Tufts Negotiations for 2004 Contract Begin
Partners current three-year contract with Tufts Health Plan is due to expire at the end of this calendar year. Representatives from both sides began negotiations in June. According to Andrew Sussman, MD, chief medical officer, BWPO, both parties are interested in moving toward a managed-care system that rewards physicians and hospitals financially if they provide high-quality care for patients while at the same time controlling spending. Progress on the negotiations will be included in future issues of Medical Staff News.
Blue Cross/Blue Shield Overlay Contract in Place
July 1 marks a new contract with HMO Blue, which is an overlay to BWH’s existing agreement with the payer. As a result of the new arrangement, utilization improvement in the areas of inpatient, Emergency Department, Radiology and Pharmacy will be a focus. Savings compared to expected utilization trends in these areas will be shared between the payer and BWPO/PCHI. A small amount of resources will be provided by HMO Blue to help with management of seriously ill patients, but efforts of all physicians will be relied upon heavily. Also, the collaboration of physicians and care coordinators will be vital to testing new models for care improvement, as well as to demonstrating BWH’s medical management value to Blue Cross. As capitation contracts fade, these new types of contracts, that focus on performance objectives, and surplus sharing, are becoming more popular. There is no withhold of fees or risk of loss of payments for the physicians or the hospitals.
“Overall the targets in the four focus areas for utilization improvement seem reasonable and should promote efficiency without compromise in quality of care,” said Andrew Sussman, MD, chief medical officer, BWPO.
More details will follow in the coming months.
GIC Negotiations Are Completed
The State employee indemnity insurance plan, GIC, has agreed to its first substantive professional fee increase in many years after negotiation with the BWPO/MGPO/PCHI. The increase will begin this summer, with an additional bump slated for October 1. In addition, a slightly higher in-crease in the anesthesia rate went into effect on July 1,
which translates into a favorable increase for the BWPO. GIC has an enrollment of 110,000 patients, a reasonably large fraction of which seek some of their care at BWH and other Partners members.
Partners Physicians Urge Halt on Cuts to Medicaid
More than 500 BWH and MGH physicians have called on state lawmakers to put a halt to further budget cuts in the state’s Medicaid (MassHealth) Program. On June 3, the doctors signed a letter to all 159 members of the Massachusetts House and Senate.
BWH physicians spoke out against MassHealth budget cuts – but also offered their help in identifying ways to reduce Medicaid spending without “eroding patient access to needed medical care.” The physicians wrote that “…further MassHealth cuts will have devastating consequences for our most vulnerable residents, preventing many of our poorest residents from accessing primary and preventive health care.”
During the past year, Governor Romney and the Legislature have enacted a number of MassHealth cuts, eliminating coverage for individuals and services.
The physicians urged lawmakers “to preserve a health care policy that promotes timely, preventive and cost-efficient access to needed medical care, rather than a policy that severs our relationships with our patients and drives them into a maze of emergency department visits and preventable hospitalizations.”
The efforts of the physicians seemed to pay early dividends as the House and Senate adopted a budget that restores coverage for some 36,000 people under Mass Basic.
Medicaid accounts for one-quarter of the state’s $23 billion annual budget and provides coverage for approximately one million Massachusetts residents, some 15 percent of the state’s population. While children and adults make up the majority of Medicaid recipients, 70 percent of Medicaid spending covers the disabled and elderly patients in nursing homes. Prescription drugs are the fastest growing component of Medicaid spending.
BWPO and MGPO have also introduced legislation on Beacon Hill to improve Medicaid rates, make payments more timely, and encourage adoption of disease management programs to improve quality and efficiency. The bill was heard by the Joint Healthcare Committee and is now under discussion. If adopted it would increase payments to Massachusetts physicians by 10 percent per year for three years, to better cover the costs of care.