Tuesday, May 17, 2011

State House Testimony


Governor Patrick testifies to the Joint Committee on Health Care Financing, May 16, 2011

Yesterday, in the Gardner Auditorium at the Massachusetts State House, I had an opportunity to testify to the Joint Committee on Health Care Financing and provide comments regarding Governor Deval Patrick's proposed health care reform bill.  It's a bill with far reaching consequences for the entire health industry in the commonwealth, though it provides more in the way of structure and principles than it does in specifics.  Nevertheless, industry groups trotted out arguments pro or con and gave, sometimes in painstaking detail, all the reasons the Governor's plan is salvation... or doomed to failure.

I was proud to be the only representative from the home care industry in attendance at the meeting, supporting the efforts of the Massachusetts Home Care Alliance.

Some of the key points made during the day are as follows:

The Patrick Administration: This bill is essential to reigning in costs and to sparking a continued economic recovery in the state.  Creating more transparency around reimbursements to providers is essential.  Health and Human Service Secretary JudyAnn Bigby, at one point, acknowledged that "home health care providers are underpaid."  We agree.

The hospital industry: The bill is too highly regulatory and government-centric in approach.  More of a public-private partnership would be more effective.  The chronic problem of underpayments by government payers (and the resulting need for hospitals to make up for it elsewhere) is not addressed in the bill, nor the high cost of medical education.

The HMO industry: They touted more of a free-market position and one that capitalizes on what presently works in the system.

Here is the text of my remarks:

Chairman Moore, Chairman Walsh, members of the Committee and staff, I would like to thank you for the opportunity to offer comments today.


I am Rey Spadoni, President of the Visiting Nurse Association of Boston, the very first home care agency in the United States.  We are proud to be celebrating our 125th continuous year in operation, serving patients in and around the Boston area.  We care for 2,000 patients every day.


We have a long history of responding to public health crises in the Commonwealth of Massachusetts… and of acting as a reliable and unfaltering safety net for our most vulnerable citizens and our most challenged neighbors.


Governor Patrick’s proposed bill and today’s testimony well document the fact that we are experiencing another crisis.  We note the facts that Medicare reimbursements per Massachusetts enrollee are among the highest in the nation, we ranks thirty-third on avoidable hospital use and costs… and all this despite the fact that our commonwealth leads the nation in the percentage of residents who have health insurance… at greater than 98% covered.


It is another crisis… and my organization and the Massachusetts home health care industry… is poised once again to become a central and leading voice in developing the solution.


According to the Medicare Payment Advisory Commission, the estimated 2010 cost per day in an acute care hospital approaches $7,000.  In home care, it’s $140.  When a patient needs to be in a hospital, no other setting will suffice.  But when a patient is in the hospital due to avoidable causes, $140 versus $7,000 is a very dramatic difference.


In figures from a study published in the New England Journal of Medicine in 2009, 20% of Medicare enrollees discharged from an acute care hospital are readmitted within 30 days of discharge.  According to the researchers, three quarters of those readmissions can be classified as preventable.   Readmissions which are estimated to cost our system well over $12 billion each year.


In the United States, 29% of all individuals who receive home care services… and remember that these patients are home bound and already among the sickest of all patients… will be readmitted to the hospital within the 60-day episode of care.  At the Visiting Nurse Association of Boston, that number is 25%.  That four percent difference, if applied to a larger population, represents a very substantial savings… and opportunity to improve the quality of life, independence and dignity of our sickest and most vulnerable populations.  But that four percent difference did not happen by accident.  It happened due to investments in technology, clinical centers of excellence that serve patients with chronic disease, staff training and the addition of support services designed to keep people at home and independent or achieving the highest quality of life levels possible for them.


Each day in the hospital, including all the avoidable ones, costs our system $7,000.  A day of home care, $140.


Home care can be a central and critical part of solving the health care cost crisis.  Innovations and cost saving possibilities here are numerous and should be prominently featured in emerging systems based on accountable or integrated care organizations… and encouraged, not disadvantaged, in new alternative payment methodologies.  Without specific and designated representation on the health care innovation advisory committee, health information technology council, and other guiding bodies charged with overseeing the transformation of our state system, I fear we will not fully exploit the opportunities that lie in appropriately deinstitutionalizing the provision of health care services in Massachusetts.


It is the home care industry voice, and perhaps only that voice, that will advance this perspective and help make real this possibility.


Finally, at the Visiting Nurse Association of Boston, we care for residents in every neighborhood in Boston and every patient, regardless of their payer status.  We are a valuable part of the delivery system safety net and encourage policy makers to consider the role that organizations such as ours plays in caring for those who, despite 98% insurance coverage in Massachusetts, still fall through the cracks which still do remain.


That has been our mission for the past 125 years.  We are ready to carry it into the future.


Thank you.  I would be happy to answer any questions you may have.

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