Tag: Massachusetts

Why is Massachusetts failing at COVID-19 vaccination?

December 28th, 2020 by

Israel (population 9M) has already vaccinated 200,000 people against COVID-19 with the Pfizer/BioNTech vaccine and expects to be injecting over 100,000 per day shortly.

Massachusetts (population 7M)  has injected only 35,000 so far. Here, as in many other states, half the doses are being saved as boosters and not injected out of fear that a future supply glitch could delay dosing from a supposedly magical 21 or 28 day target time.

In Israel, senior residences had multiple stations manned by the local equivalent of the Red Cross, and military personnel with medical training are being used as well. Israel is prepared to ramp up to a 24/7 vaccination schedule if needed. They are treating it as an emergency, which it clearly is.

In Israel, the teams are equipped with epinephrine to handle the occasional severe reaction, which seems to be an issue with both the Pfizer and Moderna vaccines.

Meanwhile, what is the actual logistical plan in Massachusetts? It seems pretty vague. I’ve heard from friends at Boston teaching hospitals (and read in the press) that distribution is a mess. There is general talk of drugstores like CVS and Walgreens providing shots. Are they going to be ready with epi-pens or just call 911?

And what about the idea of giving one shot instead of two if supply is tight? We might get to herd immunity faster if we applied creative approaches such as this one.


By healthcare business consultant David E. Williams, president of Health Business Group

Are we there yet? COVID-19 test and trace in MA still lags

May 19th, 2020 by
Image 5 19 20 at 9.45 AM
Can someone explain this to me?

What on earth does that slide mean? You know, the Massachusetts Testing & Tracing Strategy page from the highly anticipated Reopening Massachusetts plan. We were hoping it would provide some clarity and confidence, especially since testing and tracing are the only green lights on the reopening dashboard.

Unfortunately, the graphic raises more questions than it answers. Here are a few that come to mind.

  1. Why are we only using 1/3 of our available testing capacity now?
  2. What good is capacity if we can’t get the tests to the people most in need (symptomatic and high-risk)?
  3. How do we know if the actual caseload is declining if testing continues to be underutilized?
  4. By July, testing will be available for “all symptomatic individuals, even mild symptoms.” Does that mean having symptoms now isn’t enough to justify a test? Is it really true that testing won’t be available for asymptomatic individuals even by summer?
  5. According to the projection, we will be filling all of our available capacity at 45,000 tests per day in just 6 short weeks. However, at that level, we will still be well under the estimated capacity that public health and infectious disease experts are calling for (71,000100,000 tests per day). Why is this an acceptable target?
  6. By December, we still remain at the lower end of target capacity, and woefully under it in terms of daily tests administered. What is the plan for getting further ahead of the necessary testing for the ‘second wave’ – and to avoid making the same costly mistake twice?
  7. Comparing the testing projections in the plan and what many of us believe is required, should we conclude that the committee doesn’t believe the need for more testing is real?
  8. There are a variety of tests available currently – some accurate and some no better than a coin flip.
    1. What types of tests are included in these figures at the various timepoints?
    2. In July, is only RT-PCR with nasopharyngeal samples collected by healthcare professionals accounted for? Or are other tests and collection methods included?
    3. Other methods are mentioned in the December description, so does this assume that there is no use of antigen or sequencing based tests until then?
  9. If commercial entities increase the availability of at-home testing, how does this factor into the plan?
  10. So, thinking through all of this, how can we have a green status on testing capacity now? In July?  Ever?

We have heard repeatedly that adequate COVID-19 testing capacity and contact tracing would be necessary for the safe reopening of our economy.  Until these questions are answered it’s hard to be confident.

We hope that everything will work out for the best, but we also know that hope is not a substitute for a strategy. Some answers to these questions would be a helpful place to start.

By Surya Singh MD, president of Singh Healthcare Advisors and healthcare business consultant David E. Williams, president of Health Business Group

Is reopening Massachusetts really driven by public health data?

May 18th, 2020 by

Today’s much anticipated Reopening Massachusetts presentation has a page entitled, “Reopening will be driven by public health data.” But look critically at the dashboard and you’ll see that some rows must be missing.

Not ready for prime time

There are six indicators. Two are green (positive trend) and four are yellow (no real trend). None are red (negative trend). But even the two green ones are not that reassuring:

  • COVID-19 positive test rate is a reasonable indicator. All else being equal, a drop means less COVID-19 in the community. But if testing is expanded beyond people who are obviously sick, you’d expect the percent positive to drop. The metric I’d really like to see is No new cases
  • Testing capacity is also shown as green. But weirdly, the previous slide (which will be the subject of a subsequent post) seems to show we are only using one third of the available capacity, despite the fact that testing is not widely available.

Looking at the dashboard you’d see it’s not time to move forward. So what else is going on?

There must be considerations beyond public health, such as:

  • Financial stress on individuals, businesses and state and local governments
  • Political pressure
  • Mental health concerns
  • Societal resilience

You can see some of this in the reopening plan. For example:

  • Supposedly there shouldn’t be gatherings of more than 9 people, and yet religious services are allowed to restart now
  • Hair salons are reopening despite the impossibility of social distancing. Six-foot scissors, anyone?

I think it’s ok to show the extra rows on the dashboard and take everything into account more explicitly. It’s better than pretending they aren’t there.

By healthcare business consultant David E. Williams, president of Health Business Group with input from Surya Singh MD, president of Singh Healthcare Advisors.

Medicaid block grants would be ok for Massachusetts

January 24th, 2017 by
Look mom, no waivers!

The old Republican idea of replacing Medicaid with block grants to the states is back on the front burner. In general I oppose it because it is likely to be used as a backdoor way to screw people with low incomes by reducing available funding. And I also fear it will increase healthcare disparities in many states where the commitment to universal coverage is low. Read (Everything you need to know about block grants – The Heart of GOP’s Medicaid Plans) from Kaiser Health News for the ins and outs.

But a shift to block grants would be fine for Massachusetts. It might be preferable to the status quo, even with the threat of a slowdown in funding.

In particular, Massachusetts is operating under a waiver from the Centers for Medicare and Medicaid Services (CMS) that will enable the commonwealth to shift Medicaid recipients into accountable care organizations (ACOs). We need permission from the feds to tackle Medicaid reform, and have had to argue with CMS to get funding for priorities that the state government thinks are important, such as directing funding to providers for the uninsured.

Under a block grant program, Massachusetts (and other states) could do as they please. In Massachusetts, I’m confident that we’d do the right thing. Frankly, under the current system I worry that the Trump Administration could decide to punish Massachusetts and our level-headed, bi-partisan oriented Governor by yanking the waiver.

I’ll go a step further and say it would also be fine for Massachusetts if the whole Affordable Care Act were repealed and not replaced. Even though Obamacare was based on Romneycare, there are enough differences that it has caused painful adjustments in the Massachusetts market that we could do without.

As long as we are exploring radical ideas, we could go a step further and establish that each state receive back from the federal government the same share as it pays in from taxes. Instead of redistributing revenues from Democratic states like Massachusetts and California to Republican ones like Mississippi and Alabama as we do now (ironic isn’t it), we could even things out. That’s kind of agains the ethos of our republic, but hey, times are changing.

In any case, while block grants and repeal of the ACA are bad ideas that will hurt the country as a whole if enacted, in Massachusetts we should be just fine.

Image courtesy of sattva at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

Are Massachusetts healthcare costs ok after all?

December 20th, 2016 by


The best defense is a good offense. I assume that’s what Partners HealthCare CEO David Torchiana had in mind when he penned First do no harm in the Boston Globe. In a nutshell, he argues that healthcare costs in Massachusetts are more affordable for businesses and individuals than elsewhere in the country, that they are becoming relatively more affordable, and that the state should resist the urge to impose further cost controls.

I’ve made similar arguments about affordability myself. See for example, Massachusetts: Land of affordable health insurance from back in 2011.

And yet…

While Massachusetts has retained its affordability relative to other states, healthcare is taking up a higher and higher percentage of families’ incomes, including in Massachusetts. Medicaid and other healthcare spending dominates the state government’s spending growth, squeezes out discretionary initiatives for priorities such as education, and necessitates the tough budget cuts Governor Charlie Baker is making.

I’m sure I’m not the only one whose eyebrows were raised by Torchiana’s sanguine perspective.

Partners also should not claim too much credit for the reasonableness of healthcare spending in Massachusetts, considering that its own costs are among the highest. Despite receiving substantially higher reimbursement from commercial payers than other providers and enjoying a richer payer mix, Partners recently reported a record loss of $108 million for the year. Meanwhile, its smaller rivals –including those who treat a higher proportion of Medicaid patients and receive lower commercial reimbursement rates– are reporting better financial results.

If Partners had remained just Massachusetts General Hospital and the Brigham & Women’s Hospital I don’t think its executives and lobbyists would have to expend so much effort fending off the state. Massachusetts residents are justifiably proud of the worldwide reputations of these hospitals, which draw tremendous research dollars from the NIH and elsewhere, attract patients from around the world, and are equipped with the medical expertise and equipment to treat the most complex conditions.

No, the issue is that over the years Partners has dramatically expanded its footprint throughout the region, buying up or partnering with community hospitals and physician practices, and expanding its own overheads as it grapples with the balance between central and devolved management. Partners is now in the business of providing routine care throughout the region, and that helps drive up costs and puts the company in the spotlight. As the state grapples with bringing costs in line with benchmarks, Partners cannot expect to be given a free pass.

So there are a couple of alternatives: #1: Partners can bring its own costs closer in line with rivals or #2 it can divest its community assets and focus on being a great academic medical center. From what I can see, Partners is pursuing a light version of #1 while simultaneously slowing its plans to further expand in the community and mounting a charm and lobbying offensive with the state and the public.

By healthcare business consultant David E. Williams, president of Health Business Group.