Not goood news from Massachusetts

In today’s Boston Globe, Liz Kowalczyk tells us we’ll have to wait for health system payment reform in Massachusetts.

The state’s ambitious, first-in-the-nation plan to transform how hospitals and doctors are paid is on hold, at least for this year, largely because of disagreements among key officials, legislators, and providers over how best to control health care spending.

Senate President Therese Murray, a leading advocate of payment changes, said in an interview that she will not file legislation to change the system this year, as originally planned, because of the logistical and political complexity of changing a system that has been in place for decades. The current payment system — in which doctors and hospitals are typically paid a negotiated fee for every procedure and visit — is also profitable for many providers.

There’s broad agreement that the current fee-for-service system is unsustainable. But agreeing on how change it is another story. This is not surprising. Somebody, probably everybody, will have to give something up, whether it’s profit or access. There’s no way to cut costs without such changes.

Meanwhile, emergency room use has continued to go up.

The number of people visiting hospital emergency rooms has climbed in Massachusetts, despite the enactment of nearly universal health insurance that some hoped would reduce expensive emergency department use.

According to state data released last week, emergency room visits rose by 9 percent from 2004 to 2008, to about 3 million visits a year.

It’s not entirely clear how much Massachusetts’ health reform law is to blame.

But, according to a report from the Division of Health Care Finance and Policy, expanded coverage may have contributed to the rise in emergency room visits, as newly insured residents entered the health care system and could not find a primary care doctor or get a last-minute appointment with their physician.

David Morales, commissioner of the division, said several national and statewide studies have shown that expanding insurance coverage does not reduce emergency room visits. This is because the uninsured “are not really responsible for significant ER use’’ he said.

The growth in emergency room use predates the health insurance law and mirrors national trends, according to Nancy Turnbull, a senior lecturer at the Harvard School of Public Health.

“I don’t think the increase has anything to do with health care reform,’’ she said. “It’s much more reflective of [primary care] access problems.’’

So, there you have it. Costs are rising, in part due to increased ER use. But efforts to rein in costs with a reformed payment system is on hold. I’m not surprised by either of these. The forces pushing increased costs and maintenance of the status quo are strong. Things will have to get far worse before they get better.

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