'07 Forecast: health care
National spotlight on Bay State healthcare industry in 2007
By Margaret Leroux
This coming year will see Massachusetts’ ground-breaking health care program emerge from legislation to reality. Last October, the new insurance program, Commonwealth Care, began enrolling adults with incomes below the federal poverty line of $9,800; in January it will open for adults with incomes up to three times the federal poverty line of $29,400.
By July 1, new insurance options are to be available for small employers and uninsured people ineligible for Commonwealth Care. Providers are now developing insurance products, while the Commonwealth Health Insurance Connector Authority, which oversees the operation, is busy with outreach efforts to employers, employees and the general public.
"This is so dramatic and significant – the whole country is watching," says Daniel Moen, chair of the board of the Massachusetts Hospital Association and CEO of Heywood Hospital in Gardner. If the state succeeds in providing coverage for the previously uninsured, estimated to number more than 500,000, it will reduce the financial burdens of uncompensated care for hospitals. But legislation alone cannot address significant issues of rising costs and looming personnel shortages, warn the region’s health care leaders. Wiser use of available resources, improved technology, and accessible information on cost and quality will be critical to the new law’s success, they indicate.
The storm ahead
Having more patients come through the doors with some form of insurance coverage would be a major financial relief for institutions like UMass Memorial Health Care, which provided $100 million in uncompensated care in 2006, making it one of the largest providers of indigent care in the state. CEO John O’Brien says the new law creates an opportunity for patients and a benefit to all hospitals.
Andrei Soran, CEO of MetroWest Medical Center in Framingham, predicts the year ahead will be "a defining moment for the healthcare industry as we face the convergence of many factors." He cites the high costs of capital, as hospitals expand and renovate in order to compete, as well as counter-punches from the rising costs of insuring their own employees.
Medicare reimbursements are not keeping pace with hospitals’ expenses, Soran says, and community hospitals face competition from large academic centers that are offering laboratory services and outpatient surgery facilities in their own neighborhoods. Some community hospitals "won’t make it through the storm ahead," he warns.
Affordability is very much on the minds of healthcare providers too. If health care costs continue to rise, it will be hard to sustain the reforms enacted by the state’s health insurance reform legislation, says Andrew Dreyfus, executive vice president, healthcare services for Blue Cross Blue Shield of Massachusetts.
"The big test of the new law will come for people who don’t qualify for subsidies," Dreyfus says. Low-cost insurance products call for cost sharing in the form of co-payments or high deductibles. "How receptive the public is to the new insurance products will be a major issue in 2007."
"We’ll continue to see a lot of activity in new products," says Robert Egan, senior vice president, marketing and product development of Waltham-based Tufts Health Plan Inc. "The goal is to find affordable price points to increase the numbers of insured people."
Massachusetts leads in prescriptions |
A first-of-its-kind collaboration between healthcare providers and technology vendors with support from drug store chains puts Massachusetts ahead of the nation in promoting electronic prescriptions, with almost six million of them being written in the Bay State right now.
The eRx Collaborative partners are: Blue Cross Blue Shield of Massachusetts, Tufts Health Plan, Neighborhood Health Plan and technology partners DrFirst, Inc. and Zix Corporation. Participating pharmacies include: Brooks, CVS and Stop & Shop. The Collaborative has given more than 3,400 prescribers a handheld device and/or web browser. Prescription information is transmitted from the prescriber’s software through electronic data interchange into the pharmacy system.
Doctors using the eprescription software get immediate information about their patients’ medication histories, potential drug interactions or allergic reactions, and receive real-time FDA safety alerts.
Andrew Dreyfus, executive vp, healthcare services, Blue Cross Blue Shield of Massachusetts, notes that in June of this year, nearly 8,000 potentially harmful prescriptions were changed as a result of drug-drug and drug-allergy interaction alerts through the eprescription software. The Washington D.C. based eHealth Initiative estimated the financial benefits of the national use of e-prescribing to be $2.9 billion.
The first physician in central Massachusetts to use eprescription software is an enthusiastic convert. Dr. Deborah Hazen, a Shrewsbury internist who’s been using Pocketscripts software by Zix Corp. for two years, says, "there’s no downside whatsoever" to eliminating handwritten prescriptions.
"The system is easy to use; it’s very intuitive," Dr. Hazen says. "My staff and I had no problem learning, even though we represent a wide range of computer abilities."
A sole practitioner who writes about 150 prescriptions per week, Dr. Hazen says the electronic system has saved her practice "a huge amount of time."
"For any task that is done repetitively, I look for the easiest and least painful way to accomplish it," she explains, "and it’s amazing how easy it is to do prescriptions this way. Renewing a prescription is just a matter of pressing ‘renew’ and ‘send’ and you’re done."
M.L.
Continued investment in technology
UMMHC spent $128 million for its state-of-the art emergency department, the Duddie Massad Emergency and Trauma Center, which opened earlier this year. UMMHC plans additional capital improvements in excess of $80 million, including $27 million in information technology in 2007, according to O’Brien.
UMMHC is the second hospital in New England and the first in Massachusetts to have an electronic intensive care unit. This unit uses voice, data and video technology to identify potential concerns in a patient’s condition in the early stages, allowing ICU staff to intervene with prompt treatment before conditions worsen. The eICU program also includes specially trained critical care physicians known as intensivists, who work from the eICU support center at the Medical Center’s Hahnemann campus. They have access to computer terminals displaying all ICU patients’ vital signs such as blood pressure, oxygen saturation and heart rate. In 2007, UMMHC will extend the eICU program to its four member hospitals: Marlboro, Clinton, Health Alliance and Wing Memorial, and there’s talk of providing it to other Central Mass. community hospitals, O’Brien says.
Saint Vincent Hospital in Worcester opened its new Lung Cancer Center this year. The first of its kind in greater Worcester, the Center places an emphasis on prompt access to care, guaranteeing patients will be seen by a specialist within 48 hours of their first call. It provides patients with comprehensive, multidisciplinary lung cancer expertise under one roof, according to John Smithhisler, president and CEO.
The Lung Cancer Center’s diagnostic technology includes a state-of-the-art PET/CT scanner with three-dimensional capabilities to localize tumors. Lung cancer is the leading cause of cancer related deaths in men and women in the U.S. An estimated 172,500 cases will be diagnosed and over 160,000 people will die of it this year. According to the Massachusetts Department of Public Health, Worcester and Fitchburg have a higher than expected incidence of lung cancer.
Medicine comes into the electronic age
Technology is also at the forefront at Fallon Clinic Inc., the region’s largest for-profit group practice with more than 250 physicians. Fallon Clinic fully implemented a digital radiology system at all of its nearly 30 locations this year. Acting President and CEO Dr. Stephen Pezzella reports that Fallon Clinic’s electronic health record migration is now over halfway complete, with its practice scheduling and billing systems in place. Computers now being installed in all of Fallon’s exam rooms, he adds.
At the non-profit HMO Fallon Community Health Plan Inc., President and CEO Eric Schultz says he expects to see increased use of electronic medical records. Meanwhile, technology remains fragmented at most hospitals and providers, with most computer systems remaining incapable of "talking" to other providers’ or insurers’ computer systems. Continued reliance on paper records by even some of the most sophisticated health care providers can result in delays in treatment and duplication of services, all at significant financial cost, he says.
Nurse and doctor shortages ahead
Workforce issues will continue to concern area hospitals in the year ahead, according to MHA’s Moen, with more legislative negotiations likely over nursing staff ratios. The MHA and the Massachusetts Nurses Association, the state’s largest union for registered nurses, back opposing legislative approaches. The House bill supported by the MNA mandates staffing ratios; the Senate bill favored by the MHA does not.
This summer, the MHA and the Massachusetts Organization of Nurse Executives released a white paper concluding that by 2010, Massachusetts will have 9,096 fewer nurses than it will need.
Moen predicts a significant shortages in nursing and allied health professionals, citing a waiting list for the nursing program at Mount Wachusett Community College that he’s been told is in the hundreds. "We’re working with the state to open up the pipeline," he says. "There needs to be additional faculty, laboratory spaces and clinical rotations available to train nursing professionals."
Physician shortages, especially in primary care, will continue to bedevil the healthcare industry in Central Massachusetts in the year ahead. At MetroWest Medical Center in Framingham, CEO Andrei Soran notes a severe shortage of primary care physicians. The hospital plans to recruit 100 primary care physicians over the next three years, he says, but adds that the hospital also faces shortages of nurses, physical therapists and radiologists, whom he says are in high demand and difficult to find.
Getting everyone to play their parts
The final predictions about the year ahead are from Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority, who heads up the effort to link businesses and individuals with health insurance.
"The Connector’s challenge is to explain health reform to employers, the uninsured, insurance brokers carriers and others who are directly affected by it," Kingsdale says, "so that they can understand their new responsibilities and options and play their parts."
The second challenge, Kingsdale says, "is to build a new distribution channel for health insurance that works flawlessly for target customers – individuals and small businesses newly entering the insurance market."
Margaret LeRoux is a freelance writer. She can be reached at mleroux@charter.net.
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