Health policy commission outlines cost control recommendations
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A mother holds her newborn baby at Harrington Memorial Hospital's Family Birthing Center in Southbridge. Harrington has the lowest C-section rate of all Massachusetts hospitals, according to The Leapfrog Group. The Health Policy Commission is attempting to address "unwarranted" price variations.
In an effort to combat rising health care spending in Massachusetts, the Health Policy Commission on Wednesday called on the state to take a series of actions including implementing consumer protections and easing practice restrictions for certain nurses.
The policy recommendations come as part of the commission's 2015 cost trends report, which examines the 4.8 percent increase in per capita health care spending in 2014.
As main drivers of the spending growth, the report cites high pharmaceutical spending -- based on the introduction of new high-cost drugs, large price increases and some drugs going off-patent -- and spikes in MassHealth enrollment brought about by the Affordable Care Act.
The commission's 13 recommendations focus on advancing alternative payment methods, improving transparency and data availability, promoting quality and efficiency in care delivery, and fostering a value based market.
One proposal tackles high charges for patients served by out-of-network providers, urging the Legislature to require that providers inform consumers whether they are in- or out-of-network before delivering services. The commission also calls on legislators to require that insurance carriers hold their members harmless in cases of out-of-network emergency services and boost awareness of existing "surprise billing" protections.
"There is no area which is more egregious than this one," commission chairman Stuart Altman said. "If we could sort of have little flashing lights on one of the recommendations, it would be this one."
The commission also calls on lawmakers to: require greater transparency in drug pricing and manufacturer rebates, limit the definition of providers eligible for hospital outpatient payments, and remove scope of practice restrictions for advanced practice nurses.
Scope of practice laws set legal boundaries on what tasks a medical professional can perform and under what level of oversight. Suggesting that easing the restrictions could increase access to primary care, the report says that nurse practitioners provide lower-cost care and are more likely to treat Medicaid patients and practice in rural areas.
Health and Human Services Secretary Marylou Sudders said she hoped to see commission staff also develop recommendations addressing what she identified as major spending themes that have come up in discussion for years -- use of emergency rooms, re-hospitalization rates and a disproportionate use of long-term care compared to other states.
"Let's understand more of the root causes here as we also look at some of these other issues," Sudders told reporters.
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