Health Care is in the Intensive Care Unit

A young Westfield woman, working on a graduate degree in nursing at Massachusetts General Hospital in Boston, called to ask my thoughts on health care in the Commonwealth. It was a class assignment--call a Legislator and do a research paper on the interview.

If I had to write the paper, I'd point out that any doctor would immediately put health care in Massachusetts in the Intensive Care Unit. Does that sound too strong? I don't think so.

First, our hospitals are in dire straits. Some, like our own Noble Hospital, are survivors, thanks to the hard work and careful spending by administrators, trustees, and health care workers.

Others are not so lucky. More than half the hospitals in Massachusetts are losing money, a lot of money, on day to day operations. We've seen some temporary fixes--bailing out Quincy Hospital, for example, with a state loan. But I, and many other legislators, are convinced that more hospitals will close their doors in the next decade, cutback services, layoff employees, and go bankrupt.

Why? Well, to note just one major reason, the squeeze put on them by insurance companies. When HMOs came into being, they, and other insurers, wanted to pay the least amount of money possible to hospitals for their customers. So, the insurance companies and HMOs put a lot of pressure on hospitals to accept deeply discounted payments for services.

The hospitals suffered, of course. They wanted the business. So they, admittedly, entered in contracts whereby they provided the same service, but at lower costs and slimmer, if any, profits.

But, the insurance companies also suffered. And we are seeing that feedback now, with the disappearance of HMOs across New England. Because, they, too, are losing money. And, therefore, not about to enter into more generous contracts with health care providers like hospitals. Or, doctors. Or to take on a population with increasing health care costs. Like our elderly.

And, doctors tell me, as they testify at hearings in Boston, in their offices, and in their phone calls, letters and e-mails, that the HMOs are not paying their bills in a timely manner. Many, many claims are delayed because the HMOs say they are not "clean claims," with every i dotted and every t crossed. Doctors, who are increasingly beginning to focus on the positive aspects of a single payer system, say that payments may not be received--even at discounted rates--until 90, 160, or 365 days, or more, after submitted.

Hospitals, again, have the same complaints. Baystate Medical Center, for example, told legislators recently that they have $134-million in outstanding claims.

Even more problems are blamed on the balanced budget amendment in Washington, which put additional and devastating limits on Medicare payments. And Medicare is the largest payer for health services in the state. Even with an additional $270 million federally earmarked for this state's hospitals over the next five years, hospitals still face almost $2-billion in cuts in federal payments.

The Commonwealth of Massachusetts is under increasing pressure to do something--provide health care for everyone? underwrite additional pharmacy bills? mandate more coverage? demand more federal dollars?

For two legislative sessions, I've been a member of the Conference Committee on Managed Care reform, one of six Senators and Representatives trying to come up with a compromise bill to satisfy both arms of the legislature, while being fair to consumers and hospitals and doctors but without further jeopardizing the HMOs we still have.

We agree on a few basics--like payment for emergency room care if you think a situation is an emergency, an appeals process for denied services, allowing a woman's ob-gyn to be her primary care physician, and prompt payment of bills. But I don't think we'll come to any agreement on the legislation in the weeks remaining this year, or maybe even all of next year.

And, in the meantime, you deserve better. Our doctors deserve better. And our hospitals--community hospitals like Noble in particular--deserve better.

So, Amy, if you haven't written your paper yet, you can borrow this one. And, thanks for going into a field that is under appreciated. I hope that, by the time you graduate, we can come up with some solutions to make your job easier.

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