Mass. Legislature

House Approves Critically Needed Changes to Physician EHR Requirement

Posted in Electronic health records, Electronic Medical Records, Mass. Legislature on February 13th, 2014 by MMS – 10 Comments

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UPDATED: March 20, 2014

Read an update about this issue here.

The Massachusetts House this week approved changes in state law that would disconnect medical licensure from a physician’s use of electronic health records. The issue has been a major focus of the MMS’ advocacy efforts this year.

Under current law, effective Jan. 2015, physicians who wish to renew their license must demonstrate that they utilize EHRs that are at the level of the federal government’s meaningful use program.

MMS President Ronald W. Dunlap, MD, has met several times this year with legislative leaders, and cautioned that if the requirement is enforced, more than 10,000 physicians could lose their license, most of whom cannot, under law, qualify for Meaningful Use incentives. The resulting impact on the health care system would be devastating.

The House language would instead require practicing physicians to demonstrate that they use “digitized patient-specific clinical information.” Practicing physicians who don’t use digitized health records would be given the opportunity to demonstrate that they know how to use such records, by a method to be determined by the Board of Registration in Medicine.

Following a recent meeting between MMS President Ronald W. Dunlap and House Ways and Means Chairman Brian Dempsey (D-Haverhill), the House approved the language Wednesday by a very wide margin.

Unfortunately, the Senate’s supplemental budget bill did contain not such language, so the matter now heads to conference committee, where Chairman Dempsey has indicated will be a strong advocate for the substitute language.

We’d like to extend a big thank you to Chairman Dempsey and the House of Representatives for their actions this week.

Two State Budget Provisions Improve the Physician Practice Environment

Posted in Mass. Legislature on July 2nd, 2013 by MMS – Comments Off

We’re pleased to report that the FY 2014 state budget passed by the Legislature yesterday contains two provisions that will improve the physician practice environment in Massachusetts.

The first provision narrows the conditions under which physicians would be required to use the state’s Prescription Monitoring Program. It states that physicians must reference the program when prescribing for the first time a narcotic that is contained in Schedule II or III.

This is in contrast to pending state regulations, which would have forced physicians to use the monitoring program for every new patient, regardless of the purpose of the visit or consultation. Through numerous calls to action, emails and letters, we argued that the pending regulations would have imposed significant administrative burdens, with very little benefit to public safety or clinical care.

In another budget section, the Legislature agreed that payments to patients made under the new Disclosure Apology & Offer program should not be part of a physician’s disciplinary record or reported to the Board of Registration in Medicine, absent a determination that the physician had rendered substandard care.

We had argued that without such a provision, physicians would be reluctant to participate in the new program, which seeks to fairly and promptly compensate injured patients without litigation.

The budget is now on Gov. Patrick’s desk. He has 10 days to sign the bill, or veto any section he doesn’t like. MMS President Ronald W. Dunlap, MD, wrote Gov. Patrick and urged him to approve the two sections outlined above.

The Legislature’s Ambitious Health Care Bill: Steps Forward, and Concerns

Posted in Accountable Care Organizations, Global Payments, Health Reform, Mass. Legislature, Payment Reform on July 31st, 2012 by MMS – 5 Comments

By Richard V. Aghababian, MD
MMS President

(Update: The House and Senate passed the legislation today by overwhelming margins. Gov. Patrick is expected to sign the bill.)

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.

Steps Forward

  • 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.

Concerns

  • 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.

First Look at Payment Reform Legislation

Posted in Accountable Care Organizations, Global Payments, Health Policy, Health Reform, Mass. Legislature, Payment Reform on July 31st, 2012 by MMS – Comments Off

349 pages.

7,489 lines.

The Legislature’s House-Senate conference committee finally released its consensus payment reform bill last night. The House and Senate are scheduled to vote on it today – just in time for the end of formal sessions at midnight tonight.

If you want to take a look at it yourself, here’s the full text and the Legislature’s own summary of the bill.

We’re analyzing the fine print and will comment later.

Legislature Names Conference Committee for Health Care Bill

Posted in Mass. Legislature, Payment Reform on June 14th, 2012 by MMS – Comments Off

According to the State House News Service, the House and Senate have named the six people who will negotiate the differences between the two chambers’ health care payment reform and cost containment legislation. In accordance with the Legislature’s  rules, each chamber named two Democrats and one Republican each.

House conferees:

  • House Majority Leader Ronald Mariano (D)
  • Rep. Stephen Walsh, co-chair of the Health Care Financing Committee (D)
  • Rep. Jay Barrows (R)

Senate conferees:

  • Sen. Richard Moore, co-chair of the Health Care Financing Committee (D)
  • Sen. Anthony Petruccelli, co-chair of the Financial Services Committee (D)
  • Senate Minority Leader Bruce Tarr (R)

According to the Legislature’s rules, the committee is generally restricted to negotiating on points where the bills differ. Where the bills are alike, there is usually no negotiation permitted. The committee has until midnight July 31 to produce consensus legislation and get it passed by each chamber.

The MMS plans to advocate to the conference committee on the health care spending benchmarks, the House’s proposed “luxury tax” on high-spending hospitals and physician organizations, the registration and reporting duties of small practices, the composition of the state oversight agency, and other issues.

 

Key Similarities and Differences Between the House and Senate Payment Reform Bills

Posted in Accountable Care Organizations, Defensive medicine, Electronic health records, Electronic Medical Records, Health IT, Health Reform, Malpractice, Mass. Legislature, medical liability reform, Payment Reform on June 8th, 2012 by MMS – 1 Comment

After two years of discussion and debate, the Massachusetts Legislature must now deal with two huge pieces of payment reform and cost control legislation.

Earlier this week, the House passed its legislation by a wide margin, following eight hours of deciding which of 275 amendments it would accept. The Senate passed a separate bill on May 17.

During the House debate this week, the MMS sought to protect most small and medium physician groups from the House’s very rigorous reporting requirements. The original House bill exempted groups with fewer than 10 physicians. Due to MMS advocacy, the House agreed to increase the exemption to 25, which we will try to increase further during the conference committee’s deliberations.

When the members of the conference committee are appointed, they will have until adjournment on July 31 to agree on a single bill and get it passed by both chambers.

Despite their many similarities, reconciliation and consolidation of the bills is not expected to be an easy task.

Key Similarities

  • Cost containment: Each bill states that overall health care costs should rise in concert with the growth in the state’s economy. (Differences noted below.)
  • State oversight: Each creates a new state agency to certify provider groups, and collect volumes of information on quality measures and costs. The House agency is placed inside the executive branch, under the Executive Office of Health and Human Services. The Senate agency is an independent entity.
  • Market power: Both bills require payers to negotiate separate contracts for each hospital facility, with some exceptions.
  • Alternative payment models: The bills define ACOs and their requirements. They provide a 2 percent bonus in Medicaid payments to providers starting in July 2013, if they move to alternative payment methodologies.
  • Electronic Health Records: Each requires physicians to be proficient in the use of electronic medical records. (Differences noted below.)
  • Medical liability: Both mandate waiting periods for civil suits brought against health care providers. They require disclosure of case information to patients and providers; protect statements of apology from being admissible as evidence; provide for early payments to patients without prejudice. They reduce the prejudgment interest rate in malpractice cases from 4 percent to 2 percent. No contract may prohibit a physician from serving as an expert witness.
  • Determination of Need: They expand the Determination of Need process to include more new technologies, transfers of ownership and site expansions.
  • Administrative simplification: Both bills require standards forms for utilization review.
  • Peer review: Both bills expand the peer review statute. The House specifically provides ACOs with peer review protection; the Senate provides such protections to any provider group that conducts peer review activities.
  • Charitable immunity: They raise the charitable immunity cap from $20,000 to $100,000 (affects most hospitals in Massachusetts).
  • Physician assistants and nurse practitioners: Each bill provides more independence to physician assistants and nurse practitioners.
  • Limited service clinics: Both bills eliminate some existing regulations for the operation limited service clinics, such as those located in pharmacies; however their approaches differ.

Key Differences

Cost Containment

  • The House’s benchmark is 3.6 percent for 2012 and 2013. In 2014 and 2015, it would be equal to the growth rate projected in the Governor’s budget submissions. From 2016 to 2026, it would be equal to a half percentage point below the Gross State Product (GSP) from 2016 to 2026, and equal to one point above GSP after 2027.
  • The Senate’s cost benchmark is a half point above GSP through 2015, and equal to GSP from 2016 to 2026.
  • The House imposes a penalty on providers who costs are 20 percent higher than the benchmark. It establishes rate setting for governmental units. The House gives the state the ability to force providers to reopen contracts that it considers contributing to excessive spending. The House gives the attorney general to block unreasonable increases in rates, and block changes that adversely affect patient access and the quality of care. In the Senate bill, groups that exceed the benchmark must file improvement plans.

Market power

  • The House subjects provider groups of 10 or more physicians to a market impact review.
  •  The Senate gives the attorney general the power to prevent excess consolidation and collusion.

Certification

  • The House requires any physician group with 25 or more physicians to be certified by the Department of Public Health.
  • The Senate requires certification for all providers entering into alternative contracts. It exempts groups with less than $500,000 in annual net patient service revenue and fewer than five affiliated physicians, if the group does not accept risk.

Electronic Health Records

  • The House requires providers to adopt EHRs that are fully interoperable and connect to the statewide health information exchange.
  • The Senate updates existing the requirement for EHR proficiency by 2015 by requiring physicians must demonstrate the skills to comply with the federal government’s meaningful use requirements. It creates an institute to facilitate the implementation of interoperable records statewide, and promote the use of other health information technologies.

MMS President: State Can Do Better On Prescription Drug Checks

Posted in Drug Abuse, Health Policy, Mass. Legislature on February 9th, 2012 by MMS Communications – 2 Comments

By Lynda Young
President, Massachusetts Medical Society

The Massachusetts Senate’s recent unanimous passage of a bill to expand the state’s Prescription Monitoring Program is well intentioned, addresses a serious and growing problem, but, like The Boston Globe editorial of February 8 that speaks to the issue, falls short of addressing the heart of the matter.

Since 1992 when the PMP was established (with Massachusetts Medical Society support), the Department of Public Health has electronically recorded every prescription for Schedule II drugs, and since 2010, every Schedule III through V as well.  DPH has had regulatory and statutory mandates to review those prescriptions to find doctor shoppers and prescribers who overprescribe.

Its efforts, however, have fallen short, as no meaningful data, such as cross referencing Schedule II prescriptions with overdoses in the PMP database, has been compiled.  Prescribers are already registered with the DPH, yet are not given automatic access to the database, so additional registration by physicians would only seem redundant.  Further, prescribers are not notified of doctor shoppers among their patients with any frequency, another action that could reasonably be taken with an electronic system and an accurate read of the database.

An electronic database is a strong tool in the fight against prescription drug abuse, but the data must be accurate and timely. Real-time information, instead of that from the current lag of 10 days in pharmacies reporting to the DPH, is better.

Let’s also recognize that a major source of the prescription drugs being abused come from outside the state – a fact reported by the Cape Cod Times – and confirmed by law enforcement – in an eye-opening three-part series, “Pills that kill,” published in September of 2010.

We’re  keenly aware that “doctor shopping” is part of the problem, and that means that doctors can be part of the solution.  As prescribers, we are willing and eager to help. But it is not, as The Boston Globe suggests, “inconvenience”and “technophobia” that prevent us from enthusiastically backing the proposed legislation.

Before the state adds more administrative and costly steps, and before we take those steps that may risk delaying and denying appropriate care to patients who require it, let’s recognize that we have an adequate system in place. We should use it to its fullest capacity.

New: Read Dr. Young’s  Commentary on CommonWealthMagazine.org

This post was updated on February 15, 2012.

MMS President Shares Concerns With Senators On Prescription Drug Abuse Bill

Posted in Drug Abuse, Health Policy, Mass. Legislature, Public Health, Uncategorized on February 2nd, 2012 by MMS Communications – 2 Comments

In a letter delivered today to state senators, MMS President Lynda Young,  M.D. shared physician concerns on Senate 2122, An Act Relative to Prescription Drug Diversion, Abuse and Addiction, proposed legislation intended to address the growing problem of prescription drug abuse in the Commonwealth. Here is the text of her letter:

The Massachusetts Medical Society shares your concern over high rates of opioid abuse in Massachusetts.  The Society works closely with the legislature and the Patrick administration to address the problem and frequently hosts events targeted at educating physicians regarding responsible prescribing habits, pain management, drug diversion and patient education.  Most recently, the MMS collaborated with the Board of Registration in Medicine to implement CME’s for physicians on pain management.  We are proud of our efforts to reduce prescription drug addiction and diversion, but realize more could, and should be done.

S.2122, “An Act Relative to Prescription Drug Diversion, Abuse and Addiction” is a good multi-pronged approach to the problem of prescription drug abuse.  The MMS supports language in the bill designed to increase the usefulness of the prescription monitoring program as a valuable clinical tool in prescription decisions.  We support the production and distribution of educational materials to inform and enlist consumers in actions that will protect their families from access to narcotics and help patients decide their treatment options.  We strongly support the provision of limited immunity from drug possession charges and prosecution when a drug related overdose victim or a witness to an overdose seeks medical attention.  The Society also looks forward to working with the Executive Office of Health and Human Services on a joint policy group to investigate best practices for reducing diversion, abuse and addiction.

However, the Society must register its concern regarding S.2122’s mandate that all prescribers enroll in the Prescription Drug Monitoring Program, some by next January, and utilize the program before prescribing any schedule II or schedule III drug.  While a very useful tool, the PDMP is still evolving and the MMS questions its ability to accommodate the needs of twenty thousand or so new practitioners in a timely and useful manner.  For some physicians, including those who may fall into the “high prescriber” category like emergency physicians, time is of the essence.  Primary care providers have a jam-packed schedule and checking with the program several times a day during a patient visit may extend waiting times for patients, extend clinical hours for overworked clinicians and distract providers from patient care issues unrelated to abuse.  What if the system is down, or unavailable?  Would the physician be prohibited from writing the necessary prescription?

First it is essential that the DPH has the capacity to develop good quality data on prescriptions and that the data is accurate and meaningful.  A phased-in registration process that begins with high volume prescribers of schedule II opioids is a reasonable approach which we support.  Mandating review of patient records in the PMP prior to an initial prescription for oxycontin is a reasonable approach to gain value from the PM P.

The legislation should require the DPH to make outreach efforts to all prescribers detailing the program’s benefits and making free and quick on-line registration for physicians available before mandates are initiated.  By working with Board of Registration, the DPH could issue secure passwords and registrations to all actively licensed providers with prescribing privileges in the Commonwealth.

Coming on the heels of last year’s mandate for pain management CME’s for all physicians who write prescriptions for any medication, the MMS would further suggest that the working group created in Section 18 of S.2122 should begin its investigation and study into best practices for reducing drug abuse, and that those recommendations be considered prior to any further legislative mandates or requirements.  One point for consideration is to remove mandates for pain management training for physicians who do not write prescriptions for opiates and other pain medications.

In conclusion, the MMS appreciates the efforts of Senator John Keenan and the Mental Health and Substance Abuse Committee and looks forward to continuing to work on revisions to S.2122 and other initiatives to reduce prescription drug abuse.

Sincerely,

Lynda M. Young, M.D., F.A.A.P.

MMS Weighs in on Governor’s Payment Reform Bill

Posted in Mass. Legislature, Payment Reform on May 16th, 2011 by MMS – Comments Off

Gov. Patrick’s payment reform legislation got the full range of comments today, from the Governor’s own depiction of the legislation as the key to a better world, to the health plans’ concerns that the bill could produce a long list of unintended consequences. The Boston Globe and WBUR’s CommonHealth blog have summaries of what was said.

Our own comments were delivered to the Legislature’s Health Care Finance Committee in writing.  Some major points:

  • Physicians want to help with efforts to contain health care costs.
  • You don’t need an ACO to deliver properly integrated health care.
  • The current pilot projects for patient-centered medical homes and Blue Cross’ new alternative quality contract are good things; they help us learn what works best, and what doesn’t.
  • We need to reduce the practice of defensive medicine.
  • The legislation’s advisory council must include more than just the leaders of state agencies. Health care stakeholders, such as physicians, must have decision-making authority.
  • We don’t support state-mandated rate-setting, or mandated participation in state-sponsored risk reinsurance programs.
  • Don’t forget the patients. The alignment and engagement of patients is necessary for this to work.

Our complete testimony is available here.

Governor, House Majority Leader Not Exactly on Same Page at Doctors’ Day

Posted in Global Payments, Health Reform, Mass. Legislature, Payment Reform on May 9th, 2011 by admin – Comments Off

In addressing more than 200 Massachusetts physicians gathered this morning for Doctors’ Day at the State House, Gov. Deval Patrick reiterated his sense of urgency about controlling unsustainable health care costs.

“The complexity of this has to stop defeating us,” the governor said. “We have to stop looking for blame and start finding solutions.”

At the same time, the governor pledged to “make changes equitably,” and he thanked  MMS President Alice Coombs, M.D., whom he said “has been at the table” from the beginning.

In separate remarks to the Doctors’ Day crowd, House Majority Leader Ron Mariano said the House is interested in the governor’s plan, “but it’s just a starting point,” he emphasized. Rep. Mariano said that the House supports a more deliberate approach to ensure input from all health care stakeholders.

Conceding that he could not predict what the state Senate will do, Rep. Mariano concluded to a round of enthusiastic applause when he said, “Whatever we do, we don’t want to make the situation worse than it already is.”