At the State House, MMS Leaders Urge Caution and Pilot Projects for Payment Reform

Massachusetts Medical Society physicians joined several health care providers Thursday in urging the State Legislature to move carefully in adopting a new payment model for physicians and hospitals.

MMS President Mario Motta, MD, said, “If we move too quickly and rattle the tree too abruptly, you’re going to have physicians fall out of their practice like leaves on a tree.” His comments came during a three-hour hearing held in a packed committee room in the basement of the State House.

Motta said that while some physicians work under a global payment system, it’s never been tried before on a system-wide basis. “There are many unknowns and unpredictable effects that could happen,” he said. “For that reason, we are strong advocates for establishing pilot projects for these innovations.”

But, Motta noted, “Coordinated care is better than fragmented care. We want to support innovations that move us in that direction. It’s better for the patient, and it’s better for our health care system.”

MMS President-Elect Alice Coombs, MD, was a member of the commission that studied alternative payment models in the state. She said, “A new payment model is worth looking into if, and only if, there is adequate time, support and preparation for physicians making this enormous transformation.”

Coombs told the committee about the concwerns she’s heard from physicians statewide about global payments. “Most of all, physicians have been saying, We’ve tried this before. It was called capitation, and it didn’t work.”

She said physicians ask how they will be protected against undue financial risk, whether physicians will get adequate resources to provide the right care, and whether patients will trust a global payment system. She said the Legislature must address these and other issues before implementing a new payment model.

Coombs also added an “urgent plea” for naming practicing physicians to any oversight authority for payment reform. “One thing we learned at the commission,” she said, “is that the voice of the practicing physician is absolutely essential to developing a system that will work.”

Most other health care providers testifying also urged a careful, deliberate implementation, including representatives of family physicians, Cambridge Health Alliance, and the Massachusetts Hospital Association.

Others disagreed. The outgoing secretary of Administration and Finance for the state, Leslie Kirwan, said, “Standing still or inching forward is in fact falling back.” Marylou Buyse, MD, president of the Massachusetts Association of Health Plans, said, “We don’t have the luxury of five years.”

Dolores Mitchell, executive director of the state agency that purchases insurance for state employees, said payment reform “may be our last best hope” for controlling health care costs.

Watch Dr. Motta’s testimony (Length: 7:56).

Watch Dr. Coombs’ testimony (Length: 6:40)

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