Coalition Presents Comments to Health Policy Commission on Partners-AG Agreement

| Posted On Jul 03, 2014 | By:

The following remarks were presented to the Health Policy Commission on July 2nd by Dr. Guy Spinelli, Chairman of the Board of Atrius Health and president of Granite Medical Group in Quincy, Massachusetts. Dr. Spinelli was representing a coalition of hospitals and healthcare providers including Atrius Health, Beth Israel Deaconess Medical Center, Lahey Health, and Tufts Medical Center, among others.

Public Comments

On Monday, the Massachusetts Superior Court approved a process under which interested parties have until July 21st to file comments on the proposed settlement agreement between the Attorney General’s Office and Partners HealthCare.  We appreciate Judge Sanders’ willingness to hear from us and others, but the coalition remains disappointed that the Attorney General rejected requests from us and others for a broader public airing of an agreement that will have profound and deeply negative impacts on the Commonwealth, its businesses, and its citizens for decades to come.  The Attorney General’s Office has characterized this agreement as a piece of litigation that has now been settled. In contrast, we view this as establishing broad and far reaching health care policy that deserves far more than an expedited judicial review.   We believe this agreement calls for the involvement of the people affected – all of us who are committed to reducing the cost of health care for the benefit of Massachusetts consumers, our patients.

Questions Raised by Settlement Regarding Health Care Cost Growth

As providers who worked together with policymakers, legislators, and many of you to create Chapter 224 and the nationally-leading processes that are intended to increase transparency, reduce costs and improve quality, we have deep respect for the role of the Health Policy Commission and the work that that you and your staff have done to date. We do not understand the rush to close this agreement without waiting for the concerns that are being raised today in your draft report or without further drawing on the expertise that the Commission has to offer.  There are at least three areas that we think need objective and detailed scrutiny.

The first area is Component Contracting. While the Attorney General’s complaint sought to prevent Partners’ proposed hospital acquisitions, the settlement agreement instead offers an alternate remedy – component contracting, which is predicated on provider, payer and consumer conduct never exhibited in this marketplace or elsewhere in the country. Any impact on cost restraint is, at best, entirely speculative.

The second area is physician growth. The settlement agreement raises serious questions regarding the growth of Partners physician network, which is already – by far – the largest in Massachusetts. Based on our understanding from statements made by Partners’ executives, the agreement authorizes Partners to add approximately 500 physicians to its physician network. The formulas for defining and adding physicians are sufficiently complex as to raise questions of their own.  The demographics of Massachusetts ensures that Partners’ growth will come at the expense of the lower-cost academic medical centers, safety net institutions, low-cost community hospitals, and physician groups that struggle to compete with Partners’ vast resources to recruit and maintain primary and specialty care services.

The third area is price growth. As you know, the current market environment has meant very little growth in provider reimbursements and no growth at all for many providers. Many of us are envious of increases matching inflation, on top of a high base for fee-for-service pricing, with no limits on increased utilization or increasing referrals within the Partners system to further drive up revenue. Many of us would welcome 3.6% price growth on risk contracts. This settlement agreement raises serious questions regarding cost growth in the Commonwealth because it provides a clear path to continued leading rate increases for the largest system in the Commonwealth, authorized on top of the highest payment rates in Massachusetts – as CHIA and the Attorney General have pointed out in the past.   We do not see how this will generate lower healthcare costs.

Furthermore, we do not see in the settlement agreement any of the other factors that the Health Policy Commission is tasked to examine: How will this affect access to care for our poorest citizens? What facilities must be maintained in support of mental health? Which services must we provide in support of children and others who deserve our protection?

Request to Health Policy Commission

We believe that the Health Policy Commission has a significant and continued role to play in understanding and potentially helping to mitigate the negative impact of this proposed settlement agreement. To that end, we respectfully request that the Commission take the following actions:

First, to the extent not already addressed in the preliminary “Cost and Market Impact Reviews” (CMIR) release today, we ask that the Commission consider submitting comments to the Attorney General during the comment period established by the court.   Both your preliminary and final reports should be before the court before it rules on the matters before it.

Second, we ask that the Commission examine, or ask the Center for Health Information and Analysis (CHIA) to examine, the potential impact of the proposed settlement on health care cost growth and on consumers as part of its cost-trend hearings scheduled for October 6th and 7th, 2014.

Third, if this settlement is approved, we ask that the Commission use its authority to more closely monitor cost growth at Partners over the coming years.

Fourth, we ask that the Commission respond to any request that may be made by the Office of the Attorney General, by the Superior Court, or by the Legislature to conduct an independent examination of the proposed settlement agreement and its impact on health care cost growth and on consumers throughout the Commonwealth.

Conclusion

Chapter 224 was intended to assure that complex healthcare transactions with the potential to change the dynamics of the health care marketplace would be fully transparent and thoroughly and thoughtfully reviewed.

In its entirety, the proposed settlement agreement undermines that goal, and we respectfully urge the Commission to consider all opportunities that may be available to the Commission to assist the public in understanding and challenging the cost, quality and access impact of this proposed settlement agreement. Our goal is to see an agreement that takes a strong step forward towards reducing health care costs in the Commonwealth and moving everyone towards a level playing field that ensures people across the Commonwealth have access to financially viable providers in their own communities.

Click here to read our previous post regarding the coalition and the Partners-AG Agreement.

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