R&B Healthcare Blog

Money for Illinois crime victims’ fund sits unused

Money for Illinois crime victims’ fund sits unused By BRIANNA EHLEY – Lee News Service Writer | Posted: Sunday, March 18, 2012 4:01 am SPRINGFIELD — When Illinois abolished its death penalty last year, the new law specified that state money that had been set aside for death penalty trials would instead go to helping crime victims and their families. Today, the money in that fund, about $18 million, sits unspent. “The fact that the money is just sitting there is a sin in itself,” said Cindy McNamara of Rolling Meadows, whose 21-year-old daughter was murdered a decade ago, with the killer now spared. “It was enough that the state gives money to the murderer, they need to release that money to victims’ families,” McNamara said. “That’s the only good thing to come from abolishing the death penalty.” McNamara’s daughter, Shannon, was slain in her Charleston apartment by Anthony Mertz in 2001. Mertz was sentenced to death. When the death penalty was abolished last year, Mertz’s death sentence was commuted to life in prison. Officials say the holdup in making that money available is because of controversy over how the original fund was used, after the St. Louis Post-Dispatch uncovered questionable spending from it in recent years. When Illinois’ death penalty was in force, the state funded a Capital Litigation Trust Fund designed to provide money for defense and prosecution in death penalty cases. The law abolishing the death penalty, signed by Gov. Pat Quinn in March 2011, specified that the money still in that fund would go to a newly created Death Penalty Abolition Fund, as of Jan. 1, 2012, for victim services. It was a concession made to pro-death penalty advocates who didn’t want the ultimate punishment taken off the books. However, legislation that’s required to allocate the money to the Death Penalty Abolition Fund wasn’t filed until Feb. 24. “While everybody was busy celebrating the abolition of the death penalty, it was talked about that … this money that was left over would actually go to these victims’ families,” said one of the those death penalty proponents, state Rep. Dennis Reboletti, R-Addison. “This money was supposed to be transferred to victim’s families, and there was never any mechanism to do that, and now it’s just sitting there.” At this point, the bill to appropriate that money wouldn’t transfer it until July 1. Steve Brown, spokesman for House Speaker Michael Madigan, D-Chicago, said the process of shifting the funds has been slow because legislative leaders are proceeding cautiously. “There was some controversy with how the previous fund was spent, so some people want to make sure the same mistake isn’t made this time around,” Brown said. “I think it’s better to have a deliberate process than to rush and make mistakes.” The Capital Litigation Trust Fund was put in place in 1999, and the Post-Dispatch later uncovered widespread abuse of the fund by defense teams that used it for extravagant expenses, leading to reforms.

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New HIPAA Operating Rule Guidance for Medicaid, CHIP

New HIPAA Operating Rule Guidance for Medicaid, CHIP Joseph Goedert MAR 26, 2012 3:27pm ET Health Data Management

The Centers for Medicare and Medicaid Services has issued guidance on implementation of “operating rules” that tighten uniformity of the HIPAA eligibility and claim status transactions.

The guidance targets the Medicaid and CHIP programs. The Affordable Care Act mandates adoption of a series of operating rules between 2013 and 2016, starting with eligibility and status. “We are highlighting the individual operating rules here so that States are aware of the requirements,” according to the guidance. “It will be important for States to secure a copy of the operating rules which are available at no charge from the Council for Affordable Quality Healthcare Committee on Operating Rules for Information Exchange Web site at caqh.org. Further, CAQH CORE staff are available for technical questions and guidance, and CORE conducts frequent town hall meetings and webinars that are free of charge.”

The guidance walks through provisions of the operating rules and also touches on elements of the rules that the Department of Health and Human Services did not adopt. These include mandated CORE certification, and use of acknowledgement standards, both of which at this time are voluntary. The guidance is available here.

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HIMSS Preview: Connecting EHRs to HIEs

You can pair this one up with the C level execs saying they want to do HIE but start up costs are an issue.

HIMSS Preview: Connecting EHRs to HIEs Elizabeth Gardner JAN 19, 2012 11:32am ET Health Data Management Feeding information from electronic health records to health information exchanges ought to be easy, but so far it’s been plagued by the same kinds of costs and technological obstacles as any other effort to interface one piece of HIT to another. “There are lots of HIE standards out there, but they’re not being consistently implemented,” says Anuj Desai, director of business development for the New York eHealth Collaborative, which oversees HIT for New York State. “Some vendors are trying to charge physicians $150,000 to get their EHRs connected to a health information exchange.” To remedy that situation and make the connections straightforward, New York and seven other states are collaborating with HIE and EHR software vendors to define “plug and play” interoperability between the two types of systems, and significantly reduce the barriers to HIE adoption. Desai and David Minch, HIPAA/HIE project manager for John Muir Health in California, will describe the activities of the EHR/HIE Interoperability Workgroup during a session at HIMSS12 in Las Vegas, and explain to attendees how they can participate in, and reap the benefits of, the group’s work. Its secret is strength in numbers, Desai says. “Most HIE organizations have a staff of five and a budget of $1 million to $3 million, so they don’t have a lot of leverage with the vendor community.” The workgroup’s goal is to create specifications that all its members can require their vendors to comply with. For example, New York’s Regional Extension Centers are working with more than 10,000 physician practices, and they plan to add the EHR/HIE connection specification to the requirements vendors must fulfill in order to be on their “preferred vendor” list. The workgroup already includes eight major EHR vendors and seven HIE vendors working with eight state organizations, and Desai expects it to grow further in all categories. Participating vendors will demonstrate the workgroup’s specs, and display its logo, at the HIMSS Interoperability Showcase on the exhibit floor. The group’s website is at interopwg.org. The HIMSS session, Connecting EHRs to HIEs, is scheduled on Feb. 21 at 12:15 p.m.

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The End of Health Insurance Companies?

Can insurers survive in an ACO-driven market? By Dina Overland, Fierce Health Payer

Health insurance companies will be extinct in the next eight years and replaced by accountable care organizations (ACOs) throughout the industry, said a former White House advisor. ACOs render insurers unnecessary by increasing coordination of patient care among providers and shifting the focus of healthcare toward keeping people healthy, Ezekiel Emanuel, an oncologist and University of Pennsylvania vice provost, wrote in a New York Times editorial. The most significant reason insurers can’t survive in an ACO-dominated healthcare market, Emanuel said, is that ACOs pool the risk of high-cost patients with patients who typically have lower costs into large groups, potentially more than 15,000 patients each. Dovetail the risk-sharing ability of ACOs with the end of fee-for-service payments and insurance companies are no longer needed to handle billing and claims processing. Instead, employers, Medicare or Medicaid can directly make payments to ACOs. Because ACOs will be paid a fixed, per-patient fee with bonuses for achieving quality targets, they will make money by keeping their patients healthy and avoiding unnecessary medical services. An added bonus for ACOs is recent developments in information technology and new models of integrated care delivery that will help ACOs improve health outcomes while also reducing costs. Despite his overall doom-and-gloom outlook, Emanuel does believe there’s room in the health industry for insurers – as long as they adapt and transform their business models. Some insurance companies already are taking steps toward that goal. For example, Wellpoint’s purchase of clinic operator CareMore will help it transition into the ACO business. Also, UnitedHealth is developing data analysis services it can sell to ACOs. The key to a successful transformation, Emanuel said, is that insurers make themselves useful in a market dedicated to coordinated care.

January 30, 2012, 9:00 pm The End of Health Insurance Companies By EZEKIEL J. EMANUEL and JEFFREY B. LIEBMAN New York Times

Here’s a bold prediction for the new year. By 2020, the American health insurance industry will be extinct. Insurance companies will be replaced by accountable care organizations — groups of doctors, hospitals and other health care providers who come together to provide the full range of medical care for patients.

Already, most insurance companies barely function as insurers. Most non-elderly Americans — or 60 percent of Americans with employer-provided health insurance — work for companies that are self-insured. In these cases it is the employer, not the insurance company, that assumes most of the risk of paying for the medical care of employees and their families. All that insurance companies do is process billing claims.

For individuals and small businesses, health insurance companies usually do provide insurance; they take a premium and assume financial responsibility for paying the bills. But the amount of risk sharing that is accomplished is limited because the insurers charge premiums that vary, depending on the health of an individual or a group of employees, and use their data and market power to identify healthy people to cover and unhealthy people to exclude from coverage. (The health care law’s total ban on exclusions for pre-existing conditions will begin in 2014.)

Many health insurance companies also impose barriers — like requiring prior authorization for tests and treatments and denying payment for covered services, which forces patients to appeal — to discourage patients from using the medical services for which they are insured and to attempt to avoid paying for those services. While these barriers can reduce waste by preventing unnecessary care, they can also discourage patients from receiving care they need, as well as impose administrative burdens on doctors and patients.

But thanks to the accountable care organizations provided for by the health care reform act, a new system is on its way, one that will make insurance companies unnecessary. Accountable care organizations will increase coordination of patient’s care and shift the focus of medicine away from treating sickness and toward keeping people healthy.

Because most physicians and hospitals today are paid on a fee-for-service basis, medical care is organized around treating a specific episode of illness rather than the whole patient. This system encourages overtreatment and leads to mistakes and miscommunication when patients are sent between their primary care doctors, specialists and hospitals. Indeed, under today’s payment system, investments in providing better care are doubly penalized. If a hospital hires a nurse to follow up with patients after they are discharged in order to reduce readmissions — for example, to help patients with diabetes improve blood sugar control — it must pay for the nurse, which is typically not reimbursed by insurance companies or Medicare, and it loses revenue by preventing the readmission.

In contrast, accountable care organizations will typically be paid a fixed amount per patient, along with bonuses for achieving quality targets. The organizations will make money by keeping their patients healthy and out of the hospital and by avoiding unnecessary tests, drugs and procedures. Thus, they will actually have a financial incentive to hire that nurse for follow-ups.

In addition to providing better and more efficient care, A.C.O.’s will also make health insurers superfluous. Because they will each be responsible for a large group of patients (typically more than 15,000), they will pool the risk of patients who have higher-than-average costs with those with lower costs. And with the end of fee-for-service payments, insurance companies will no longer be needed to handle complicated billing and claims processing, nor will they need to be paid a fee for doing so. Payments can flow directly from an employer, Medicare or Medicaid to the accountable care organizations. A.C.O.’s will require enhanced information systems to track patients and figure out how to deliver more effective care, but this analytic capacity will be directed at improving health outcomes, not at imposing barriers to those seeking treatment.

A.C.O.’s are not simply a return to the health maintenance organizations of the 1990s. Although in both models patients are members of a provider network with a specific group of doctors and hospitals, and both are paid primarily per member rather than per procedure or test, there are big differences between them. H.M.O.’s were often large national corporations far removed from their members. In contrast, A.C.O.’s will consist of local health care providers working as a team to take care of patients who are likely to be members for years at a time. H.M.O.’s often cut costs not by keeping people healthy but by denying patients services and by forcing doctors and hospitals to take lower payments. In the 1990s, we lacked the information technology and proven models of integrated care delivery that we have now. These advances will allow A.C.O.’s to simultaneously improve health outcomes and reduce costs.

A final bonus of A.C.O.’s is that they will lead to a better form of competition in health care markets. Today, consumers have to choose among insurance plans with a bewildering array of copayments, deductibles and annual out of pocket maximums — choices that few of us are any good at making. In the A.C.O. model, consumers will choose a primary care physician and the team of doctors and hospitals that are in the same group. Choosing a doctor and provider group is a responsibility that consumers want to have and are likely to be much better at.

A few health insurers see this asteroid coming. Wellpoint, for example, bought the clinic operator CareMore for $800 million last summer to make the transition into the A.C.O. business. Others, like the Optum unit of UnitedHealth Group, are developing data analysis services to provide to future A.C.O.’s. If they don’t want to go the way of the dinosaurs, insurance companies will have to find a new business to be in, one that is useful in the new world of coordinated care.

Ezekiel J. Emanuel is a contributing opinion writer for The New York Times. Jeffrey B. Liebman is a professor of public policy at Harvard. Both were advisers in the Obama administration.

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Blue Cross bows out of state Medicaid privatization

Blue Cross bows out of state Medicaid privatization By Dina Overland, Fierce Health Payer

Blue Cross Blue Shield of Kansas has decided not to participate in the state’s shift toward privatizing its Medicaid program. The decision announced Wednesday means the state’s largest health insurer won’t be submitting a proposal to become a private Medicaid contractor, reported the Kansas City Star. Under Kansas Gov. Sam Brownback’s (R-Kan.) plan, all Medicaid members would shift into a private managed care program. But Blue Cross spokeswoman Mary Beth Chambers said the Medicaid contracts would require the insurer to provide services that it doesn’t currently offer, such as helping families decide whether they should admit elderly members into a nursing home, according to the Associated Press. “We just felt it wasn’t responsible for us to commit to changing our business model that much,” Chambers said. “In the end, although we believe the [request for proposals] may present a sizeable opportunity, it would have required us to dramatically change our business model to serve new populations in different settings in less than a year,” Angie Strecker, director of institutional relations for Blue Cross, wrote in a letter to providers. “We decided that we could not responsibly commit to so great a change at this time.” Chambers clarified though that the Blue Cross decision shouldn’t be interpreted as a criticism of Brownback’s plan to privatize Medicaid, the AP noted. “We certainly have no intent – and would be disappointed – if people read our decision as criticizing the governor’s proposals,” she said. Meanwhile, state Rep. Jim Ward (D-Kan.) introduced a bill (H.B. 2573) that, if implemented, the privatization plans would require Medicaid contractors to undergo annual audits to ensure Medicaid recipients’ benefits aren’t reduced, the Kansas City Star noted. The audits would determine whether changes were made to the quality or quantity of service, the number of people receiving services or rates paid to providers. They also would survey Medicaid contractors and recipients to find out whether they’re satisfied with the new program, the Wichita Eagle reported.

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Gov. Rick Scott signs Medicaid billing changes; may cost counties $326 million

Gov. Rick Scott signs Medicaid billing changes; may cost counties $326 million By Tia Mitchell

Gov. Rick Scott signed a controversial bill into law that will could force local counties to pay more in Medicaid costs. Herald/Times Tallahassee Bureau TALLAHASSEE — Against the wishes of counties and tea party leaders, Gov. Rick Scott signed a controversial bill into law Thursday that will change the way counties are billed for Medicaid costs and could set up a legal showdown. If nothing changes, counties could be forced to pay the state an additional $325.5 million in the coming years in disputed Medicaid bills. “Nobody really knows what this is going to mean to our budget,” said Gretchen Harkins, Broward County director of intergovernmental affairs. The Florida Association of Counties has convened a task force to recommend future steps, such as seeking an injunction or filing a lawsuit. Scott took the unusual step of submitting a letter to the Secretary of State’s office explaining why he signed the bill, HB 5301. Scott acknowledged the counties’ concerns and vowed to work with them to resolve years of disagreements with the Agency for Health Care Administration on how much they owe for Medicaid. “To that end, I have pledged to the counties that AHCA and my staff will work diligently with them to certify that any billings for which counties are charged are accurate and valid,” Scott wrote. Representatives from AHCA will travel to each county to review the disputed amounts and discuss other issues with the billing process, the letter said. Counties say the system has been flawed for years, resulting in incorrect and duplicative statements. Under the plan, counties can dispute the unpaid Medicaid bills in administrative hearings but are on the hook for paying back 100 percent of the backlog if they lose. Or, counties can agree up-front to pay back 85 percent of the disputed bills. The state will withhold sales tax revenue sharing dollars from counties to cover past, as well as any future, Medicaid costs. All but seven of the state’s 67 counties sent Scott letters urging him to veto the bill. They accused the state of tinkering with the Medicaid billing system in an effort to shift additional costs to local governments. Florida Association of Counties President Doug Smith said the bill “represents the worst kind of body blow to taxpayers.” “Rather than correcting Tallahassee’s error-ridden Medicaid billing system, HB 5301 codifies it and leaves local taxpayers with the bill,” said Smith, a Martin County commissioner, via email. The Florida Tea Party Network, a coalition of about 80 groups, joined the counties in lobbying against the proposal. Henry Kelley of Fort Walton Beach, the Tea Party Network’s legislative liaison, said he was disappointed in the governor’s actions. “From a tea party perspective (and) the issue of limited government, now you’re tying the hands of the counties,” he said. “But you’re also signing into law something where you know there’s a billing problem.” Although the Medicaid billing issue drew the most attention, HB 5301 affected other areas of the state’s Medicaid program, which provides health care services to 3.2 million poor and disabled Floridians. It cuts costs by limiting nonpregnant adults to no more than six emergency room visits a year and allows state employees to enroll their children in the KidCare health insurance program. Scott also signed nine claims bills into law Thursday, compensating victims of government wrongdoing nearly $40 million. Scott signed a $10.7 million claim for the family of Eric Brody, who was permanently injured 14 years ago when a speeding Broward County Sheriff’s deputy plowed into his car. Most jury awards against government entities or employees — school bus drivers, hospital workers, police officers — have to be approved by the Legislature if they are in excess of $200,000. The governor used his first veto this year to strike down a bill that would have given $1.4 million to a man who lost a leg in an accident with a Sumter County school bus, indicating that the amount was too high. Herald/Times staff writer Toluse Olorunnipa contributed to this report.

Medicaid law to cost Florida counties millions By Ron Shinkman, Fierce Health Finance

Florida Gov. Rick Scott has signed into a law a bill that dramatically cost shifts the Medicaid program over to the state’s 67 counties, The Miami Herald reported. The bill, HB 5301, changes how counties are paid for Medicaid. Since the early 1990s, the counties have had to reimburse the state for up to 35 percent of Medicaid costs, according to the Fort Lauderdale Sun-Sentinel. The percentages under the new law will verge toward 100 percent. Counties will be allowed to dispute payments the state claims it is owed in administrative hearings, but will bear the full balance of the charges if they lose in the hearing. If counties opt out of the hearting, they will have to pay back 85 percent of the amount to the state, the Herald noted. All of the counties objected to the legislation, according to the Herald, claiming it failed to address shortcomings in how the Florida state government handles Medicaid billing. “Rather than correcting Tallahassee’s error-ridden Medicaid billing system, HB 5301 codifies it and leaves local taxpayers with the bill,” Doug Smith, a Martin County commissioner and president of the Florida Association of Counties, said in a statement. The change is expected to cost shift as much as $335 million a year to counties, including $14 million a year to Broward County, the state’s second most populous, according to the Sun-Sentinel.

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5 states top Medicaid fraud list, States recover $1.7B

5 states top Medicaid fraud list, States recover $1.7B By Karen M. Cheung, Fierce Healthcare

States recovered $1.7 billion through Medicaid fraud and patient abuse investigations and enforcements of civil and criminal cases, the Office of Inspector General reported last week.

The Medicaid Fraud Control Units (MFCUs) investigate and prosecute fraud, as well as patient abuse and neglect at healthcare facilities. In fiscal year 2011, MFCUs conducted 10,685 Medicaid fraud investigations and saw 824 convictions. MFCUs conducted 4,134 investigations into patient abuse and neglect, including patient funds cases, and saw 406 convictions. The federal and state government spent a combined $208.6 million on MFCUs. The OIG reported that return on investments translated to $8.39 for every $1 that the federal and state governments spent to operate the MFCUs.

MFCUs recovered the highest amounts from California, Texas, New York, Ohio and Kentucky in 2011, according to OIG data.

For more information: - read the OIG summary - check out the Medicaid fraud map - see the Medicaid chart (.xls)

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HHS Questions 71% of the Rate Hikes Reviewed

By Allison Bell

LifeHealthPro

March 22, 2012

U.S. health insurers have had to post explanations of 186 individual health insurance rate increases on the Web since new federal rate review rules took effect Sept. 1, 2011.

The U.S. Department of Health and Human Services (HHS) and state insurance regulators started the rate review program to implement a section of the Patient Protection and Affordable Care Act of 2010 (PPACA).

PPACA does not give state or federal regulators the authority to limit rate increases, but it does give HHS the authority to require health insurers to explain what HHS believes to be “unreasonable” rate increase on the Web.

The federal government’s rate review disclosure website has attracted about 50,000 visitors, officials say.

HHS officials have said in regulations that state regulators with the ability and willingness to review rate changes should review the reasonableness of any notices of increases over 10%. In states in which state regulators are unable or unwilling to review rates, HHS handles the task.

The 186 double-digit rate increases announced from Sept. 1, 2011, through March 10, 2012, could affect a total of 1.3 million people, officials say in a report on the performance of the rate review program.

HHS has reviewed 61 of the rate filings subject to reviews and completed 28 of the reviews, and state regulators have reviewed 125.

Regulators in some of the states have had the authority to reduce or reject rate increases since before PPACA was enacted, and regulators in other states have gained rate-control authority since the act was signed into law.

States have required or persuaded insurers to reduce the increases they have reviewed by an average of 6.4%, officials say.

HHS has concluded that 71% of the 28 rate increase proposals it has reviewed were unreasonable.

The most common reason was that another PPACA provision requires plans to spend 80% of individual and small group revenue on health care or quality improvement efforts, and federal regulators believed the proposals would result in projected medical loss ratios below 80%.

Kentucky, Nevada and Texas are some of the states that report seeing a reduction in the number of insurers announcing rate increases exceeding 10%, officials say.

California, New York and Oregon are some of the states in which regulators have taken active steps to reduce proposed increases, officials say.

The average size of rate increase reductions seems to be growing over time, and, in Nevada and Oregon, individual rates seem to be falling as a result of the rate review program, officials add.

HHS officials do not discuss in the report whether they have taken any steps to verify whether reductions in rate increase requests are warranted or whether, in any cases, cuts in proposed rates have led to losses at insurers or cutbacks in the scope of insurers’ operations.

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AP: Mass. health care 5-year lobbying topped $51M

By Associated Press | Sunday, March 25, 2012 Boston Herald

BOSTON — Hospitals, insurers, doctors and unions are spending tens of millions of dollars trying to make sure their voices are heard on Beacon Hill as Massachusetts lawmakers weigh sweeping changes to the way the state pays for health coverage.

In 2011 alone, the health care industry, one of the largest economic sectors in the state, doled out more than $11.6 million on lobbying.

And during the five years since the state passed its landmark health care overhaul, from 2007 to 2011, the total amount spent on lobbying by the industry topped $51.6 million, according to a review of state records by The Associated Press.

By contrast, the casino gambling industry spent $11.4 million on lobbying during that same stretch.

The flood of health care lobbying comes as lawmakers debate whether to create systems designed to reward health care providers for keeping patients healthy rather than paying them piecemeal for treating illnesses.

House Speaker Robert DeLeo and Senate President Therese Murray have both said they hope to deliver a payment overhaul bill to Gov. Deval Patrick this year.

This month, DeLeo said the goal of the House bill — which has not been introduced — would be to bring the annual growth in health care expenses more in line with Massachusetts’ overall economic growth rate of 3.7 percent.

Health care costs have been rising at an annual rate of 6.7 to 8 percent in recent years, said DeLeo.

“Costs are coming down, but we need a long-term sustainable plan,” said DeLeo, D-Winthrop, during a recent speech. “Health care is a $70 billion industry in Massachusetts, and we need to be more thoughtful in how these dollars are spent.”

The size of the industry and the high stakes involved in the proposed overhaul could account for the massive and sustained lobbying push.

Nine of the top 10 health care groups broke the $1 million lobbying mark during the past five years, the AP review found.

The top spender was Partners HealthCare, which spent more than $2.9 million on lobbying in that five years.

Much of that went to pay the salaries of more than a dozen lobbyists and companies working to make sure Partners’ message reached lawmakers. A smaller portion went to operating expenses.

Partners was followed by Blue Cross Blue Shield of Massachusetts and Massachusetts Association of Health Plans, both of which spent more than $2.1 million, followed by the Massachusetts Nurses Association, which spent about $2 million and Harvard Pilgrim Health Care, which spent more than $1.6 million.

They were followed by the Massachusetts Medical Society ($1.51 million), Tufts Associated Health Plans ($1.46 million), Vanguard Health Systems ($1.42 million), Children’s Hospital Boston ($1.38 million) and Baystate Health ($992,000).

Rich Copp, a spokesman for Partners HealthCare, defended the amount spent on lobbying, as did representatives for some of the other groups.

It’s critical that the health care provider keeps the lines of communication with lawmakers open as they consider new options to control the soaring costs of health care, he said.

“There’s been an intense effort in recent years to rein in health care spending,” Copp said. “We have a responsibility on behalf of our patients and employees to engage in that dialogue with government leaders on health care cost control.”

Copp said the lobbying is even more important given the reach of Partners.

The health care provider is one of the largest employers in the state, with more than 60,000 employees and nine hospitals.

Sharon Torgerson, director of public relations for Blue Cross Blue Shield of Massachusetts, said the sweeping changes to the state’s health care system required the insurer to stay involved on Beacon Hill.

“As Massachusetts’ largest health plan, we have a long and proud history of community and civic engagement,” she said. “It is important that during public policy debates we advocate to reform the way health care is delivered and paid for in order to keep it more affordable.”

Eric Linzer, a senior vice president at the Massachusetts Association of Health Plans, said the nonprofit group also wants to maintain a voice on Beacon Hill during the health care cost debate.

The group represents 13 health plans that provide coverage to more than 2.3 million Massachusetts residents.

Specifically, Linzer said in a statement that the group wants to make sure that any new laws and regulations curb what he said was the lopsided influence of better-known hospitals and other health care providers on the cost of care.

A 2010 report by Attorney General Martha Coakley found that higher-priced hospitals help drive up health costs in Massachusetts.

The report found that prices hospitals charge for the same services vary widely within the same geographic area and those changes that can’t be explained by quality of care. The report also found that higher-priced hospitals have gained more market share, forcing lower-priced hospitals to close or consolidate.

David Schildmeier, spokesman for the Massachusetts Nurses Association, said the union’s lobbying is different from the lobbying by insurers and hospitals.

Schildmeier said the union’s main concern is making sure that the welfare of nurses, staff and patients don’t get lost in the push to curb health care spending.

One bill the union has been pushing on Beacon Hill would create nurse-to-patient ratios that the union said are needed to ensure patient safety and comfort.

“Every time they try to change the payments system, they end up hurting patients,” Schildmeier said. “Our money was spent on protecting the public and protecting nurses.”

DeLeo’s speech came more than one year after Patrick unveiled a cost containment plan that sought an end to the traditional fee-for-service approach that charges patients on the basis of the tests and procedures.

Patrick’s plan called for the creation of so-called accountable care organizations and a system of payments that are tied more closely to patient outcomes.

Patrick has said that while the landmark 2006 health care bill signed by his predecessor, Republican Mitt Romney, has made health care almost universally accessible in Massachusetts, it has not made it any more affordable.

DeLeo declined to say whether the House plan would include elements of the governor’s proposal.

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Cost of health reform quietly rises $111B

Cost of health reform quietly rises $111B By Ron Shinkman, Fierce Healthcare

The U.S. Department of Health & Human Services estimates the cost of the Affordable Care Act will increase by $111 billion between 2014 and 2021, prompting some initial Congressional inquiries, reported the Associated Press. Rep. Dave Camp, a Michigan Republican, has begun to inquire as to why the cost has risen. The new calculations were in the upcoming budget proposed by the Obama administration, Bloomberg News reported. Administration officials claim the costs are increasing due to budget technicalities, noted the AP. “This staggering increase … cannot be explained by legislative changes or new economic assumptions, and therefore must reflect substantial changes in underlying assumptions regarding … costs,” Camp wrote Friday in a letter to Treasury Secretary Tim Geithner. Some observers have suggested the Obama administration has quietly recalculated that more employers will abandon covering their workers once the key portions of the Affordable Care Act take affect in 2014, or that the estimated cost of providing healthcare is continuing to grow. “The estimates do not assume changes in what exchanges look like, the cost of insurance, or the number of Americans who will get their insurance in this new marketplace,” said Treasury spokesperson Sabrina Siddiqui.

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