Tuesday, October 11, 2011

Essex Happenings October 11, 2011

New Spaulding Web Site

Many of you who read this BLOG on a regular basis know that I have become an avid advocate for Spaulding Rehabilitation Hospital since they took such wonderful care of me and certainly impacted my recovery from a recent illness. The Hospital has recently developed and brought a new web site on line, and about a month ago, they filmed a video related to my illness and subsequent recovery. If any of you might have any interest in viewing the video it can be accessed at www.spayuldingnetwork.org and the video can be found on the homepage of that site under the Media Center section under the section "About Us." The testimony that I provided in the video continues my strong ebdorsement of the hospital as a sensational, if not undervalued l resource in this region.

The video provides a little insight into the medical experience and provides a little preview of the book called BELIEVE, that I anticipate will be published before the end of this year.

Recent Agreement between Health Network and a Regional Hospital group could have major Ramifications on how Health Care is provided in the future.

I recently received a message from Paul Lanzikos the Executive Director of North Shore Elder Services, where I serve on the board that included a recent column from the Boston Business Journal that outlined a recent development and the changes in medical insurance networks that most certainly could have an impact in how medical services particularly to small businesses are to be delivered in the future. I have included a copy of the column for your information as awareness of the world of medical health care should be important to all of us.

Medical shakeout looms: Closed network would create winners, losers among hospitals

Boston Business Journal by Julie M. Donnolly , juliedonnolly@bizjournals.com
Friday, September 23, 2011, 6:00am EDT

The partnership between Tufts Health Plan and Steward Health Care to offer a low-cost insurance option for businesses comes with strings attached for subscribers and delivers a blow to some prominent hospitals, particularly Children’s Hospital Boston and the Floating Hospital for Children.

The Tufts-Steward deal helps usher in the era of so-called limited networks, where patients are largely confined to an orbit of pre-selected health care providers. The new health plan proposal, geared towards small businesses, would limit subscribers to receiving care at Steward facilities, which will include 11 Massachusetts hospitals, among them St. Elizabeth’s in Brighton, if pending deals are approved. In cases where care cannot be delivered in the network, patients will be referred to the two downtown Partners HealthCare academic medical centers — Massachusetts General Hospital and Brigham and Women’s Hospital. In addition, all inpatient pediatric care will be provided by MGH for Children.

That’s bad news for two of the state’s highest profile care facilities for children. Children’s Hospital Boston and the Floating Hospital for Children at Tufts Medical Center are being frozen out of treating children covered under the new plan, a feature Children’s says may come with some risk.

“I’m concerned about the breadth and depth of expertise for children with complex conditions,” Children’s Hospital President Sandi Fenwick said. “Not to disparage MGH, but for many complex procedures there is a direct correlation between volume and outcomes.” Children’s had 13,232 discharges in 2009, versus 2,892 pediatric discharges at MGH, according to the state.

Fenwick said, for instance, Children’s performed 90 bone marrow transplants on children this year, versus just a handful at MGH.

Parents need to be educated about what a limited network would mean for their child’s care, Fenwick said, and that they could be hit with astronomical bills if their child suddenly developed a complex or rare condition and needed to be treated at Children’s.

Steward Hospitals will retain their clinical affiliations despite the new Tufts deal, Steward spokesman Chris Murphy said. Floating hospital pediatricians, for instance, staff Steward’s Morton Hospital in Taunton 24 hours a day, referring them to Floating when necessary. But for patients enrolled in Steward’s new limited network, called Steward Community Choice, referrals to Children’s or the Floating would be eliminated.

To smooth the flow of admissions to MGH for Children, members of the new plan will have access to Partners-affiliated pediatricians.

As a result, existing primary care relationships could be disrupted. For instance, large numbers of pediatricians near Quincy Hospital, which Steward is moving to buy, are affiliated with NECQA, Tufts Medical Center’s physician organization— not Partners or Steward.

Incoming Tufts Medical CEO Eric Beyer said in the long run his hospital is well-positioned to take advantage of limited networks. “We cannot be afraid of plans designed to help small businesses,” Beyer said. “If this plan is high quality and low cost and keeps care in the community, then it might be a reasonable option.”

However, it’s clear that some care previously being done in the community will move downtown, a trend generally associated with higher costs to the system. With Steward’s new insurance product, Partners HealthCare, has agreed to provide services at MGH and the Brigham at a lower negotiated rate to help the plan meet its goal of reducing small business premiums by 30 percent. Partners executives declined to give specifics on its rates.

Meanwhile, more closed networks loom. “We’re in preliminary discussions with half a dozen provider groups,” Tufts Health Plan CEO Jim Roosevelt said. They include Tufts Medical Center. Harrington Hospital in Southbridge might also form the core of a lower cost product in Central Massachusetts, Roosevelt said.

Gov. Deval Patrick has tasked insurers with coming up with limited or tiered networks (which assign different co-pays to different hospitals), at prices discounted by at least 12 percent from their existing small business insurance products. Tufts Health Plan filed its Steward limited network plan with the state Division of Insurance last week.

DOI spokesman Jason Lefferts said Blue Cross Blue Shield of Massachusetts and Harvard Pilgrim Health Care have yet to file qualifying health plans but are expected to do so by the end of the year.

Important Salem Harbor Station Report to be released

Earlier this week the long awaited action plan that the city and Dominion have been working on was presented, A reuse plan for the power station on Fort Avenue in Salem, if it were to be closed as the company has indicated several options. The plan has been paid for with funding from the state, that provided the funds as the impact on the City due to the potential loss in tax revere might be devastating. Both parties have been participating in the planning process although in reality the city is just an interested party as the ownership of the site remains in the hands of Dominion. The proposed plan that was just exposed would call for re-development to be accomplished in phases and it is possible that there might be multiple uses on tap for the site, including a cruise ship port, marina and even a residential component. There even remains the possibility that another energy company might wish to continue the use as a power facility with an alternate source of energy like the natural gas pipeline that could be accessed.

Boxford Town Meeting Scheduled

The Town of Boxford has scheduled a special town meeting on October 22, 2012 to address school improvement issues, the purchase of land to be developed as a parking lot. The body will also consider moving the day for future meetings from Saturday back to Tuesday evenings.

North Shore Elder Services and WickedLocal.com are pleased to present:

We Give Thanks” 2011 Awards!

These awards emphasize the care and service others provide to older persons on the North Shore. The awards dinner is our opportunity to publicly thank those whose accomplishments and contributions best exemplify and advance the mission of North Shore Elder Services – Life. Made Easier. for elders.

Please join us for an uplifting and inspirational evening to applaud this year’s award recipients.

For information on how to purchase tickets for thid entertaining and rewarding evening contact North Shore Elder Services ar www.nses.org.

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