Notwithstanding the recent 4,700-word Spotlight report in the Boston Globe, the idea that Partners HealthCare has played a dominant role in setting health care prices in the Boston area and commanded higher rates for the same services than other hospitals isn’t exactly new. In fact, this has probably been the most discussed dynamic of Massachusetts health care over the last decade. Paul Levy, the blogging president of Beth Israel Deaconess Medical Center, has written about it repeatedly. Harvard Pilgrim’s Charlie Baker has voiced similar concern, and former Globe columnist Steve Bailey regularly teed up the story of Partners’ outsized market clout, doing so in 2006 as well as in 2002 and 2000. CommonWealth wrote about the “Partners Effect,” as the Globe dubbed it, back in 2001.
Because of confidentiality agreements governing contracts between insurers and hospitals, however, hard numbers have been hard to come by. “We would LOVE to have those prices made public because we believe it would make clear that the largest player in our market … gets higher rates because of its market dominance,” Levy wrote, referring to Partners, in a 2006 blog post. The Nov. 16 Globe Spotlight report was the answer to his plea, laying out in stark detail the disparities in reimbursement rates that lead to Partners’ two flagship hospitals, Massachusetts General and Brigham and Women’s, commanding “an average of 30 percent more than similar nonpediatric hospitals statewide for each procedure,” according to the Globe. The paper, which obtained the price data from an unnamed “health official,” says this payment premium comes with no consistent evidence of superior outcomes for Partners’ patients, and is helping to drive up Massachusetts health care costs.
“There is no other sector of the economy anywhere in this country in which that kind of price variability with no appreciable difference in service or product quality can sustain itself over time,” Harvard Pilgrim’s Charlie Baker told the Globe.
But what now? Four days after the Spotlight report came the obligatory follow-up story that is supposed to highlight the big impact the story is having. But despite a few comments of outrage from players in the health care field, the follow-up lacked much in the way of promised action. Attorney General Martha Coakley, the one figure who could shake things up, said market forces alone cannot ensure an even playing field in health care, but she gave no hint of specific steps she plans to take.
At Health Care for All’s blog, research director Brian Rosman calls the Spotlight report “old news” and says attention must shift from “diagnosis” to “cure.” Rosman says today’s health care landscape is exactly what lawmakers set in motion with the 1991 deregulation of hospital prices in Massachusetts. The Legislature recently created a health care payment reform system. Rosman says we should put our focus there and begin to structure payments to reward providers for keeping patients healthy rather than simply pay them for each procedure performed or hospitalization. He also says we should move to quickly ramp up the Health Care Quality and Cost Council (see CommonWealth story), which was created by the 2006 health care reform law and is supposed to be providing the public with the sort of information on cost and quality that the Globe got an early look at, thanks to an apparent leak from the state office.
The Spotlight report was something of a field day for those who follow the ins and outs of Massachusetts health care. The story notes briefly at one point that “Blue Cross officials discount Partners’ role” in driving up health care costs. That’s an interesting nugget, since there is assumed to be a natural tension between payers and providers. On the other hand, Partners and Blue Cross already raised some eyebrows with the cozy collaboration they struck up to push for the recent health care law.
Lots of big health care players have current or past connections to Partners, which was created by the 1994 merger of MGH and the Brigham. The old adage says where you stand depends on where you sit. Thus, former Partners executive Ellen Zane is now singing a different tune as CEO of Tufts Medical Center, telling the Globe: “Clout, over anything else, has driven insurers to disproportionately and inappropriately pay some providers more than others.”
On the other hand, it’s hard not to wonder whether some old institutional loyalties are influencing the thinking of JudyAnn Bigby, the state’s secretary of the health and human services, who spent years as the medical director of community health programs at Brigham and Women’s. “I don’t have any basis to suggest that to the reasons why you see the differences has to do with market power,” she said of the hospital-price disparities, a conclusion that many health care thinkers would find hard to swallow.
What’s next? Partners seems to be girding for more. In a statement responding to the Globe story that the hospital system posted on its website on the day of the Spotlight report, it says: “We expect that you may see similar stories in The Boston Globe in the coming weeks.” There is some talk around town that Blue Cross could figure in future reports. In the meantime, Partners is trying to tell its own story.
Another old saying is that you should never pick a fight with a guy who buys ink by the barrel. But Partners is doing some ink buying of its own, taking out a full-page ad in yesterday’s Globe that tries to shoot down the idea of the giant hospital network as the 800-pound gorilla of Massachusetts health care.
