Representative Steven Walsh has attended 800 meetings with health care industry executives while researching the House’s health care cost-control legislation. But his personal experience as the father of a very sick infant has been eye-opening too.
During a breakfast Tuesday sponsored by the Massachusetts Health Council, a non-profit group that promotes public health, Walsh said he witnessed overuse and denial of medical care for his 1-year-old twin son, who was born with a serious heart condition. He was hospitalized more than 90 days during his first year.
“I watched him get over-tested on a pretty regular basis,’’ he told the audience of several hundred insurers, providers, and consumer advocates.
Walsh said he fought back, especially in the emergency room, where it’s hard to get admitted to the hospital without a battery of X-rays and other tests. “On the 50th X-ray, I said enough is enough,’’ he said.
Walsh’s son received most of his care at Boston Children’s Hospital, which he has praised, but he said coordination of care across the health care system could be better.
He said he also witnessed denial of medical care. For example, at one point during his son’s first year, a medical supply company called to say his son had used up his “life-time supply of oxygen.’’ Walsh said his insurance company intervened.
Walsh did not want to go into more detail about his son’s experience to protect his family’s privacy. But he said he is doing much better now.
Over-testing is a key issue in the debate over soaring medical costs. In April, nine medical specialty groups released a list of 45 tests and procedures that patients often do not need -- even though doctors routinely perform them. They include annual electrocardiograms, CT scans for low back pain, and chest X-rays before surgery. Excessive use of X-rays in children in particular can raise their risk of cancer later in life.
The House and Senate have passed separate cost-control bills, and both aim to encourage coordination of medical care, in part through widespread adoption of electronic medical records and the development of Accountable Care Organizations -- large groups of connected providers that oversee all of a patient’s care.
Walsh and Senator Richard Moore, who oversaw development of the Senate plan, outlined their key strategies to the group Tuesday morning. Moore said the two chambers’ leaders will begin negotiations soon and will present a joint plan to the governor by early or mid-July.
“We need a coordinated health care delivery system that takes out the waste,’’ agreed Dr. JudyAnn Bigby, , secretary of Health and Human Services, who also spoke to the group.
Liz Kowalczyk can be reached at firstname.lastname@example.org.