Saturday May 5, 2012

BOSTON (AP) -- Massa chusetts House leaders unveiled a health care payment bill Friday that they say will lower family premiums by nearly $2,000 annually over the next five years in part by cutting waste and inefficiency out of the existing health care system.

The approximately 150-page bill detailed Friday is designed to reward doctors and hospitals for keeping patients healthy instead of paying them for each operation or service they provide.

It creates a new consumer website with price and quality information categorized by medical procedure to help patients compare hospitals and insurers, while overhauling medical malpractice laws by letting doctors apologize for mistakes without fearing a lawsuit and creating a 180-day "cooling off period" to give both sides a chance to reach a settlement.

The bill would also establish a new quasi-public agency -- the Division of Health Care Cost and Quality -- to oversee the new law and consolidate the state’s various health care agencies.

Lawmakers have been grappling for ways to slow spiraling costs since 2006, when then-Gov. Mitt Romney signed Massachusetts’ landmark health care law.

That law has dramatically expanded access to health coverage.

Massachusetts now has the highest rate of insured residents in the nation -- more than 98 percent of the population. But soaring premiums and other health care costs have threatened to undermine the long term fiscal stability of the law.

House Speaker Robert DeLeo said the House version of the financing bill goes a long way toward reining in those costs.

DeLeo said the bill "limits cost growth while maintaining high quality health care and innovation."

"We also ... empower patients to make the best decisions about what their health care options are," said DeLeo, D-Winthrop. "We focus attention on prevention."

The House bill is designed to even out wide disparities in the costs of hospital services by requiring those hospitals that charge more than 20 percent above the state median price for a specific service to pay a 10 percent surcharge into a fund to help support hospitals that serve the poor and most vulnerable.

It also would require the adoption of electronic medical records by 2017 that will allow emergency room doctors to call up a patient’s medical history while simultaneously notifying the patient’s primary care doctor that they have visited an emergency room.

The bill sets guidelines for the size of "accountable care organizations" -- health care networks that take a coordinated approach to medicine so that risks like high blood pressure and elevated blood sugar are managed better and patients get help leading a healthier lifestyle.

There are already five accountable care organizations in the state. The bill would require the networks have at least 15,000 members to manage risk and no more than 400,000 so they don’t become too dominant.

Under the bill, patients would be allowed to appeal decisions made by their accountable care organization, including the right to a second opinion from any provider.

House leaders said the bill could save the Massachusetts economy $160 billion in unnecessary health care costs over the next 15 years. It’s also designed to slow the increase in health care premiums. Premiums for families in Massachusetts average over $15,000 annually.

Rep. Steven Walsh, a Lynn Democrat and co-chairman of the Joint Committee on Health Care Financing, said the House bill has "far less government regulation" than Gov. Deval Patrick’s bill and no rate regulation.

DeLeo said the House could vote on the bill around the beginning of June.

The Senate is scheduled to unveil its version of the bill next week and could begin debating it the following week.

Senate President Therese Murray has said she expects passage by July 1 of a major health care overhaul aimed at saving billions of dollars for consumers and small businesses in the next decade.

Murray said the Senate measure would establish independent oversight of the health care industry, improve the quality of care and increase accountability for providers. She estimated potential savings in tens of billions of dollars during the next 10 years.

Gov. Deval Patrick first proposed in February 2010 that the state move toward a so-called global payment system to replace the fee-for-service approach.

The House bill met with mixed reviews.

Michael Widmer, president of the business-backed Massachusetts Taxpayers Foundation, said the bill "inserts government into the marketplace to an extent that carries serious risks for the state’s world renowned health care system."

Amy Whitcomb Slemmer, executive director of the advocacy group Health Care for All, praised the focus on patients, saying the bill will "transform the Massachusetts sick care system into a true health care system."

Highlights of House health care bill

A bill passed by the House would save the state’s economy more than $160 billion over the next 15 years. The bill would:

n Require electronic medical records by 2017 to let emergency room doctors call up a patient’s medical history while simultaneously notifying the patient’s primary care doctor of the emergency room visit;

n Reduce premiums for patients who show they’re committed to maintaining their health and following their doctor’s advice;

n Create a new consumer website with detailed comparative price and quality information for medical procedures, hospitals and insurers;

n Encourage more medical students to go into primary care by providing loan forgiveness grants for those who work in rural and underserved areas

n Help the health care industry make the transition to alternative payments systems such as "global payments" and bundled payments for acute or chronic conditions instead of rewarding hospitals and doctors for the number of tests and procedures they do;

n Require hospitals that charge more than 20 percent above the state median price for a specific service to pay a fee into a fund to help support hospitals that serve the poor;

n Create a new quasi-public agency, the Division of Health Care Cost and Quality, to oversee the new law and consolidate the state’s various health care agencies.

n Overhaul medical malpractice laws by letting doctors apologize without fearing a lawsuit, creating a 180-day "cooling off period" to give both sides a chance to reach a settlement, and raising the cap on damages for nonprofit hospitals;

n Establish guidelines for the size of "accountable care organizations," that creates leadership teams to ensure patients receive the physical and mental care they need to keep them healthy;

n Give patients the option of appealing decisions made by their accountable care organization, including the right to a second opinion from any provider;

n Create a "medical home" or single point of coordination for each patient’s health care needs.