The Boston Globe prints as news a story that Partners HealthCare collects a lot of the dollars spent on medical care in Massaachusetts. It's not news, but I guess later is better than never. The lede:
Nearly one-third of all the money that Massachusetts insurers spent on acute hospital care last year went to Partners HealthCare, according to a new Patrick administration analysis that underscores the dominance of the state’s largest medical provider.
In addition, Partners-affiliated doctors received 25 percent of the money paid to physicians in 2011. In both cases, Partners received two to three times as much as the providers receiving the next most in payments.
The statements above are rendered less informative without some kind of metric that indicates what percentage of the hospital beds, or discharges, or whatever are owned by Partners. Or, what percent of the state's doctors (by specialty) are in the Partners network. That is nowhere to be seen in the story. (Maybe some of these charts would have been helpful.)
Absent that information, too, the story's reported assertion by the head of the state's Health Policy Commission has no basis. The story quotes him as saying that the report underlines “why we are the most expensive state in the US. It’s because of the structure of our system,’’ which leads residents to “use expensive teaching hospitals,” including those owned by Partners, more often than people in other states.
What if the explanation, instead, is that the amount Partners' hospitals and doctors receive for patient care--in its academic centers, in its community hospitals, and its physician office practices--has been substantially above the rest of the market for two decades? What if the percentage rate increases granted by the state's largest insurer to Partners exceeded the average rate increases given to other networks, even though the base on which those increases was applied was already well above the state average?
Both of those statements are true but are not part of the news story. The underlying issue, with due respect, is not that people in Massachusetts use academic centers more than in other states (although that can certainly be a contributing cost factor.) It's that the dominant provider--which is about to expand its holdings--is paid hundreds of millions of dollars in excess revenue relative to the market. It's that the dominant insurer has displayed no capacity for taking on that behemoth.
Fortunately, buried in the story is the conclusion by the Center for Health Information and Analysis "that cutting spending on medical care will depend in part on controlling payments" to Partners and other systems that have used market power to extract high prices. You can't control health care costs in Massachusetts without equalizing the rates of pay among the health providers by basing the amounts paid on clinical value received, irrespective of market power. However, there is no appetite in this state to make that happen. Since it will not happen, we will simply see periodic reports and news stories about ever rising costs while the industry giants demand more. Meanwhile, hospitals and doctor groups outside of the market drivers will be left with the scraps. As those latter hospitals slowly decapitalize and those doctors lose income, they will be inevitably drawn into the big systems, allowing those systems to exert still more influence over payment rates. It will not matter if those payment rates are based on fee-for-service or bundling or capitation. Regardless of payment design, the rates of the monopolistic systems will generate supernormal returns. Their income is our costs.
Nearly one-third of all the money that Massachusetts insurers spent on acute hospital care last year went to Partners HealthCare, according to a new Patrick administration analysis that underscores the dominance of the state’s largest medical provider.
In addition, Partners-affiliated doctors received 25 percent of the money paid to physicians in 2011. In both cases, Partners received two to three times as much as the providers receiving the next most in payments.
The statements above are rendered less informative without some kind of metric that indicates what percentage of the hospital beds, or discharges, or whatever are owned by Partners. Or, what percent of the state's doctors (by specialty) are in the Partners network. That is nowhere to be seen in the story. (Maybe some of these charts would have been helpful.)
Absent that information, too, the story's reported assertion by the head of the state's Health Policy Commission has no basis. The story quotes him as saying that the report underlines “why we are the most expensive state in the US. It’s because of the structure of our system,’’ which leads residents to “use expensive teaching hospitals,” including those owned by Partners, more often than people in other states.
What if the explanation, instead, is that the amount Partners' hospitals and doctors receive for patient care--in its academic centers, in its community hospitals, and its physician office practices--has been substantially above the rest of the market for two decades? What if the percentage rate increases granted by the state's largest insurer to Partners exceeded the average rate increases given to other networks, even though the base on which those increases was applied was already well above the state average?
Both of those statements are true but are not part of the news story. The underlying issue, with due respect, is not that people in Massachusetts use academic centers more than in other states (although that can certainly be a contributing cost factor.) It's that the dominant provider--which is about to expand its holdings--is paid hundreds of millions of dollars in excess revenue relative to the market. It's that the dominant insurer has displayed no capacity for taking on that behemoth.
Fortunately, buried in the story is the conclusion by the Center for Health Information and Analysis "that cutting spending on medical care will depend in part on controlling payments" to Partners and other systems that have used market power to extract high prices. You can't control health care costs in Massachusetts without equalizing the rates of pay among the health providers by basing the amounts paid on clinical value received, irrespective of market power. However, there is no appetite in this state to make that happen. Since it will not happen, we will simply see periodic reports and news stories about ever rising costs while the industry giants demand more. Meanwhile, hospitals and doctor groups outside of the market drivers will be left with the scraps. As those latter hospitals slowly decapitalize and those doctors lose income, they will be inevitably drawn into the big systems, allowing those systems to exert still more influence over payment rates. It will not matter if those payment rates are based on fee-for-service or bundling or capitation. Regardless of payment design, the rates of the monopolistic systems will generate supernormal returns. Their income is our costs.
0 comments:
Post a Comment