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Massachusetts Working on Putting Hospitals and Doctors on a Budget – The HMO Revisited?

Posted May 08 2009 10:42pm

Are we trying to re-invent the HMO here?   It does take a bit of business intelligence software to analyze and compute to bring the entire picture of one patient into focus.  The one statement that I thought was caught in this whole article was a section below about patients being protected from image Doctors denying services.  If I am correct here, they are the ones who are trying get services for patients and it is rather the insurance companies for the most part that deny services.

Again we are talking about software and technology to be able to create all these figures we need to evaluate the care of one patient from start to finish and a lot on a budget.  Just last week here in California, Sutter Hospitals signed a 5 year contract with Sutter for physicians to use to calculate the cost and quality of healthcare portions.  

Sutter Hospitals and Ingenix working together on Business Intelligence Software

My personal feelings, I want the doctor to take care of me and not be distracted with cost, especially if it is something that is urgent.  Small items certainly can be looked at, but when the big one hits, I don’t believe I want the doctor sitting there trying to figure out what I could afford.  I do one other item worth mentioning here too, we have not even crossed the electronic medical records plateau yet, so are we putting the cart before the horse in a big race to save money and how many of the doctors will use it?  Utilization managers will be all over it to audit what the physicians have done you can bet.  If we make it any more difficult to practice medicine, it will only serve to discourage more from entering the field. 

It looks in essence like this is just another way to reduce services in order to save money.   If you don’t offer the services to the patients, the money is not spent and then you are back to square one, not improving their healthcare and going without.  BD 

Massachusetts soon may embark on another bold healthcare experiment, with a state commission poised to recommend this month that insurers radically change how they pay doctors and hospitals.

Commission members said they will urge Governor Deval Patrick and the Legislature to replace the current system, in which insurers typically pay doctors and hospitals a negotiated fee for each individual procedure or visit, with a set payment for each patient that covers all that person's care for an entire year.

Massachusetts would be the first state to broadly adopt such a system, which would essentially put doctors and hospitals on a budget in an effort to restrain health spending.

The 10-member commission includes administration officials, key legislators, and representatives of hospitals, physicians, and insurers, boosting chances that Massachusetts will overhaul its payment system.

Patients would be protected from doctors' denying them services, because the new system would monitor the quality of care doctors provide, members said.

But other commission members who represent providers and insurers say even five years may be impossible, because most doctors and hospitals don't have the computer systems or provider networks in place yet to fully coordinate care for patients, which would cost millions of dollars.

State seeks to revamp way doctors, hospitals are paid - The Boston Globe

Related Reading:

Sutter Hospitals and Ingenix working together on Business Intelligence Software

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Texas Joining the Ingenix Inquisition with Introducing Bill for New Penal Codes – Fraud Against Practitioners

The AMA and the California Medical Association file legal suit – WellPoint and Ingenix

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