Welch focuses on healthcare reform bill

Date: 11/30/2017

SPRINGFIELD – In the Commonwealth today, the same medical procedure could cost different amounts depending upon the size and location of the hospital in which it was given.

Creating an even playing field between large and small hospitals and their costs is one of the goals of new legislation from the Senate.

The new healthcare reform bill should make a positive impact in reducing costs for both people who receive their insurance through the Commonwealth and for those who have insurance through an employer, state Sen. James Welch said.

The bill, “An Act Furthering Health Empowerment and Affordability by Leveraging Transformative Health Care,” was recently passed by the Senate. Welch explained in an interview with Reminder Publications and Focus Springfield, the House will probably begin work on its own version of the bill when the Legislature begins its next session.

Welch said the legislation doesn’t affect the MassHealth program, as the Senate did not want to decrease benefits nor access to health insurance.

“The reforms that we did are mostly focused on the market correcting itself in some areas to allow people to get their healthcare services closer to home,” he said.

Welch explained that where and how a person receives healthcare affect the cost of insurance, both private and public.

The bill, if passed, would attempt to lower hospital admission through two measures: telemedicine and mobile integrated health. Welch explained telemedicine “would use technology to our advantage.” Depending upon the ailment, many people could get the same level of care by having a Skype-like interaction with a physician, he said.

“Not all doctor’s visits need to be done in person,” he added. “Some are just follow-ups, some are evaluations, but many could be done from a person’s home or another locations where the doctor is at the office.”

A doctor’s visit can take up a whole day for many people between the visit itself and waiting and travel time, he noted.

Mobile integrated health would allow paramedics, with additional training and licensing, the ability to treat a person at their home as part of an ambulance call, preventing an unnecessary trip to an emergency room.

“From a cost standpoint the more we can do to decrease the amount of unnecessary emergency room visits is very important,” Welch said.

The Massachusetts Health Policy Commission has estimated that 42 percent of all emergency department visits are avoidable.

Although the increase in health insurance participation through MassHealth has cut down on some emergency room visits, Welch said it will take a generational shift to see greater reductions.

“We’re talking 10 or 20 years down the line to really see the impact of having everyone covered with preventative healthcare insurance. The golden rule in healthcare is a healthy patient is the cheapest patient to serve and the more preventative healthcare services you provide to a person the chances them making frequent or unnecessary emergency room visits should slow down, should drop but it will take some time,” he added.

Welch said the costs of medical procedures vary from small to large hospitals because the larger hospitals have been able to negotiate better terms with commercial insurance carriers.

“Typically, what we found out through study and research is those hospitals that have the largest market dominance have to been able to negotiate the largest commercials rate payments from insurance companies,” Welch said.

Welch explained that if the number 1 represents the average payment, some hospitals get as much as 1.5 while others only receive .7. In this legislation, there is no mandate, however hospitals and insurance carriers would have three years to correct the market so every hospital would reach .9.

“We’re looking for the market to get back into order a little bit,” he added.

Many smaller hospitals are having difficulty surviving because of these low insurance rates, Welch explained. It’s a condition the Commonwealth “must address and address soon.”

In terms of how the federal government could influence insurance costs, Welch noted the “unstable” atmosphere in Washington DC when it comes to healthcare reform. It’s important for Massachusetts “to have its own house in order, so to speak,” he said.

What concerns Welch the most is the level of Medicaid payments, based on expanded Medicaid programs. If Republicans in Congress were able to decrease or eliminate funding for these programs, it would affect Massachusetts, among other states.

“If those federal dollars disappear or they change the way they flow to use, we will have some very serious decisions to make,” Welch said.