Office-based care penalties will harm patients and physicians

By Dr. Alain A. Chaoui, President, Massachusetts Medical Society

Last week, I addressed the membership of the Medical Society via a special video announcement to provide an update about this incredibly busy, and likely impactful, state legislative session, which will end on July 31st. In that address, I mentioned one issue that is of particular concern: two separate health care cost and access bills passed by the House and Senate, which are currently under final negotiation and reconciliation by a six-legislator conference committee. We and many others have provided extensive comment to the committee to highlight provisions that we find concerning, including taxes on ambulatory surgery centers and urgent care clinics, as well as fee increases and surcharges on physicians.

Dr. Alain A. Chaoui

I’d like to take a moment to highlight an issue covered in all of the Medical Society’s testimony and comment on these bills that has evaded mainstream attention: a proposal to regulate and tax “office-based surgery.” This new category is defined as any procedure provided in a physician office that requires at least moderate sedation. The affected physician offices would be subject to new regulatory oversight such as DPH clinic licensure, and they would be subject to an 8.75% assessment on all charges for office-based surgery. If these provisions pass, the resulting changes will constitute the first-ever breach of the physician office exemption from these aspects of DPH’s purview.

The MMS has strenuously opposed this proposal. In a letter to the legislature, the Society called this proposal an “unnecessary, costly and burdensome change that, if implemented, will force many physicians’ offices to offer a decreased range of services, close, or sell to a larger entity – outcomes which would decrease access and increase cost, threatening to diminish the gains Massachusetts has made in reducing cost and improving efficiency in the market.” These provisions were put forth in a bill that purported to increase access to health care throughout the Commonwealth. If passed, however, these changes would have the opposite effect.

Every day throughout Massachusetts, physicians provide critical procedures to patients in their offices, as a routine aspect of low-cost, high-value, community-based care. From gastroenterology to oral surgery to plastic surgery, physician offices — often in solo or small practices — regularly provide procedural care to patients. Providing this care in physician offices benefits patients, who do not need to travel to a hospital or other surgical facility. It also benefits the health care system, as these procedures are offered at lower costs without facility fees. We continue to believe that providing these high-value, low-cost procedures at small physician offices should be promoted, not discouraged.

The Medical Society believes that sufficient regulation already exists for these procedures. Ambulatory surgical centers are already regulated by the Department of Public Health. And all physicians practicing in Massachusetts are under the oversight of the Board of Registration in Medicine. The data show that surgical care provided in physician offices is of equivalent quality to care provided in other settings. We therefore oppose this additional regulation of office-based surgery. If office-based surgery becomes subject to high taxation rates, patients will pay the price.

If office-based surgery becomes subject to high taxation rates and further regulation, patients will pay the price.

I personally know physicians who would be forced to stop providing surgical care if these policies are passed as currently proposed. For some patients, there may be another clinic or hospital down the street where their own doctor can provide the care, albeit at a higher cost to the system. For others, this policy could force that care to be provided by a different doctor. Some physicians’ offices might even have to close their doors—a tragic outcome for both patients and physicians.

I have also heard from many physician colleagues who have already seen a movement of Massachusetts patients seeking care in New Hampshire ambulatory surgery centers as a result of less onerous regulation. If these taxes and assessments are passed as proposed, even more of our patients will seek care across state lines.

I am pleased to report that many other stakeholders, including many in the business community, have opposed these proposals out of concern that they could raise costs and jeopardize access. In fact, this week, the Boston Globe urged a more moderated approach to the legislation which would avoid these surcharges and taxes, while the Boston Business Journal cautioned that the proposal is “is flawed and ambiguous” and should be vetoed by Gov. Baker if a version with these provisions reaches his desk.

We’re hopeful that the legislature will appreciate that regulation and taxation of high-value settings of care is not a sound, long-term solution to the Massachusetts health care delivery system. Office-based surgery, as detailed above, is the perfect example of a setting of care that should be supported, rather than penalized. We will continue our work to promote and safeguard that care, in solidarity with our colleagues who provide it, and with the patients they care for.

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