened “certificate of need laws” that prevent hospitals and other providers from competing with high-cost, entrenched suppliers. The state now requires that ambulatory surgical centers and outpatient treatment facilities get permission from regulators before they can enter the market. Their rivals invariably lobby the regulators to block competition, and usually win.

 And, the NY Times holds up MGH research as an example of the limits of targeted cancer therapies.

 Enthusiasts for the targeted drug have been saying for years that tumors will eventually be characterized by their molecular profiles — which mutated genes they have — rather than where in the body they occur. Names like breast cancer and lung cancer will be supplanted by terms like B-RAF-positive or EGFR-positive tumors. And drugs will be chosen based on that profile, the way antibiotics are generally selected based on the pathogen that is causing the infection, not on where in the body the infection occurs.

 Massachusetts General Hospital, for instance, is running a clinical trial testing a drug from AstraZeneca on any type of cancer — providing it has a mutation in the gene B-RAF, the same gene that is the target of PLX4032.

 But the test of PLX4032 in colon cancer suggests that the location of the tumor still does matter, that it will not be just a case of looking at the target. There are other examples as well. Erbitux and Vectibix do not work in colon cancer patients with a mutation in a gene called K-RAS. But the relationship between the mutation and the effectiveness of Erbitux does not seem to hold in lung cancer.

 

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Shell game on Massachusetts health costs

Hospitals are making money. Insurers are losing money. If only it were that simple.

Most hospitals in the state are flush, according to a pair of new state reports.

Well, maybe sort of.  Partners told the Globe said they’ve started losing money since the report on hospital reserves showed that Partners has $5.7 billion in total net assets.

“Having sufficient assets allows us to sustain our mission of patient care, teaching, research and service to the community during economic downturns like the one we just experienced,” said Partners spokesman Rich Copp. “Since 2008, our numbers have been reduced by hundreds of millions of dollars as a result of the recession.”

The Mass Hospital Association called the state numbers “misleading.” The Globe story also quotes Nancy Kane, a Harvard School of Public Health researcher, saying that it all depends on how you define profit and losses

“More needs to be done before one could make a final determination that there are excess resources in these institutions,’’ Kane said.

While trying to make sense of all this, it is worth noting that a recent BU study found that Acute hospital costs per person in Massachusetts have long been the highest in the nation, and therefore in the world. In hospital fiscal year 2007, hospital costs here reached 55.4 percent above the U.S. average—the greatest excess then recorded.

So, is it a surprise that, at the same time, health insurers say they are losing money?

Or are they? Again, the Globe reports:

Barbara Anthony, undersecretary of the state Office of Consumer Affairs and Business Regulation, which oversees the insurance division, said insurers continue to enjoy large financial surpluses. A state report released May 2 showed eight health insurers in Massachusetts had a total surplus of $2.5 billion in 2008, the latest data available.

“The real issue in health care is the skyrocketing increases that are drowning small businesses and working families, who do not have billions of dollars in reserves to fall back on,’’ Anthony said. She said regulators are working to make sure insurers remain solvent while state officials try to engage insurers, hospitals, and doctors to tackle the issue of costs.

In the midst of all these swirling apples and oranges, the state Senate passed a health care measure yesterday that would use some of the hospital surpluses to help small businesses deal with rising premiums. AP reports.

To slow premium increases, the bill would require wealthier hospitals to contribute to a fund to help ease those rising costs. Senate backers of the bill say the contribution of $100 million could reduce small-business health care costs by 2.5 percent.

Tipping point for health costs in Mass?

BHN is not a fan of the overused term “tipping point.”  But, it works here.

Let’s connect the dots. 

The Globe‘s reports on back room deals at Partners, the hospital giant that helps fuels the regions high health care costs high. The ever-looming high costs of care in Mass.  The state’s – and now the public’s –– stake in high health costs. The insurance industry attempt to raise some rates for small businesses by, in some cases, more than 30 percent.

 Tipping point?

 The state says no to high rates.  Insurers sue – and lose — but some start dropping high-cost hospitals. Partners — facing pressure for running thos high-costs hospitals — chips in $40 million for small businesses insurers.  And the state has a plan to cut waste by rewarding docs for who cure patients, not those who order lots of tests.

 BHN  was going to put all these pieces together. But the New York Time did it in yesterday’s staff editorial.

  When Massachusetts’s politicians designed their reform, they calculated that achieving near-universal coverage first would then give all participants in the health care system an incentive to help rein in costs. There are encouraging signs that that is starting to happen.

 

Herald: Scott Brown victory delivered health reform

Herald front page w/Ted Fitzgerald photo
And, oh, are those Tea Partiers angry. From today’s Boston Herald:

Republican folk hero Sen. Scott Brown is being taunted by triumphant Democrats – and slammed by irked conservatives – after the historic health-care bill he was elected to kill was signed into law by President Obama yesterday…

“If it wasn’t for the Tea Party movement, Scott Brown wouldn’t have gotten that seat. We expect to see a true conservative in there.”

In fact, Democrats now say Brown’s election as the so-called “41st vote” to block Obama’s health-care overhaul inspired them to seek procedural means to bypass GOP efforts to derail the bill.

“Scott Brown’s election actually delivered health-care reform, because we didn’t need the 60 votes to make it happen. He delivered a significant victory in that,” ( Massachusetts Democratic Party chairman John) Walsh said.

Brown’s senior adviser, Eric Fehrnstrom, countered that the senator has been a stalwart voice against the Democratic initiative.

“Sen. Brown has made it clear, every way he knows how, that he is opposed to Obamacare and the higher taxes and increased spending it entails,” Fehrnstrom said.

Brown declined to comment.

BHN Report: Massachusetts health costs hearings

The Commonwealth is getting serious about health care costs. Increases are unrelenting and over the top.

In Massachusetts, health costs are rising at three times the rate of wages, according to testimony below. Rising prices are eating away at company profits, family savings, worker’s wages and public health programs.

Studies, bills, hearings. Will we get action?

See the Globe’s reporting on the ongoing hearings on health costs and the push toward global payments. Instead of paying per procedure, global payments cover costs per patient. The idea is to encourage quality instead of overtreatment.

The testimony continues on Thursday and Friday. The state is streaming the hearings live and posting copies of speaker statements.

BHN caught the end of Monday’s testimony, which came from Harvard Professor Nancy Turnbull and a panel of consumer groups. Below find some unedited audio from the panel, which was called “Consumer Experiences with Health Care Cost Trends.”

Nancy Turnbull, Senior Lecturer on Health Policy and Associate Dean for Educational Programs, Harvard School of Public Health.

“In Massachusetts, health insurance premiums are increasing faster than income, which is creating a crisais of affordaility for individual and families.”

Cheri Andes, Lead Organizer, Greater Boston Interfaith Organization

“GBIO believes that this trend of out-of-control health care costs is a moral issue as well as an economic one.”

Robert Restuccia, Executive Director, Community Catalyst, Inc.

Matt Selig, Executive Director, Health Law Advocates

“In our work with individual clients we find that consumers still consistently face the burden of out-of-pocket health care costs aside from premiums, deductibles and copayments.”

Deborah Banda, Massachusetts State Director, AARP

Written testimony

Finally, the March Madness review of the Health Wonk Review is up. I live with a couple of Tar Heel fans. So, with the the boys’ team out,  our motto here is — Go Big Red!  The Yankee half of the family has Cornell links.

Patient Deaths, Doctor Shortages and Reform in Maine

Also, Obama’s proposal is up.

More coverage here.

The Globe had a good story Sunday on a fatal device breakdown at Mass General

 Looking at the second paragraph, it appears this story was heavily lawyered, as we say in the news biz — edited with liability in mind. It lists everything that MGH has done since and goes on to quote someone saying these devices are faulty.

A Massachusetts General Hospital patient died last month after the alarm on a heart monitor was inadvertently left off, delaying the response of nurses and doctors to the patient’s medical crisis.

Hospital administrators said they immediately began an investigation, which led them to inspect and disable the off switch on alarms on all 1,100 of Mass. General’s heart monitors within a day of the death. The hospital also has temporarily assigned a nurse in each unit to specifically listen for alarms, out of concern that sometimes even functioning alarms can’t be heard over the din of a busy ward.

Patient safety officials said the tragedy at Mass. General shines a spotlight on a national problem with heart sensors and other ubiquitous patient monitoring devices. Numerous deaths have been reported because alarms malfunctioned or were turned off, ignored, or unheard.

 

From AP via WBZTV

ME Lawmakers Urged To Keep Working On Health Care

AUGUSTA, Maine (AP) ― Many measures aimed at expanding health care coverage in Maine should await final action in Congress, but policymakers should not stop working on the issue, Maine insurance regulators say.

In a preliminary report, the state Insurance Bureau says Maine’s options to improve access, affordability and security in the health care system will vary depending on what, if any, federal laws are enacted. Separate bills passed by the U.S. House and Senate await final disposition.

KHN story on rural doctor shortages cites Mass fix: Make nurse practitioners primary care providers.  (Note. I wrote a story about 15 years ago about how the county featured here had no doc. It is very isolated part of the state. NC has a good rural health program but it can be hard to keep them down on the farm.)

Harvard Pilgrim for Governor

     It does have the magic “H” word in its name. (Not the be confused with   Harvard Vanguard, a group of now unrelated clinics and health centers.) From today’s Globe:

A Boston Globe analysis of contributor reports shows that in seven months (Republican Charlie) Baker’s campaign raised more than $122,000 in contributions tied directly to Harvard Pilgrim (health insurer.) This includes not only $43,000 in contributions from Harvard Pilgrim’s employees, directors, and affiliated companies, but also a broad array of vendors: its accountants, auditing firm, advertising agency, information technology providers, and consultants.

In backlash news, see the item in the NY Times Prescriptions blog/column on how no one loves the Mass plan anymore.  

   Health care legislation in Washington may be stalled, but that has not stopped  legislatures in more than two-thirds of the states from objecting to one of its central planks: a requirement that everyone buy health insurance.

The objections, many of them driven by the Tea Party movement, may turn out to be largely symbolic. But they nonetheless serve notice to President Obama and the Democrats of real anger over their health care plans and signal the potential for political upheaval down the road.

These measures, which are in various stages of ripening in about 36 states, could also pave the way for a major court challenge.