Volume 17, No. 3, Summer 2009
As most of the nation’s attention is focused on Washington and the Obama Administration’s efforts to get a healthcare reform bill through Congress, concerned Cape Codders are fighting their own battle on Beacon Hill.
At issue is legislation that would create a Cape Care Community Health Trust that would, in the supporters’ words, “establish a community-owned health care plan providing affordable and comprehensive coverage for everyone on Cape Cod.”
A bill to this effect has been filed in the Legislature by Representative Matt Patrick (D-Falmouth) and Senator Rob O’Leary (D-Barnstable). The bureaucratic road, however, is long and winding.
As Representative Patrick’s office explained as of this writing, “This bill creates a corporation, so it needs to be certified by the Secretary of State's office before it can begin to move through the House. [They] had the Cape Care people complete some public notification such as: print in newspaper and inform all towns involved. This has been completed and we are just waiting for the Secretary of State to sign off on it.”
Representative Patrick estimates that there may be some action on the bill this fall.
Just getting this far is an achievement.
The Cape Care project arose almost six years ago, based on the principle that health care should be a tax-supported service available to all citizens not unlike public schools or police and fire protection. In this case it probably would be a property tax surcharge, which also, it was noted, would impact summer residents.
Under this plan, Cape residents would continue to be free to choose their own healthcare providers and coverage would not be related to employment.
During last year’s election, the Cape Care Coalition collected enough signatures to put this premise on the ballot as a public policy question in three of the Cape’s six legislative districts. The question received a 71 percent affirmative vote.
As Dr. Brian O’Malley, a Provincetown physician, points out, support for the idea has “grown exponentially, person by person” during the ensuing months.
Among supporters is the Cape’s Congressman, Bill Delahunt, who has written the Coalition, “I share your views.” Others include Dr. Richard Salluzzo, president/CEO of Cape Cod Healthcare, and one of his predecessors, Jim Lyons. Hospital officials have long complained about the high cost of managing the claims process through a morass of public and private insurers, all of which would be eliminated by a simple single-payer insurance system.
At a recent meeting of the Cape Care Coalition, Representative Patrick reminded the audience that “this is an important thing that you’re doing and it’s not going to be easy. The bill could come up this fall. Be ready. When there are hearings, fill the room. And bring posters.”
More information about the Cape Care Coalition and the Cape Care Community Health Trust bill is available at www.capecare.info or by contacting 1-877-700-8070 or info@capecare.info.
By Senator Rob O’Leary
The current adversarial malpractice system in Massachusetts stands in the way of necessary efforts to improve patient safety, retain quality physicians and cut high medical costs. In response to these shortcomings, I have filed a number of bills which I believe will help to bring down the cost of malpractice insurance, thus bringing down the cost of healthcare itself.
The first bill, Senate Bill 574, An Act Relative to Malpractice Reform, will improve upon the status quo through two important changes to current law. The first section encourages open communication between doctors and victims of medical errors or negative outcomes by allowing them to apologize to patients without such a statement being used against them in court. The second section institutes a six month cooling-off period between the occurrence of a medical error or negative outcome and the filing of a lawsuit.
The bill’s first main provision establishes a procedure for healthcare providers to openly acknowledge errors and other negative results to their patients. This bill would encourage physicians, nurses and other allied health professionals, hospitals and health systems to take extra steps towards fair negotiations with patients and their families with the help of two little words: “I’m sorry.”
In the fall of 2008, a State House briefing featured testimony from patients who had been victims of hospital errors. Every member of the panel agreed that an honest apology from the physicians involved would have meant the world to them, perhaps even kept them from filing suit.
A “cooling-off period” simply would allow six months from when a person considers filing a claim for medical malpractice to when they actually do so. This would provide the opportunity for all parties to reach a settlement without the need for costly litigation. Some critics argue that this could be “anti-patient.” However, I would argue that the current culture of immediately filing suit against medical professionals after a negative outcome raises the price of malpractice insurance, encourages defensive medicine, and thus raises the cost of healthcare exponentially–a far greater burden to all consumers in the long run.
The next piece of legislation I filed, Senate Bill 573, An Act Providing for a Fair Judgment Interest Rate for Medical Malpractice Actions, will help lower the cost of medical malpractice lawsuits. From 1992-2005 the cost of professional liability insurance to Massachusetts physicians rose by 132 percent, making it one of the major factors in the falling numbers of licensed physicians in our state. One factor is that the current statutory interest rate for judgments is four points higher than the Federal Treasury Bill rate. This results in higher healthcare costs by artificially raising the cost of professional liability insurance. My bill would set the rate on prejudgment interest on damages for the plaintiff in line with the average accepted auction price for 52-week U.S. Treasury Bills for the entire period that the case was pending through the date a verdict was rendered or a final order made. The current judgment rate in Massachusetts encourages attorneys for the plaintiff to extend the trial as long as possible, and encourages attorneys for the defense to advise their clients to settle, even in cases of innocence. Calculating interest rates in the suggested manner eliminates incentives to delay cases during periods of interest fluctuations.
Along with other efforts to improve our healthcare system, ensuring medical malpractice reforms can help lead to a more comprehensive and patient-friendly system that will keep Massachusetts in the forefront of real healthcare reforms and improvements nationwide.
(Senator O’Leary, D-Cummaquid, represents the Mid and Lower Cape and Islands and is a member of the Legislature’s Joint Public Health Committee.
By Representative Cleon H. Turner
In an age of unprecedented obesity rates, rising healthcare costs, and a new trend of health conscious consumers, one is hard pressed to find anyone not in the restaurant business opposed to menu labeling.
According to the Massachusetts Health Policy Forum, in 2005 more than 56 percent of Massachusetts adults were overweight, a 40 percent increase from rates reported in 1990. Overall, nearly 21 percent of Massachusetts adults are obese.
Being overweight and obese is associated with significant social and economic costs and consequences primarily because of their effect on health and healthcare costs. The causes of obesity are complex: people are eating out more; portion sizes are larger; high calorie/high fat foods are widely available and less expensive; unhealthy foods and beverages are aggressively marketed; generally people exercise less; and nutritional education is largely ineffective.
House Bill 3715, An Act Relative to Menu Labeling in Restaurants is an effort to require restaurants to label their menus with specific nutrition information. The bill calls for the advertisement of calorie information of food items prior to their sale, be it in a brochure, a table tent, a label next to a menu item, or a separate caloric index. If a menu item is intended for more than one individual, the menu must indicate the number of diners to be served and the calorie content for each person served. Minimum and maximum calorie counts must be listed if the dish is a combination of two other items.
Nutritional and calorie content information will be required once per menu item if portion size, recipe amounts and preparation techniques are consistent. Menus and menu boards may include a disclaimer that indicates that variations may occur in nutritional contents across servings.
Beginning July 1, 2010, food facilities would have to provide complete nutritional information at the point of sale until calories are posted either on menus or menu boards. If passed, this legislation would require nutrition information to be posted on interior menu boards and menus by January 1, 2012.
This bill would apply to chains and franchises with nine or more locations and creates one statewide standard: as the law stands now, municipalities can each establish their own labeling laws.
Meanwhile, a federal menu labeling bill called the Labeling Education and Nutrition Act (LEAN Act) has been introduced that would require chains with more than 20 units to post calorie counts for all menu items.
The language in the LEAN Act is almost identical to that in House Bill 3715 and its effects will be quite similar on a nationwide scale. The problems presented by poor nutrition and obesity are in no way unique to Massachusetts. These are problems on a national scale and require a national solution.
(Representative Turner, D-Dennis, is a member of the Legislature’s Joint Public Health Committee.)
By Senate President Therese Murray
In May of this year I was asked to be the keynote speaker at the first EU Connected Health Conference held in Belfast, Northern Ireland. At this conference, doctors, researchers, scientists and businesspeople discussed the importance of developing electronic medical records and promoting connected health technologies that would increase access in underserved areas and provide patients with more consistent preventive care.
As the only government official representing the United States, I discussed where Massachusetts was in the process of Health Care Reform and what we were looking to accomplish as we move forward. One of the most promising ways for us to increase access and preventive care is through telemedicine.
Connected health systems have the ability to greatly expand the reach, the efficiency, and the quality of health care delivery and health maintenance. In the United States, 32 percent of large home health agencies already are using remote monitoring. This is great, but we need to better.
Evidence shows that targeted systems can produce real savings by reducing hospital admission rates. Of those home health care agencies that are already using telehealth, 76 percent report a reduction in unplanned hospital admissions, and 77 percent report a reduction in emergency room visits.
Hospitalizations represent a $3.5 billion annual expense in Massachusetts, and we estimate that up to 15 percent of all cases are for conditions that could be prevented. Companies in Massachusetts are on the forefront of developing connected health technologies and implementing the care programs necessary to maximize their benefit. Partners Healthcare, based in Massachusetts, is an international leader in Connected Health, and currently is collaborating with Northern Ireland and the European Centre for Connected Health.
In 1995, Partners established a Center for Connected Health aimed at creating effective new solutions to deliver quality patient care outside of the traditional medical setting. One example of this is the Connected Cardiac Care program at Massachusetts General Hospital.
This program aims to avoid unnecessary costs by improving patients’ understanding of their condition, and provide on-going nursing support and review of key health measures while the patient is at home. Data from this pilot suggests that telemonitored patients have a lower re-hospitalization rate than those who do not.
Another Massachusetts company, Dovetail Health, based out of Needham, has created an enhanced connected health model that identifies the 10 percent of the patients at the greatest risk of readmission and provides transition support for 30 days. By supporting the highest risk patients, Dovetail claims it can deliver a saving of $5 million for every $1 million invested.
The benefit can also be seen in rural areas where, residents have less access to care. According to a federal study, while 20 percent of Americans live in rural areas, only nine percent of our physicians practice there.
This means that rural residents are much less likely to have regular medical appointments or keep up on chronic conditions. This lack of access drives up the cost of service, and leads to later diagnosis.
The technology is available, and if we utilize it, the residents, regardless of where they live will have the access they deserve.
(Senator Murray, D-Plymouth/Upper Cape, is the first female President of the Senate in Massachusetts history.)