Tar­get­ing prices

Mass. at­tor­ney gen­eral sug­gests tem­po­rary price re­stric­tions

Modern Healthcare - - Regional News - Jaimy Lee

Are­port from the Mas­sachusetts at­tor­ney gen­eral’s of­fice rec­om­mends tem­po­rary price re­stric­tions on providers’ charges for com­pa­ra­ble med­i­cal ser­vices, not­ing that to­tal med­i­cal spend­ing in the state is greater for in­di­vid­u­als with higher in­comes.

The sec­ond an­nual re­port states that the shift to global pay­ments—where physi­cians re­ceive a per-pa­tient amount—will not con­trol ris­ing health­care costs un­less other is­sues, such as price dis­par­i­ties and changes in how con­sumers make pur­chas­ing de­ci­sions, are ad­dressed. It gath­ered data from six health in­sur­ers and 16 providers in Mas­sachusetts. The global pay­ments sys­tem is the “pre­dom­i­nant” non-fee-for-ser­vice pay­ment model used in Mas­sachusetts, ac­cord­ing to the re­port.

“The con­tin­ued in­crease in health­care costs is one of the most im­por­tant is­sues con­fronting fam­i­lies and busi­nesses,” Mas­sachusetts At­tor- ney Gen­eral Martha Coak­ley said in a news re­lease. “Our in­ves­ti­ga­tion shows that a move to global pay­ments is not the panacea to con­trol­ling costs with­out first ad­dress­ing provider price dis­par­i­ties that are not re­lated to the qual­ity or com­plex­ity of the ser­vices be­ing pro­vided.”

There is a 170% dif­fer­ence in the pay­ments made by health in­sur­ers to the low­est-paid hos­pi­tal and the high­est-paid hos­pi­tal in each of the in­sur­ers’ net­works, ac­cord­ing to the re­port.

Two Part­ners Health­Care hos­pi­tals, 19-bed Nan­tucket (Mass.) Cot­tage Hos­pi­tal and 25bed Martha’s Vine­yard Hos­pi­tal, Oak Bluffs, and 396-bed Chil­dren’s Hos­pi­tal Bos­ton were cited as the three hos­pi­tals re­ceiv­ing the high­est pay­ments.

“In­no­va­tive in­surance prod­ucts—tiered and lim­ited net­work prod­ucts—show prom­ise in pro­mot­ing value-based pur­chas­ing, but the com­pet­i­tive ben­e­fits of those prod­ucts can­not coun­ter­act the his­toric ef­fects of price dis­par­i­ties that con­tinue to threaten the fi­nan­cial vi­a­bil­ity of many ex­cel­lent, efficient health­care providers,” the re­port’s au­thors wrote.

The re­port also said providers that re­ceive global pay­ments do not “con­sis­tently” have lower to­tal med­i­cal ex­penses. It also found that tiered and lim­ited net­work prod­ucts in­creased con­sumer en­gage­ment.

The re­port of­fers five other rec­om­men­da­tions: pro­mot­ing tiered and lim­ited net­work prod­ucts to in­crease value-based pur­chas­ing de­ci­sions; en­cour­ag­ing con­sumers to se­lect a pri­mary-care provider; pro­mot­ing co­or­di­na­tion of pa­tient care through pri­mary-care providers; tak­ing steps to im­prove the use of the payer claims data­base; and de­vel­op­ing ad­di­tional reg­u­la­tory and stan­dards for providers in­volved in the man­age­ment of risk for in­sured and self-in­sured pa­tients.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.