Previous Page | Print this Document

By Senate President Therese Murray and Senator Richard T. Moore

March 6, 2008 ... The first phase of Massachusetts health care reform took advantage of some of Massachusetts’ historic strengths, most notably the state’s high percentage of employer-sponsored insurance and its nationally low percentage of uninsured. This is not to diminish the enormity of its planning and implementation, which continues to engage state policymakers. 

Considering the challenges we are facing now, however, the second phase of health care reform could be billed as an all-or-nothing proposition. Some health care experts have suggested that we have become a victim of our own success. In some ways, this is true. 

Since health care reform became law in April 2006, we have enrolled more than 300,000 formerly uninsured individuals. By most accounts, we are halfway to our goal of insuring every person in the commonwealth. 

This has exceeded our expectations and brought some anticipated challenges. We knew that as more people entered the system, access to quality health care would become a greater concern due to the pre-existing shortage of primary care providers. And we understood that enrolling more people would contribute to escalating costs. 

The irony is that the first step in health care reform was necessary, and yet we cannot continue to increase coverage without bringing down costs and advancing primary care. Our health care system could collapse under the pressure of such an unbalanced formula. 

We should remember that health care cost-drivers have been threatening our system long before health care reform became law. 

Now is the time to address those issues in the all-important second phase of health care reform. Health care costs have become the No. 1 issue facing our economy. Rising health care costs are squeezing our state finances and cutting into resources for other essential public services, including education, public safety and transportation. These costs also make it increasingly difficult for young people, families and businesses, large and small, to make ends meet. 

The Senate legislation announced this week seeks to control the cost curve through a comprehensive approach to the health care system. The bill is designed for the future of the commonwealth — to make health care efficient, sustainable and affordable, while increasing access to primary care and setting new standards for providers, insurers and drug makers. 

This legislation attacks some of the biggest and traditional costs to consumers. For example, in an effort to halt years of double-digit rate increases, the bill requires public review of any insurance company submitting premium increases above 7 percent. This initiative will help peel back the curtain on how insurance companies themselves contribute to rising health care costs. 

The Senate bill also requires an annual public hearing with health care providers and insurance companies to investigate industry-wide cost-drivers, including expenses and surpluses. It also establishes an outright ban on pharmaceutical gifts to physicians. 

Transparency in these matters is crucial to the integrity of our health care system. Everyone must be held accountable. The gift ban, for example, seeks to pull physicians away from the marketing influences of the drug companies and re-emphasize the value of academic physician education and knowledge, while realigning spending needs and expectations on prescription drugs. 

Another major cost hindrance to our health care system is the failure to implement information technology systems. The Senate legislation requires statewide adoption of electronic health records by the year 2015, supported by $25 million a year from the proposed cigarette tax increase. 

It also will set a deadline of 2012 for statewide adoption of “computerized physician order entry” systems and require physician competency in health information technology for board registration. 

Updating these systems could save us billions of dollars while also reducing the occurrence of medical errors. 

The Massachusetts Technology Collaborative and the New England Healthcare Institute tell us that statewide adoption of computerized order entry alone could save us $170 million a year and prevent 55,000 adverse drug events annually that result in patient injury or death. 

Standardized billing and coding is another area in which technology can save money. The current system for documenting services and processing claims is antiquated. Our proposed legislation sets a statewide standard for uniform billing and coding among health care providers and insurance companies to reduce administrative costs, saving hundreds of millions of dollars. 

Finally, the proposed legislation seeks to bridge the primary care access gap through a variety of measures, including: a statewide work force recruitment campaign; increasing enrollment slots at the University of Massachusetts Medical School for students committed to providing primary care in the commonwealth; and expanding the role of nurse practitioners as primary care providers. 

Some in the health care industry are taking it upon themselves to advance health care reform initiatives. UMass Medical School certainly has been a leader in this area, developing its own strategy to address the shortage of primary care physicians and considering its own gift-ban requirement. 

Participation and collaboration will be the keys to our success. The first phase of health care reform was possible thanks to the broad coalition of citizens, businesses, providers, insurers and state government committed to increasing access. This next phase — cost control — will require a new and even greater commitment. 

This legislation is the beginning of that effort. The time to act is now. 

Previous Page | Print this Document