UMass Memorial head sees new era in health care - Worcester Telegram
Two years ago, Shrewsbury Town Manager Daniel J. Morgado told me the town's health care costs in one year equaled the entire budgets of the town's police and fire departments. If health care costs continued to increase at a double-digit pace, he said, Shrewsbury would eventually pay more for health insurance annually than it would for its entire municipal budget, excluding schools.
According to the Associated Industries of Massachusetts, health insurance premiums in Massachusetts "have increased 50 percent since 2003, bringing the average cost paid by employers and workers to insure a single Massachusetts family through a health maintenance organization to $15,864 a year."
We in this country think we have the best health care system in the world. But what we actually have is the most expensive health care system in the world.
It is unclear to me whether the health insurance coverage-for-all plan instituted in Massachusetts — a model that is being used by the Obama administration for the country as a whole — is the answer. Or if health care payment reform — moving from a fee-for-service model to a global payment model — is the answer, either. The global payment model, also called accountable care, pays providers for the quality of care, not quantity.
In this week's cover story, reporter Priyanka Dayal explores how technology is changing the doctor-patient relationship. But the story also shines a spotlight on one feature of the global payment model for reimbursement. Monitoring a chronic illness on a day-to-day basis can delay, or even prevent, an expensive hospitalization later. (That it also makes for healthier patients is a happy side effect.)
At the largest health care provider in the region, UMass Memorial Health Care, the response to the changing health care economy has been noticeable.
UMass Memorial Health Care President John G. O'Brien said the hospital and its affiliated hospitals in Clinton, Marlboro, Leominster, Fitchburg and Palmer have begun reacting to deep cuts in Medicare reimbursements, as well as changes in the landscape of health insurance that are affecting their bottom line
"This is a tumultuous time. Nothing in the (recent) past can compare to the pace of change in the health care industry right now," he said. He predicted that this era of cutbacks in health care spending and growth is the new normal, and that health care budgets will not see a return to reimbursement rates and trends of the past.
"It's going to be a much better, more affordable health care system when we are all done," he said. "But we are building the airplane, in flight."
UMass Memorial has responded by laying off 150 employees, and announced its intention to sell two of its less profitable businesses with 750 total employees. Mr. O'Brien said UMass Memorial is also taking a hard look at pensions and other benefits, such as generous paid time off, that UMass Memorial employees have long enjoyed.
"If we're going to continue to be here," he said, "we're going to have to be less costly. That's going to make some people unhappy."
In a recent interview inside the new 19,000-square-foot radiology wing at the University Campus that is set to open next month, Mr. O'Brien said patient volume across the UMass Memorial system is down 2 percent, year-to-year. At the higher-cost University Campus, patient volume is down 4 percent. In the past, patient volume had regularly gone up by 1 percent or 2 percent per year, he said.
A number of factors, he said, are playing a role. For one, the recession is causing people to delay care.
Another reason, he said, is that more and more employees are enrolled in high-deductible health insurance plans, which means that it is now more expensive for them to seek care.
Tiered health care plans are steering patients away from high-cost academic medical centers, such as UMass Memorial, to lower-cost providers, such as St. Vincent Hospital.
Despite fewer patients being uninsured, UMass Memorial has not seen a reduction in the amount of free care it provides. In fact, it's still increasing. People are still finding it difficult to pay their medical bills.
UMass Memorial has also begun beefing up the offerings of its affiliated hospitals, in order to steer patients in greater Worcester County toward those hospitals.
Clinton Hospital will begin work in June on a 28,000-square foot building that will double the size of the emergency department and provide room for growth. Marlboro Hospital has plans for a new Cancer Pavilion, while HealthAlliance Hospital in Leominster and the Simonds-Sinon Regional Cancer Center in Fitchburg are both undergoing extensive renovations. "There is huge pressure on us to be more efficient," he said.
20 May, 2012
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