Questions for the AG on Health Reform 2

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Attorney General Coakley spoke this afternoon at MAHP’s annual conference. I wanted to offer a few thoughts and questions. Video can be found here.

I like the AG’s focus on transparency and health literacy, but I am not sure these actions alone move us towards fully engaged consumers when they still have employer sponsored insurance that covers most costs. What is their motive?

Other questions:

1)Why are providers responsible for giving pricing information when insurers have that data?

2)What is the value of bringing everyone around a benchmark average price for a service? That does not reward low-cost/high quality service, it does the opposite, and allows higher cost/ lower quality service to remain.

3) Will rejections of provider contracts be per procedure, per average reimbursement, per hospital, or for the whole contract? In other words, what is the calculation based on? You can imagine providers being impacted very differently based on the diversity of services offered at a location.

4) How will special cases be dealt with? Rural hospitals, minute clinics, etc? Do we have different benchmarks based on the point of service?

5) How will temporary government intervention lead to a functioning marketplace? This is still not clear to me.

6) What impact will these price controls have on innovation and access, even in the short run for patients? How will pricing of new procedures be calculated? Will providers drop money losing services that they had previously cross-subsidized?

Finally, in this broader payment reform discussion, I am hearing very little about the impact that Medicare has on our health system. In my mind, without reform mirroring Medicare changes, the Commonwealth’s efforts are simply an unfair academic experiment on the small businesses of Massachusetts.