The Legislature’s Ambitious Health Care Bill: Steps Forward, and Concerns
By Richard V. Aghababian, MD
The Legislature has produced an ambitious health care roadmap for our Commonwealth. It seeks to make health care affordable for the residents, businesses and government of Massachusetts, while fostering quality, access and innovation.
In many cases, the legislation strikes a responsible balance between the role of government as oversight entity, with the rights of private sector entities to operate responsibly. However, there are several areas where we have concerns.
- We are pleased that providers will be free to decide whether they want to participate in alternative payment methodologies. Global payments aren’t for everyone, and fee for service still has a vital role to play in our system.
- The cost benchmarks locate a middle ground between the House and Senate proposals. We have advocated for higher benchmarks than the bill provides, and we have our doubts about sustainability of these benchmarks. We are pleased, however, that the legislation provides the opportunity for adjustments and corrections in future years.
- We support the legislation’s decision to use a corrective action plan as the mechanism to hold providers accountable for their costs – as opposed to the more punitive measures outlined in previous proposals. In addressing payment disparities among providers, the bill fairly recognizes the real progress that the private sector has achieved over the last two years.
- We are extremely pleased that the bill includes the Disclosure, Apology and Offer model of medical liability reform that we have championed for many years. We believe that implementing this alternative to traditional litigation will foster a climate of safety and openness in all health care settings, especially when a patient is harmed by an adverse medical outcome.
- The commitment to full parity of mental health and behavioral health with other areas of medicine is most welcome.
- We strongly support the proposals to address shortages in the health care workforce.
- The initiatives to foster transparency of reliable cost and quality information will not only benefit patients, but will also assist providers in recommending the most effective and affordable tests, drugs and procedures for their patients.
- We are pleased to support the wellness programs that are outlined in the legislation; prevention is the best medicine of all.
- We are concerned about the impact of the bill’s very stringent reporting requirements on the smaller medical practices in the Commonwealth. We will look to clarify how small practices will be impacted by the costs and burdens associated with reporting to new entities established by the legislation. The state must ensure that such efforts avoid duplication and provide a true net benefit to our Commonwealth.
- We are concerned that the bill goes too far expanding the practice prerogatives of some groups of providers. In particular, we find that the favored status granted to limited service clinics to be unwarranted, and thinly supported by research or facts. The classification of physician assistants as primary care providers also raises questions. We will monitor these developments closely and will be prepared to advocate for corrective measures if there are unintended consequences.
Clearly, the transformation of health care is only beginning. There is still much more work to be done. The Massachusetts Medical Society remains committed to working with all stakeholders, as we strive for a health care system that is effective, affordable and accessible to all.