Patrick Signs Health Care Cost Containment Bill | WBUR:
“I thank this coalition of leaders and advocates, of disparate and sometimes-competing interests, for coming together and sticking together for the greater good,” Patrick said. “That’s not only what it’s taken and will take to lower health care costs, that’s what it takes to make a real community. And it’s one of which I am proud to be a part. Congratulations one and all.”
So the governor signs a health care cost control bill, which is estimated to save $197 billion by 2022. And, like, everyone’s happy about it. The hospitals seem to be happy. The insurers seem to be happy. The health care consumer advocates seem to be happy (congrats to longtime BMGer, now Health Care for All mover-and-shaker Ari Fertig!).
This is nuts. Gotta be too good to be true.
And maybe it is; the goals are pretty ambitious. But what we do have in this state, is a pretty tight-knit health care community of interests: It’s people from a wide variety of interests, yet the social and business norm — at least in the last 6-7 years — is to look for common goals, try to be fair, to keep talking, and to keep the public good in mind. Everyone seems to have agreed that that which cannot continue forever, won’t. And we couldn’t afford to continue along the road we were on.
And Massachusetts cements its status as a place where things can actually get done, where the political culture doesn’t flinch from taking on enormous issues. Much credit is due to the Governor, for setting the tone; to Terry Murray, who has always leaned forward on cost control; and — dare I say it? — Bob DeLeo, who after seemingly slow-rolling the bill, got it done. One-party rule gets a lot of criticism, often for good reason … but it means things can happen without much of the spiteful and opportunistic jockeying, brinksmanship and trash-talking that happens, say, in DC. (Bipartisan government could work that way … and it has in the past … but that seems a universe away these days.)
Congrats also to WBUR’s Martha Bebinger and the Commonhealth blog folks, who have always done sterling, truly informative work. Commonhealth’s Rachel Zimmerman’s summation of the bill is here.
If Massachusetts had a fight song, I’d be singing it.
Discuss
30 Comments . Leave a comment below.Really, there’s a great team at Health Care For All of people who have been working tirelessly on this for the last number of years – they should get the credit. I just do the memes!
And you’re right – this bill could do a lot of good. But, I caution to say that how successful this will all be really depends on the implementation.
Also, I suggest that folks interested take a look at this weekend’s LEAD editorial in the New York TImes. The editorial focuses primarily on the goal to keep healthcare spending to no greater than the Gross State Product. (GSP is just GDP only for just MA.) One thing mentioned in the Times is the funding of $60 million dollars for a prevention and public health trust to invest in programs that with reduce smoking, asthma, diabetes, hypertension, and more. This was a provision Health Care For All really worked hard on with our grassroots allies and we are immensely proud of it. We also pushed for, and got, provisions which will help better integrate behavioral and mental health into the rest of our health care system, an issue that is personally close to my heart. There’s many, many other goodies buried in the bill. But with all of that said, implementation matters. And, who we have in the Corner Office, in the AG’s office, and who will be the regulators matters to the success or failure of this bill. We’ll need strong leadership to make a better healthcare system a reality — even with this law on the books.
Elections matter. Anyone who looks even cursorily at the difference between Mitt (indifferent at implementation AT BEST) and Patrick (interested in governing as effectively as possible) can see that we need to move forward, not backslide.
Elections have consequences. Hopefully MA has gotten used to good governance and wants more of it in the next election.
before I get too excited. I am happy about the effort though. People are desperate for relief from the excessive cost. I think our leaders should watch carefully the impact this has on consumers. It would be helpful to hear from the consumers themselves about their experience with it, instead of relying only on statistics provided by hospitals and insurers for evaluation of the changes. But thanks for working on this, it’s way way overdue.
the internet is not a safe place to store medical records.
Safety in this case is a choice: If it’s the difference between your doc having access to your records so as to make a good decision, you’re definitely *safer* with EMR. Yes, there’s the possibility of hacking and mischief. But there’s the possibility of fire with paper records.
and it won’t be if it is mandated that all medical records go online. What happens if we have a black out or some other shutdown of the internet or the power grid. We are already so vulnerable because EVERYTHING is digital. How many times a month do we hear about this or that bank being compromised by intruders. It’s just unsettling to me. Also, once records become compiled into a single database, who is to say that that information won’t be exploited. Companies do it now, mine different databases for information to know who to target for this product or that product. I can just see it happening. It is not a good idea.
lack of access to medical records is the *least* of the patients’ worries. The fact is that hospitals have generators for backup.
It’s true though, there are risks with EMR, including but not limited to the ones you’ve mentioned. However, the benefits are tremendous — not just cost, but also accuracy and portability. If I’m out of town and go to the ER at midnight, I’m glad that all of my records are accessible to the doctors, so that they find out that some test or record my GP performed is there and treat me appropriately. On paper, they’ve got to wait until the next M-F 9-5 to find out that info. For folks who move a lot or otherwise have their “medical records” scattered, this makes a big difference. Of course, by driving down costs, we improve medical access for society at large, which also results in better public health outcomes.
Try going to MGH and asking for all your records. I do not believe you are entitled to them as they are the property of Partners Health Care.
As such, EMRs are not private. Through regulation, the state may require access to your records as a provision of hospital or practitioner licensing. (How this doesn’t conflict with HIPPA I don’t know.) This is how “cost control” will eventually be administered…doctor thinks you need a sinus CAT scan? Some state worker may review your records to see if the request complies with their “cost controls,” perhaps too much has been spent on you, procedure denied.
It’s cloud storage except you don’t own your data!
will the records be accessible to insurance companies? As it stands now, medical records must be released on an as need basis to insurance companies for review when they are considering payment for a service. At some point, will they argue it’s easier to just give them direct access to the entire medical record via the world wide web.
only the part relating to the current office visit. Will that change once information is available in an online data base? Since so many people work in the insurance and health care industries, how long will be it before everyone has a friend, neighbor, or relative who will have access to your online medical records.
You are entitled to a copy of your medical records by HIPAA and once you have that copy, you can do whatever you want with it.
243 CMR 2.07(13)(c)
A fee for copying in excess of $.25/page or a fee for clerical work in excess of $20.00/hour is presumptively unreasonable.
Charges for copies of x-rays and similar documents not reproducible by ordinary photocopying shall be at the licensee’s actual cost, plus reasonable clerical fees not in excess of $20.00/hour.
people of this country. There are going to be consequences. First and foremost, there should be disclosure to patients that their personal medical information is being stored in an online database, accessible to medical professionals and hospital employees across the country, and quite possibly, around the world. The risks of access by unauthorized people should be disclosed. Then, after that, let’s see how many people walk out of the doctors office without treatment because they feel their privacy is at risk for being violated. (of course, once they are in the throws of a heart attack they won’t avoid treatment, but many will avoid preventative care because people are very private by nature, and often, it takes them a long time to get to the doctor in the first place, when preventive care could make a difference) Let’s see how many patients lie to their doctors because they don’t want their personal health record out out on the world wide web. You’d be amazed at how many people are not going to be happy about this, once they realize what is going on. I think most people have no clue that our government is working to make this happen.
Fight, Fight Massachusetts
Fight, Fight every day
Fight, Fight for equality
Fight all your might today
Rah, Rah, Rah
Fight down injustice Massachusetts
The Stars and the Stripes will gleam
Fight, Fight for Ol’ Bay State
Fight for the State, State, State
[repeat 3 times]
Go
Go Blue
Go Blue Mass
Go BlueMass (Group?)
Fight down injustice Massachusetts
The Stars and the Stripes will gleam
Fight, Fight for Ol’ Bay State
Fight for the State, State, State
I read Zimmerman’s “What to Know” piece carefully, and see nothing to celebrate. Only one of the “reforms” she points out matters: “The Cost of Care.” The rest are trivial.
It is a progressive conceit that smart and well-intentioned bureaucrats, empowered by politically motivated legislation, can control the market for anything simply by pulling regulatory levels. This includes controlling costs.
Read Zimmerman’s 3rd point. It predicts reduced access to healthcare services and physicians and hospitals.
RomneyCare marginally increased insurance participation but also increased utilization. Now the scramble is on to contain state aggregate spending on healthcare through cost controls.
Am I the only one that remembers Nixon’s wage and price controls? Someone please give me an example of where a government set price ceiling has worked. Despite what progressive believe, this time is no different.
…it should be easy enough to limit access to the patient, the PCP, and whomever either of those deems appropriate to give access. Access should not be given to insurance companies or the government. Maybe this is more of an intRAnet rather than intERnet job. Certainly nobody is advocating that the records just be out there for all to see, right?
since the intranet will have to be accessed from the internet in order to have the portability and access that they want. I agree that the government and insurance companies should not have access to these records, but once the information is compiled, who is to say that some politician, or group thereof won’t find a reason to make it so. Afterall, they are doing this in the first place without even asking for input on it from American citizens. There has been little to no media coverage about it. It’s kind of scary, actually. What kind of world are my kids going to be living in. Is there going to be any privacy at all?
Each individual has a right to their own private health information, with a few very specific limitations (psychiatrists case notes for some specific disorders, for example). This is already part of HIPAA. The HIPAA provisions are actually very effective at protecting individual privacy — sadly, too few people know or actually take advantage of them.
An alternative model is for each individual to collect the information from their provider and have the provider request the patient to share the information with other providers. In this model, the patient retains both the PHI (Personal Health Information) and the record of who has accessed it.
A government or insurance company with a legitimate need to know can then request the information from the individual, rather than the provider.
I’m not saying it solves the problem, but I think it ends up being a preferable approach to the current mish-mash.
and it should be provided to you without having to ask or pay for it. You already paid for the doctor visit, the lab visit and the lab analysis, it’s sort of ridiculous that you have to then pay for a copy of the report.
I agree with you.
I was thinking of electronic copies, though.
THE Internet is just a (shorthand) nomenclature for a collection of inter woven net works. Don’t get hung up on the nomenclature: the internet is not one thing; it is many things; one of which might be a network of medical information.
Strictly speaking, far more damage to your life and standing can be affected by knowledge of your credit card and/or credit history (not to mention social security number) than knowledge of your medical records. And that information is already out there…
These are legislators doing their jobs, and I neither see nor expect any more or less input from the public than any other proposed legislation. Maybe it makes sense to require an opt-in on the part of each individual patient, but frankly you strike me as just a tad paranoid on this matter.
and ask realistic questions, instead of doing the la,la,la,la,la,la if it’s from a Democrat it has to be good- thing. So many “legislators doing their jobs” has done a lot of damage to this country. Having patients opt-in is an excellent idea, but I don’t see that on the table anywhere, do you? So in order to opt-out, one must opt-out of the health care system. Putting medical records on-line is a big, big deal. It’s happening as we speak and the people of this country don’t even realize it. Go ahead and call me paranoid. I would say I am being more realistic about what could come in the future. I’d rather be aware of the possibilities and concerned about the possible outcomes than stuck with my head in the sand singing la,la,la.
If people don’t realize that medical records are going online, it’s their own damned fault. HIPAA has been the law since 1996, and it lays out the legislative framework for most of these issues. I don’t hear anybody “doing the la,la,la,la,la,la if it’s from a Democrat it has to be good”.
Microsoft rolled out “HealthVault” in 2010. Google introduced “Google Health” in 2008 and withdrew it in 2011. Private industry has explored this as well as public entities. Every provider — even drugstores — have been demanding signed HIPAA releases for at least a decade. I’m sorry, but I think that anybody who’s been signing these releases for a decade and hasn’t bothered to go understand what they’re signing is willfully hiding under a rock.
I agree that it will be better if more of us demand that the media provide information about all this, and that our candidates (of all stripes) more explicitly address this.
Like any other complex issue, understanding the impact of online medical records requires a threshold level of participation from each of us. The information is there — if we can’t or don’t find the time to inform ourselves, then we have little basis on which to complain that we weren’t asked.
and I believe the HIPAA form that is signed says ABSOLUTELY NOTHING about medical records going online. I haven’t seen a HIPAA form in quite a while. I need to get one and take a look at it. From what I remember, it was a single page form with a few short summaries of what HIPAA protects. It is not informative at all about much. Even the HHS website is very vague about information. As a matter of fact, if click on the medical records page, they show a picture of a hard copy file room. Not a single mention of records going to a storage space online.
My point is just that the fact that these forms are from HIPAA, and required by nearly all providers, is (in my view at least) a flashing “check engine” light that strongly encourages the signer to learn more about HIPAA.
While I agree that the OCR website can be improved, the information is still there and has been for a long long time. For example, the Health Information Technology section has a reasonably extensive collection of information — including material like the following introduction:
These documents, like most government regulations, are an alphabet soup of acronyms, policy references, and so on. Lord knows they are tedious for mere mortals to understand (I know, I’ve tried). They are, however, available.
I guess that some of my frustration with our media and political campaigns has been that they spend precious little time communicating and sharing the implications of all these — instead we get a steady diet of he-said-she-said spats and who’s-gonna-win junk.
It seems to me that this is primarily a failing of our media and political efforts, rather than the elected officials themselves (not to mention the audience that tolerates or even demands such an inversion of priorities).
Where can I find more information on that? What does it mean? Does it mean an individual can choose to opt out?
The “Individual Choice” provisions are spelled out at http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/individualchoice.pdf.
You do have the right to opt-out of EMR, however “covered entities are not required to agree to an individual’s request for a restriction, they are required to have policies in place by which to accept or deny such requests.” So if one wants to opt out, they have to explain that to the receptionist, who probably knows little about the provision. The doctor probably knows little about it too. I don’t think that the HIPAA form contains anything on it about permission to upload your records to the internet. I really need to get a form and look at it.
I doubt that this kind of thing is on the HIPAA forms you sign from providers, those are designed to advance the interests of the provider.
I think this needs to instead be driven by patients, perhaps in the form of a 501c3 or even a for-profit company. Some years ago I explored the business aspects of this with an eye towards starting such a venture myself (which is how I learned the little that I know). I, frankly, found the entire space so obviously populated by Vogons that I gave up the idea and moved on.
I think it remains a fertile area for someone (other than yours truly) who has courage, determination and a thick skin to advance the cause of individual rights in the health care industry.
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