The Recorder
By Mackenzie Issler, Recorder Staff , published 8/13/2009
ServiceNet, a local mental health agency, sees about 6,000 people a year, and its billing department
has to deal with about 200 different insurance companies.
“That’s costly,” said Susan Stubbs, the agency’s chief executive officer.
Studies she has read show that up to 30 percent of health care dollars
an individual or employer pays goes into paperwork and administration –
“which partly explains why health care costs are so much more here than in
other countries,” she said.
That’s why Stubbs and several other local health care officials feel
that simplifying health care’s administrative functions is one of the
outcomes they would like to see emerge from the federal health care reform
currently being hotly debated.
Stubbs said she believes that the whole impetus for a government-run
insurance option — which is supported by President Barack Obama but a bone
of contention with conservatives — is to help drive down costs with an
insurance provider that has lower administrative overhead than for-profit
insurance companies.
Stubbs said she has heard that public programs, like Medicare and
Medicaid, have sig nificantly lower overhead than the private insurance
companies.
She said she is an advocate for a single-payer system, which she
described as “Medicare for all” and would like to see at least some
uniformity come out of reform, like a standard billing form for all
insurance companies.
Status quo no go
Asked about what flaws in the current health care system should be
addressed by planned federal legislation, local health care officials
listed other concerns, like placing more emphasis and resources toward
primary care. They also complained about high costs, the prediction that
Medicare could go broke in the near future and that doctors are paid based
on the amount of care they give, not so much on the outcome or improved
health of patients.
Some of the attributes of our current system they mentioned were the
high quality of technology available and the state’s health care reform
that has increased the number of insured.
But, regardless, all agreed that national reform is necessary.
“The status quo is not a long-term solution,” said Baystate Franklin
Medical Center President Chuck Gijanto.
As a provider, he said the community-based hospital is “definitely
afraid of short-term solutions that aren’t well thought out and would
negatively impact our ability to care for the community.
Several congressional committees have been working on different
proposals, which have some stark differences on issues like whether health
insurance should be required for all, the creation of a government-run plan
and proposed changes to Medicaid.
Gijanto said that administrative functions tend to be costly and that,
typically, every insurance company wants something different, especially
with documentation.
He said automated medical records will be huge for the future and that
“no section of the economy needs a good information system more than health
care.” He said this will help cut costs and the time needed for doctors and
other health officials to share information.
He said the Greenfield hospital is fortunate to be a part of Baystate
Health, which now has electronic medical records.
More emphasis on primary care
One of the issues that plagues Massachusetts is a severe shortage of
primary care physicians in the last few years, especially in western
Massachusetts and Cape Cod, according to the Massachusetts Medical Society.
“We need to put primary care physicians back at the center,” said
Gijanto. “There are not enough primary care doctors.”
He hopes that appropriating more resources to primary care is a key
part of reform.
“The population doesn’t do primary care on a regular basis,” he said,
and as a result, these people end up having more serious injuries and
illnesses that often need hospital care. He feels that the frequency of
these acute incidents could decrease if there were more resources and an
emphasis on primary care. He said preventive and primary care should have
very minimal costs, in terms of co-pays and deductibles, and that elective
visits and procedures should foot higher bills.
Bridgette Madden, the executive director of the Community Health
Center of Franklin County, also feels that the primary care shortage is a
crucial issue that needs to be addressed.
Madden said many of the nonprofit clinic’s patients come with multiple
health care needs and its doctors and nurses try to meet their needs as
much as possible in a short time frame.
“This is very frustrating to our providers because we want to provide
high-quality care to all our patients but because of the additional
out-of-pocket costs of health care, patients often do not come for
preventive primary care appointments as often as they should.”
She said primary care recruitment is an ongoing effort for the center.
Since Madden’s arrival a year ago, she has hired five new primary care
providers.
“The number of primary care providers is decreasing and many who are
interested in health care are moving on to specialty care, which is making
this gap harder to fill,” she said.
Nationally, on average, family practitioners make $172,000 and general
internists make $176,000; compared to orthopedic surgeons who make
$439,000; radiologists, $401,000; cardiologists, $392,000. This information
was reported by Merritt Hawkins, which is a national health care staffing
firm that specializes in the recruitment of physicians.
Stubbs also feels that there is a myth among the wealthy in the
country that they have good health care, and therefore they worry that
reform will “water it down.” But she referenced a study from a few years
ago that compared the upper class in Great Britain to the same group in the
United States.
“The fact of the matter is that wealthy people are not getting as good
care as they think they are,” she said. She said the study showed the upper
class in Great Britain live longer than their counterparts in this country.
Pay system screwy
“I think we have some good providers of care; the paying mechanisms
are screwy,” she said. “There are no incentives for care to be cheap.”
Most doctors, she said, get more paid more for the more care they give
and the more visits they have.
She said she knows that in some hospitals more expensive procedures,
like surgeries, are sometimes done because they pay more.
At ServiceNet, she said, the behavioral health care providers get paid
a certain amount for a session of psychotherapy.
“The more we do, the more we get paid,” she said.
But, in other countries, it is different.
Stubbs visited New Zealand, England, Australia and Scotland during an
exchange program to learn more about their health care systems.
“I didn’t understand too well in what important ways we are different
from other countries until I started visiting them.”
She said she went to England first, where she met a colleague who is
paid a certain amount per capita per year, based on 500,000 people in her
service area. Her colleague is responsible for the behavioral care of all
those people and has a set amount of money to care for them.
“Her incentive was to get people well as quickly as possible so they
didn’t need more service.”
If she tried to cut corners, it would come back to bite her, said Stubbs.
If you turn someone away, she explained, people get worse and worse
and would then need more expensive care.
These providers have the incentive to do prevention and cheaper care
up front before things get worse.
“I don’t think people understand how differently things are done
here,” she said.
Tapestry
“It is essential that the U.S. health insurance system is reformed so
that needed preventive health care and treatment is available to all as it
is now here in Massachusetts,” said Leslie Tarr Laurie, Tapestry president
and CEO. Tapestry provides reproductive health-care services to residents
in Berkshire, Franklin, Hampden and Hampshire counties.
“Even though the Mass. program is still a work in progress, it is
wonderful to live in a state that recognizes the all should have access to
health care — not just those who don’t have preexisting conditions or
those that have the resources to pay for health insurance.”
Right now, 97.4 percent of the state’s residents are insured.
In the western region of the state, which includes Franklin,
Berkshire, Hampden and Hampshire counties, the uninsured rate is slightly
higher at 3 percent, according to the state.
She said she feels the current health care system is working well for
people who have comprehensive health insurance and live in urban areas that
have extensive medical providers and institutions.
“Unfortunately, basic services like family planning are currently
being rationed or are unavailable for those who live in rural areas and/or
rely on the subsidized system for care even in Massachusetts, Tapestry
Health cannot provide birth control services to all who need and want.”
She said she would hope the country could have a single-payer system,
but “that does not seem to be any longer on the table.”
She hopes that there will be at least a publicly funded option that
would be a part of a reform plan.
“The costs to bill for service to many insurers, as we need to do even
with the Massachusetts plan, takes needed dollars away from health care.”
Tapestry Health serves at least 50,000 individuals a year across
western Massachusetts with 130 staff at 15 locations.
Athol Memorial
“Reform is necessary,” said Steven Penka, Athol Memorial Hospital
president.
“On the positive side, there is great technology available and in
Massachusetts everyone has access to health insurance,” said Penka.
“Many private insurers do a good job and there’s no doubt that
Medicare works. Medicare and the supplemental plans have taken the fear out
of paying for health care for our seniors. Also, many of the pharmacy
programs work very well.”
“What doesn’t work is that our society has not figured out how to
encourage physicians to go into primary care medicine and we don’t provide
enough incentive to do so.”
Penka, like many of his colleagues, said administrative costs need to
be controlled and that there needs to be increased access to health care.
“More than 40 million Americans don’t have health insurance and
without that access, people won’t seek care,” he said.
He added that increased funding for electronic medical records and
provider training are “good ideas with great future benefits.”
He said he feels if reform created less administrative costs that the
Athol hospital would be “realizing expanded payment for care.”
Athol Memorial Hospital is a 25-bed hospital serving the communities
of the North Quabbin region since 1950.
