The omnibus legislation filed by Governor Charlie Baker, a former health care CEO, aims to use government’s regulatory hammer to get health care facilities to increase their spending on primary care and behavioral health care by 30 percent over the next three years. Currently, such expenditures account for less than 15 percent of total health care dollars.
But in the process of shifting that emphasis, providers and insurers would have to keep overall spending growth at 3.1 percent per year.
“The idea here, frankly, is to force everybody to just get off doing what they’ve always done,” the governor told the Legislature’s Health Care Financing Committee last week.
That, in a nutshell, is the idea behind the 179-page bill filed by the governor that seeks to change the way services are delivered — ideally encouraging hospitals to spend less on the bright shiny objects of health care and more on low-tech improvements that allow physicians to spend more time with patients. Hiring scribes, for example, to do note-taking for primary care docs.
The bill also aims to provide more transparency and a host of new protections for consumers.
Those protections ought to be an easy lift for lawmakers, who have already examined the issues in a number of separate pieces of legislation. They include:
- Prohibiting so-called surprise billing for emergency room treatment or out-of-network treatment, which Health and Human Services Secretary Marylou Sudders called “a drain on the system” in addition to being a real burden to patients.
- Curtailing “facilities fees” — another unwanted surprise for patients treated in a facility that may be away from a hospital’s main campus.
- Licensing urgent care centers, requiring them to accept MassHealth patients and provide behavioral health services on site.
- Requiring coverage of certain telehealth services — yes, bringing the system into the 21st century.
It would also broaden the state’s still-new system for controlling prescription drug prices, which now applies only to drugs purchased under MassHealth. Sudders told lawmakers that, under the new framework, health care regulators have completed negotiations with five drug manufacturers on 11 drugs for a total net savings of $ 10 million.
The administration wants to extend that oversight to the private market for new drugs costing more than $ 50,000 a year per patient. The cost containment effort would also impose fines on any pharmaceutical company for raising the price of existing drugs by more than 2 percent above inflation in any year.
Baker also noted that allowing nurse practitioners and licensed psychiatric nurses far greater latitude in their respective practices would help lower costs and provide better access to care. It was something Baker said he had proposed 28 years ago when he served as Governor Bill Weld’s secretary of health and human services.
It’s high time, no?
Baker’s bill takes a very big idea and backs it up with a lot of detailed policy prescriptions. Some, like that on expanding the role of nurse practitioners, are long overdue. Others are new answers to newly discovered problems, like surprise billing. As Senate President Emerita Harriette Chandler put it in commending the effort, it doesn’t just “tinker around the edges.”
Indeed it doesn’t — because this is no time for tinkering. Rather it’s a time to take a remarkable health care system and make it work better for everyone.
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