Here are two news items that reflect the inclination of public officials to play fast and loose with the issues when it comes to health care legislation:
(1) The New York Times reports that a result of the new federal health care law is that hospitals serving uninsured immigrants are likely to face budget stresses since those people are not eligible to participate in the health care insurance exchanges envisioned by the law, nor are they eligible for Medicaid. This comes as no surprise to students of the new law, but the response from the President's folks is off-point and misleading:
The Obama administration said the Affordable Care Act supported safety-net hospitals in other ways, pointing to measures that raise payments for primary care and give bonuses for improvements in quality.
Raising rates for primary care doctors does nothing for this population and also does nothing for hospital finances. As for bonuses for quality improvements, they are accompanied by penalties for such things as relatively higher readmission rates. Recall this conclusion from a study conducted at Brigham and Women's Hospital:
Among 905 764 discharges in our sample, patients discharged from public hospitals (27.9%) had higher readmission rates than nonprofit hospitals (25.7%, P<0.001), as did patients discharged from hospitals in counties with low median income (29.4%) compared with counties with high median income (25.7%, P<0.001).
Conclusions—Given that many poor-performing hospitals also have fewer resources, they may suffer disproportionately from financial penalties for high readmission rates. As we seek to improve care for patients with heart failure, we should ensure that penalties for poor performance do not worsen disparities in quality of care. (Circ Cardiovasc Qual Outcomes. 2011;4:53-59.)
(2) Meanwhile, at the state level, the Governor shows up as a late arrival on the issue of the disproportionate rates paid to certain health care systems, a pattern regularly documented by the Attorney General. Under the misleading headline, "Patrick offers a plan to control care costs," a story reports:
The governor’s plan requires the administration to conduct a “cost and market impact review’’ of any medical provider it suspects is engaging in or plans to engage in anticompetitive behavior.
The reporter lets the administration off the hook by never addressing why it needs legislative authorization to do what it already has the authority to do. Until now, the Governor has carefully ducked the issue whenever it has been brought up. His administration has been MIA, notwithstanding the AG's presentation of her annual findings to one of his line state agencies under previously approved legislation.
By the way, even with no teeth, the proposal has opposition:
[The] president of the Massachusetts Taxpayers Foundation, said the plan is “an open invitation for unaccountable bureaucrats to go on a witch hunt.’’
As if those bureaucrats would be any more unaccountable than the people involved in secret negotiations between the dominant provider and the dominant insurer.
(1) The New York Times reports that a result of the new federal health care law is that hospitals serving uninsured immigrants are likely to face budget stresses since those people are not eligible to participate in the health care insurance exchanges envisioned by the law, nor are they eligible for Medicaid. This comes as no surprise to students of the new law, but the response from the President's folks is off-point and misleading:
The Obama administration said the Affordable Care Act supported safety-net hospitals in other ways, pointing to measures that raise payments for primary care and give bonuses for improvements in quality.
Raising rates for primary care doctors does nothing for this population and also does nothing for hospital finances. As for bonuses for quality improvements, they are accompanied by penalties for such things as relatively higher readmission rates. Recall this conclusion from a study conducted at Brigham and Women's Hospital:
Among 905 764 discharges in our sample, patients discharged from public hospitals (27.9%) had higher readmission rates than nonprofit hospitals (25.7%, P<0.001), as did patients discharged from hospitals in counties with low median income (29.4%) compared with counties with high median income (25.7%, P<0.001).
Conclusions—Given that many poor-performing hospitals also have fewer resources, they may suffer disproportionately from financial penalties for high readmission rates. As we seek to improve care for patients with heart failure, we should ensure that penalties for poor performance do not worsen disparities in quality of care. (Circ Cardiovasc Qual Outcomes. 2011;4:53-59.)
(2) Meanwhile, at the state level, the Governor shows up as a late arrival on the issue of the disproportionate rates paid to certain health care systems, a pattern regularly documented by the Attorney General. Under the misleading headline, "Patrick offers a plan to control care costs," a story reports:
The governor’s plan requires the administration to conduct a “cost and market impact review’’ of any medical provider it suspects is engaging in or plans to engage in anticompetitive behavior.
The reporter lets the administration off the hook by never addressing why it needs legislative authorization to do what it already has the authority to do. Until now, the Governor has carefully ducked the issue whenever it has been brought up. His administration has been MIA, notwithstanding the AG's presentation of her annual findings to one of his line state agencies under previously approved legislation.
By the way, even with no teeth, the proposal has opposition:
[The] president of the Massachusetts Taxpayers Foundation, said the plan is “an open invitation for unaccountable bureaucrats to go on a witch hunt.’’
As if those bureaucrats would be any more unaccountable than the people involved in secret negotiations between the dominant provider and the dominant insurer.
