Health Care

The following is something that I wrote about in a letter to officials almost 2 1/2 years ago. However, it is from an editorial that I wrote almost a decade ago. Health care is the principal driver in our budget every year, and it is a huge cost for just about everyone in society today. Here is part of that letter:

"I have lobbied in the past to create administrative centers to handle the costs associated with paperwork and the labyrinth of health care plans and insurers. I have used examples where one person may utilize ten or more different venues of health care. Instead of being one person, he/she is treated like ten people with paperwork recreated again and again. If we had administrative centers that treated that person as one individual, we could substantially reduce administrative costs per patient. Not only would this be less costly, but we would reduce patient error and get better, more complete information on each patient. While I don’t envision said centers as gatekeepers, they would be able to more efficiently schedule both time and facilities. This would give us an opportunity to stop the proliferation of medical equipment such as MRI machines. Fewer machines could be utilized more efficiently with better centralized scheduling. This would cut down substantially on costs. The centers could be used to bulk purchase pharmaceuticals, reducing costs. Finally, freed from paperwork, health care officials could do more of what they do best, heal the sick.

Centers would also help to reduce medical errors by giving everyone involved the same information in a timely manner. If we were to combine this with the Computer Physician Order Entry (CPOE) system proposed by a consortium of health care groups through the Massachusetts Technology Collaborative (MTC), the results would be astounding. Not only would this save a tremendous amount of money for our health care facilities, but it would save lives.

Over the last few years, we have invested a lot of state resources into keeping people out of nursing homes and in their own apartments. We should continue this effort by factoring a few elderly units into every state assisted housing project. By building electronic arrays into these units, one nurse or personal care attendant can watch whether people are ok in their own homes. We should utilize technologies in-group homes such as cameras, telephony assessments, and computers to provide assistance to those in little need in order to avoid future larger costs. They can tell if people are taking medications. Again, this is a common sense approach that is part of an overall plan focused on people living healthier less expansively.

Plans to control costs don’t have to be as sweeping as this, but should be combined into a broad initiative. The issue of reuse of pharmaceuticals at Nursing homes is a good example of a small common sense cost savings.

Data Collection is another area where we can do better. For example, there are data collection tools for both Medicaid and Medicare. We use MMQ and the feds use MDS (through CMS) systems. Essentially we collect the same data to ensure against fraud. Each facility uses 1-1 1/2 registered nurses to enter data. This is 50,000-75,000 per facility, and we have 400-500 skilled nursing facilities in Massachusetts. If we eliminate the state duplication and piggy back off of the feds, we save $20-30 million that we are paying for. Plus, we could eliminate most of department staff that looks at the data and does field inspection. That would save us money as well. One of the reasons for not changing in the past has been that the feds do mostly auditing with auto accounting data software, while we do more field inspections, but the feds are starting to do more field inspections. Additionally, Nursing Homes need JCAHO certification to get paid by feds. We have DPH do the same thing. This is done less with hospitals than with nursing homes, but same issue. We need to stop the certification duplication.

Health systems that use community pharmacies waste money. The average supply dispensed of an average drug is a twenty-day supply. The average Medicare patient spends $25 per day on drugs. Waste is estimated at fifty per cent. Why? Two things. First, patient gets sick and is off meds. Second, patient has to change dosage. Systems are now being put in place in some hospitals to give dosage as needed on a day-to-day basis to stop waste. It is estimated in one community facility in my district that they would save $400,000- 600,000 in that one facility if they went to day-to-day dosage. Plus, hospitals pay less for drugs than do pharmacies. It is relatively easy to save where a hospital owns a nursing home. Should we do a pilot program?

Look at payment plans in Massachusetts. Institute of Medicine has estimated that we could save $265 billion nationally by changing our billing structure. Need to conduct a pilot program “to identify, pilot test, and evaluate various options for better aligning payment methods with quality improvement goals. Examples of possible means of achieving this end include blended methods of payment designed to counter the disadvantages of one payment method with the advantages of another, multiyear contracts, payment modifications to encourage use of electronic interaction among clinicians and between clinicians and patients, and bundled payments for priority conditions.” We should explore federal funding to conduct pilot programs. Again, this is a function that could easily be accomplished by setting up regional administrative centers

We should look at the creation of regional health and human service organizations. Many of our agencies handle parts of a problem or duplicate a type of service offered by another agency. Better coordination of efforts would lead to a reduction of costs through duplication and would lead to better services through a more holistic approach to a person’s problems. Just as we know that an individual with a chronic illness has multiple illnesses in most cases, an individual with a substance abuse or domestic violence problem may also need educational, job training, or housing assistance. By providing comprehensive services to combat multiple symptoms, we are able to avoid recidivism of individual in use of social services.

As we listened to businesses on our listening tour, we promised business that we would not merely pass an economic development bill, but would partner with businesses in order to maintain a better economy for the Commonwealth. We need to do the same with health care. Now that we have passed this unprecedented health care bill, you have given."

Health Care is an incredibly complex issue that people try to break down into a seemingly simple issue of single payer. No one state can do this alone. For example, single payer advocates don't take into account multi-state companies or tourists that would have their own health plans. That means we can't eliminate handling all the other health plans in our health facilities. But we can have a single biller plan. It gets us to the same place. Additionally, we can better use technology in a state where we have some of the most technologically advanced companies in the US. Regardless of how we do this, we have to get better at controlling costs and we need the federal government to step up on this.