Comments on: DON Reform - Half A Loaf? http://www.letstalkhealthcare.org/health-care-costs/don-reform-half-a-loaf/ Tue, 06 Jan 2009 22:48:08 +0000 http://wordpress.org/?v=2.5.1 By: Bernie Plovnick http://www.letstalkhealthcare.org/health-care-costs/don-reform-half-a-loaf/#comment-5613 Bernie Plovnick Mon, 21 Jul 2008 13:35:37 +0000 http://www.letstalkhealthcare.org/?p=246#comment-5613 I agree that the recent update of DoN regulations probably should have taken a closer look at ambulatory services. When the state deregulated ambulatory services from the DoN process decades ago, the environment was totally different. The intent was to level the playing field for hospitals with the large staff model HMO's like Harvard Community and Fallon Health Plans which were exempt from DoN review under federal law. Equally, the deregulation of ambulatory care sought to offer an incentive to hospitals to invest in ambulatory services at a time when cost reimbursement greatly favored inpatient services. I agree that the recent update of DoN regulations probably should have taken a closer look at ambulatory services. When the state deregulated ambulatory services from the DoN process decades ago, the environment was totally different. The intent was to level the playing field for hospitals with the large staff model HMO’s like Harvard Community and Fallon Health Plans which were exempt from DoN review under federal law. Equally, the deregulation of ambulatory care sought to offer an incentive to hospitals to invest in ambulatory services at a time when cost reimbursement greatly favored inpatient services.

]]> By: Barry Carol http://www.letstalkhealthcare.org/health-care-costs/don-reform-half-a-loaf/#comment-5610 Barry Carol Sun, 20 Jul 2008 10:48:16 +0000 http://www.letstalkhealthcare.org/?p=246#comment-5610 I wonder if Academic Medical Centers could not become low cost providers of healthcare if we made a couple of important changes in the payment mechanism. Specifically, why can’t we pay AMC’s for their education mission separately with a combination of medical school tuition and tax dollars instead of imbedding much of this cost into patients’ bills? Why can’t the research mission be paid solely with research grants and philanthropy, and, if needed, tax dollars? While this would obviously require CMS and Congressional leadership to effect, it could allow AMC’s to bill patients and their insurers for the cost of healthcare services only. In theory, the AMC’s have more scale, state of the art knowledge and better access to capital than community hospitals. They should be able to more easily afford electronic medical records, develop bundled payments for expensive surgical procedures, and maybe even learn to live with a capitation payment system which, in turn, would give them the incentive to provide cost-effective care and not just aggressive (and expensive) care which, as often as not, is unnecessary and sometimes even harmful. If I needed cancer care, either inpatient or outpatient, I would feel more confident receiving it from a brand name institution like Memorial Sloan Kettering or Dana Farber with a well established reputation for excellence in that field. They have the state of the art knowledge and cutting edge research in house and their doctors probably see more patients, especially the more complex cases. With volume and scale, these institutions should be low cost producers. Why aren’t they? I think the payment system is at least part of the answer. I wonder if Academic Medical Centers could not become low cost providers of healthcare if we made a couple of important changes in the payment mechanism. Specifically, why can’t we pay AMC’s for their education mission separately with a combination of medical school tuition and tax dollars instead of imbedding much of this cost into patients’ bills? Why can’t the research mission be paid solely with research grants and philanthropy, and, if needed, tax dollars? While this would obviously require CMS and Congressional leadership to effect, it could allow AMC’s to bill patients and their insurers for the cost of healthcare services only.

In theory, the AMC’s have more scale, state of the art knowledge and better access to capital than community hospitals. They should be able to more easily afford electronic medical records, develop bundled payments for expensive surgical procedures, and maybe even learn to live with a capitation payment system which, in turn, would give them the incentive to provide cost-effective care and not just aggressive (and expensive) care which, as often as not, is unnecessary and sometimes even harmful.

If I needed cancer care, either inpatient or outpatient, I would feel more confident receiving it from a brand name institution like Memorial Sloan Kettering or Dana Farber with a well established reputation for excellence in that field. They have the state of the art knowledge and cutting edge research in house and their doctors probably see more patients, especially the more complex cases. With volume and scale, these institutions should be low cost producers. Why aren’t they? I think the payment system is at least part of the answer.

]]> By: Jon Hurst http://www.letstalkhealthcare.org/health-care-costs/don-reform-half-a-loaf/#comment-5605 Jon Hurst Fri, 18 Jul 2008 14:54:38 +0000 http://www.letstalkhealthcare.org/?p=246#comment-5605 Ouch indeed! And I figured Partners' support was due to the fact that the "horse was already out of the barn" as for their own costly, unquestioned and unjustified expansion plans. Seems like the whole herd will continue to be get loose from Boston and spread across the state. What a shame for the community hospitals. And guess who gets the tab to pay for the unnecessary expansion?!? Same old story--the consumers, employers and taxpayers. Ouch indeed! And I figured Partners’ support was due to the fact that the “horse was already out of the barn” as for their own costly, unquestioned and unjustified expansion plans. Seems like the whole herd will continue to be get loose from Boston and spread across the state. What a shame for the community hospitals. And guess who gets the tab to pay for the unnecessary expansion?!? Same old story–the consumers, employers and taxpayers.

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