Insurer CEOs seek price caps for top Massachusetts hospitals: 5 things to know

Insurers called for revisions to a Massachusetts bill proposing price regulations for the state's highest-performing hospitals Tuesday, Telegram & Gazette reports.

Here are five things to know.

1. The goal of the healthcare reform bill is to lessen the gap between rates paid to hospitals with lower expenses and those with the highest. Larger research hospitals argued the higher prices allow teaching and research to take place, while community hospitals counter the bill would boost their financial performance.

2. Insurers are calling for the bill to regulate prices of all hospitals in the top tier of Massachusetts' market, rather than only the three largest, all in Boston: Massachusetts General Hospital, Brigham and Women's Hospital, and Boston Children's Hospital, the report states. 

3. Top executives of Massachusetts' six largest health plans — Harvard Pilgrim Health Care, Fallon Health, Tufts Health Plan, UniCare, UnitedHealthcare of New England and United Healthcare Community Plan of Massachusetts — expressed their concerns about the bill in a letter to state Senate President Stanley Rosenberg on Tuesday.

4. As part of their argument for tighter rate restrictions, payers said leaving the current health system unchanged would lead to higher coverage costs, the Telegram & Gazette reports. Payers expressed concern over the bill's proposals to raise rates for lower-paid hospitals to 90 percent of the average for Massachusetts hospitals in the previous year, and create target growth rates for total hospital spending.

"Specifically, increasing the prices paid to lower-paid hospitals without including sufficient measures to constrain the rates paid to high cost hospitals will lead to higher premiums for employers and consumers," the insurance executives wrote. They are also arguing for penalties for providers beyond the top three hospitals who add "excess growth," which the bill already establishes a council to levy penalties on should growth targets be missed.

5. The state Senate said it would hold a two-day debate on the bill on Wednesday and Thursday, the report states. 

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