Dick Cauchi

Massachusetts has taken another giant leap. Legislation (S 2863) signed into law August 10 goes beyond the well-publicized, near-universal health reform passed in 2006 by seeking to reduce the rising costs of health care, increasing transparency of cost and quality for consumers, and promoting electronic health records systems.

"This bill takes the next critical step by improving the quality and affordability of health care. It launches several initiatives essential to creating a transparent system of quality improvement and cost containment," said Senator Richard T. Moore, one of the chief architects of the 2006 health reform law and also of the new cost containment plan.

The universal coverage law, which began to be implemented in 2007, has helped to 439,000 formerly uninsured Massachusetts residents attain coverage. Cost overruns have been a sticking point in recent months, with some employers balking at the price of the program.  At the same time, a recent survey by the Harvard School of Public Health and the Blue Cross/Blue Shield Foundation found that public support for the program, including the individual mandate, remains high.

Restructuring Payment Systems
The practical goal of the new law is to "bend the curve" on the graph of rapid cost growth for treatment and coverage.  Many of the law's programs will be evaluated, and the outcomes reported to legislators.

The law calls for creating a Health Payment Reform Commission, aimed at restructuring the current payment system with incentives for "efficient and effective care."  The state will provide consumer information and annual cost containment and quality goals and require providers and insurers to report on progress toward the goals.

To reduce administrative costs, the state will develop standards for uniform billing and coding. All providers and insurers are required to abide by these standards by 2012. For example, computerized order entries for tests and medicines alone are projected to save $170 million per year in hospitals statewide.

The law authorizes a formal list of "never-events" (such as operating on the wrong organ) and prohibits health providers from billing for costs related to these errors. Providers also must inform the state of “serious reportable events,” adverse drug events and hospital-acquired infections.

In addition, both providers and insurers will be required to publicly explain each year the reason for any cost or premium increases. The Attorney General is authorized to represent consumers to question the basis of the increased charges.

Using $25 million for deployment, a new state e-Health Institute will oversee the mandated statewide adoption of electronic medical records. All physicians must demonstrate competency in the use of health information technology by 2015.

To educate providers on the use of therapeutic alternatives to high-cost, brand-name drugs, a Pharmacy Academic Detailing Program will be established. Pharmaceutical and medical device companies must report to the state Department of Public Health any payment or gift of more than $50 made to a health-care professional. Those gifts would be publicly reported on the state's web site. "Biased marketing and financial inducements are destructive to the sacred doctor-patient relationship," said Senator Mark Montigny, author of the gift ban legislation. "Evidence-based academic detailing enhances this relationship."

To increase the number of primary care providers, the law recognizes nurse practitioners as primary-care providers and expands the use of physician assistants. A "medical home" demonstration project will be created to promote coordinated and comprehensive care for low-income residents.