THE PIONEER BLOG

Joshua Archambault

Does Health IT Guarantee Better Care & Save Money?

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Given the near universal HIT mandate in Chapter 224 of the Acts of 2012 in Massachusetts, research on the effectiveness of the policy mechanisms in the bill should draw close interest. A WSJ op-ed this morning tackles the HIT question. SEPTEMBER 17, 2012 A MAJOR GLITCH FOR DIGITIZED HEALTH-CARE RECORDS Savings promised by the government and vendors of information technology are little more than hype. By Stephen Soumerai and Ross Koppel In two years, hundreds of thousands of American physicians and thousands of hospitals that fail to buy and install costly health-care information technologies—such as digital records for prescriptions and patient histories—will face penalties through reduced Medicare and Medicaid payments. At the same time, the government expects to pay out tens of billions of […]

Jim Stergios

Huck, Jim and our interest in education

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Twain famously noted that the difference between the right word and the almost-right word is the difference between the lightning and the lightning-bug. Getting words right is arguable the key task in educating an individual, for precise use of language is critical to developing the ability to observe and to think. Then there is the sinister twisting of language for reasons of power (most often political power). This was a topic of intense focus by George Orwell, who in his staple of 9th grade reading courses, Animal Farm, described how the vision of Old Major was transformed to the darker purpose of other animals after his death. In the novella, the animals rebel against the drunken farmer Mr. Jones for […]

Jim Stergios

The Democrats’ Platform on K-12 Education

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Here is the Democratic National Platform on K-12 education, taken from the national Democrats.org site: An Economy that Out-Educates the World and Offers Greater Access to Higher Education and Technical Training. Democrats believe that getting an education is the surest path to the middle class, giving all students the opportunity to fulfill their dreams and contribute to our economy and democracy. Public education is one of our critical democratic institutions. We are committed to ensuring that every child in America has access to a world-class public education so we can out-educate the world and make sure America has the world’s highest proportion of college graduates by 2020. This requires excellence at every level of our education system, from early learning […]

Jim Stergios

The GOP Platform on K-12 Education

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Here is the Republican platform on K-12 education, taken from the National GOP web portal: Education: A Chance for Every Child Parents are responsible for the education of their children. We do not believe in a one size fits all approach to education and support providing broad education choices to parents and children at the State and local level. Maintaining American preeminence requires a world-class system of education, with high standards, in which all students can reach their potential. Today’s education reform movement calls for accountability at every stage of schooling. It affirms higher expectations for all students and rejects the crippling bigotry of low expectations. It recognizes the wisdom of State and local control of our schools, and it […]

Joshua Archambault

$14B in Medicare Cuts under ACA for Massachusetts

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During the Presidential race, we have heard a lot about the $716 billion that will be cut from Medicare under the ACA and the savings included in Congressman Ryan’s budget. (See my thoughts on the difference in the proposals at Boston.com) Locally, the important question is, how will the ACA cuts impact Massachusetts? An updated working paper, released this morning, from the University Of Minnesota puts some numbers to this question. So how much will future reductions be for Medicare Fee-For-Service and Medicare Advantage Payments in Massachusetts? Roughly $14 billion in reductions from 2013-2022. Just for review, the ACA cuts $716 billion in the following ways: The ACA reduces annual updates to Medicare’s payment rates for most provider services in the […]

Joshua Archambault

Do Patient-Centered Medical Homes Save Money?

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Locally, much has been made about the Massachusetts Patient-Centered Medical Home Initiative, with supporters claiming it will revolutionize medicine. It is too early to tell for sure, but will it save money? Picture: University of Pittsburgh Medical Center North Carolina started down this road before Massachusetts, and while early reports claimed historic savings, recent evaluations have called that conclusion into question. Al Lewis over at The Health Care Blog as some takeaway lessons. The ongoing saga of savings estimates for the Community Care of North Carolina (CCNC) patient-centered medical home (PCMH) is finally over.  The verdict: no savings. Because the scale and visibility of the CCNC experiment are unparalleled in the Medicaid sector today, it is important that the right policy and delivery system lessons be learned from this dispositive […]

Jim Stergios

Schools and the conventional wisdoms

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Facts are, as John Adams famously noted, “stubborn things.” But facts are also what makes politicians of good will less stubborn; that is, it is empirical evidence that allows both major parties to to coalesce around reforms that will work. Compromise for compromise’s sake, or hewing to conventional wisdom, is most often pandering with an eye toward one’s own ambitions. But, armed with facts, people of even the most strongly held principles can come to very surprising positions. We’ve been hearing a lot about how education may be the area for compromise between the two major parties. What’s driving this coalescence? Hard choices by the Obama administration? Empirical evidence? Or it is conventional wisdom? With Labor Day now behind us […]

Joshua Archambault

New England Raking in $$$ for ACA Exchanges, $351 million and counting

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Josh Archambault, Director of Healthcare Policy at Pioneer Institute in Boston Many supporters of the ACA contend that the Massachusetts health care law is the exact same as the federal version. (Some have even used colorful language to make this point.) A proxy for how big the changes will be is the level of funding coming from the Federal government to bring the Massachusetts Connector into compliance with the ACA. Answer: $48,236,271 and counting. Or is that $57,131,300, with an award supplement to “accelerate changes in its current Exchange IT infrastructure.” MA HHS grants so far. To be fair $36 million of this money is for a New England regional exchange for Connecticut, Maine, Massachusetts, Rhode Island, and Vermont. However […]

Jim Stergios

An expert’s view of national standards’ focus on non-fiction texts

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(Gretchen Ertl for The New York Times) The Common Core national standards are increasingly controversial, with Utah, Indiana and a number of states that had adopted them now reconsidering. A recent New York Times education blog notes the following: Forty-four states and United States territories have adopted the Common Core Standards and, according to this recent Times article, one major change teachers can expect to see is more emphasis on reading “informational,” or nonfiction, texts across subject areas: While English classes will still include healthy amounts of fiction, the standards say that students should be reading more nonfiction texts as they get older, to prepare them for the kinds of material they will read in college and careers. In the […]

Joshua Archambault

Change Coming for FSAs? Drop the “Use-it-or-Lose-It” Rule

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HT to Meghan McCarthy at National Journal for the report and John Goodman for highlighting it on his blog, but there could be big changes ahead for flexible spending accounts. FSAs are a tool along with health savings accounts (HSAs) and health reimbursement accounts (HRAs) that can help to engage consumers to be value-seekers in healthcare. A little-noticed bulletin from the Treasury Department could have a big impact on the roughly 155 million Americans who use flexible spending accounts to cover out-of-pocket health care expenses. The government’s notice, sent out in May, included a surprise in what otherwise might have been a dry announcement on the implementation of President Obama’s health care reform law. In addition to detailing a new spending cap, […]

Jim Stergios

Sunset the Lawrence district school monopoly

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One of two kids in the Lawrence Public School system do not cross the 12th grade finish line. Even that is beyond what the “soft bigotry of low expectations” crowd can explain away on the basis of factors like poverty and family situation. Sadly, that dropout reality holds true in a couple of other urban districts around the state. But no other district is in school receivership… in a city that is in state fiscal receivership. And no other district can boast of the on-the-record, court-documented corruption within the school district office that we’ve seen in Lawrence. As noted in several previous blogs (such as this one), in Lawrence, just over 1,000 students of the 13,000 in the district will […]

Jim Stergios

Grossman wants to look squarely at reality

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The treasurer’s call for a cut in the pension’s rate of return on its investment portfolio reflects his desire to look reality squarely in the face. While investment history from the mid-80s is higher than 8 percent, investments over the last decade have been well below that target, and the market continues to be plagued with uncertainty and real structural questions. The treasurer’s call to reduce the expected rate of return is also prudent planning, because the years in which the state doesn’t meet the benchmark are usually the years in which we can least afford to kick additional money into the fund. Rhode Island’s general treasurer Gina Raimondo, a Democrat, started out similarly, seeking a reduction from 8.25 to […]

Joshua Archambault

Rent Seeking in Mass Price Capping Law

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After Moody’s issued a credit negative analysis for hospitals in the Commonwealth under the new health care law signed this week, I started to wonder how hospitals will react to the incentives in this new proposal. One line from the Moody’s report is of particular interest: Another negative credit effect of the bill is that the state will use an excise tax on insurers to support smaller and less profitable hospitals, potentially allowing them to remain in business longer than would otherwise be possible… I contacted the author from Moody’s (Dan Steingart) to ask if they had additional information on the $135 million Distress Hospital Fund and the hospitals that would receive this money. Part of his response is below. The bill is vague […]

Joshua Archambault

Medicaid Patient Access in Mass

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Yesterday the Massachusetts Medical Society released its annual MMS Patient Access to Care Studies. While the media coverage has focused on the lack of change in wait times across the Commonwealth from last year and the regional issues that remain in the state, there is one subgroup that deserves special mention– those on Medicaid. Massachusetts has roughly 1.3 million people on MassHealth (Medicaid), and they are having problems seeing a doctor. Only 62% of family doctors are taking new MassHealth patients and only 53% of Internal Medicine doctors. We are putting more folks on this program under the ACA, and the regional issues are quite pronounced. Pages 23 and 19 in the report show this. Only 14% of Barnstable family […]

Joshua Archambault

Moody’s Report: New Mass Price Capping Law “Credit Negative” for Hospitals

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In the soon to be long list of unintended consequences as a result of the brand new price capping law signed yesterday by Governor Patrick, Moody’s released a report warning of the future impact of the law on hospitals in the Commonwealth. While not a formal downgrade, it could raise the cost of capital borrowing for these hospitals and increase the cost of providing health care going forward. These extra costs will be passed onto consumers in the form of higher care costs and insurance premiums. More from SHNS($): The health care cost control law signed by Gov. Deval Patrick Monday will hurt the bottom lines of Massachusetts hospitals and limit their flexibility to grow, a major credit rating agency warned Monday. “The […]