Global Payments

MMS Calls for Changes in Medicare ACO Regulations

Posted in Accountable Care Organizations, Global Payments, Medicare, Payment Reform on June 6th, 2011 by MMS – Comments Off on MMS Calls for Changes in Medicare ACO Regulations

Today, the MMS submitted 20 pages of comments on the federal government’s proposed regulations for Medicare accountable care organizations (ACOs). Our comments were based on the principles for health care reform approved by our House of Delegates last month.

Our comments include:

  • Physician leadership, from both primary care and specialty care physicians, for the implementation of any new delivery system, including ACOs.
  • Medicare patients must have the freedom to choose their physician and ACO. The regulation proposes to assign patients based on where they have received most of their care in the recent past.
  • The 65 proposed quality measures are excessive and flawed, and will discourage many small practices from participating in a Medicare ACO. We stated that it’s “unnecessarily punitive” to require that practices meet every measure to qualify for the “shared savings” distributions at year’s end, particularly since many of the measures are hospital-based. We also believe the measures are inadequate for practices with a large number of senior patients.
  • The proposed financial withhold of 25% is too high and will hinder small practices from investing in IT and other infrastructure improvements. Financial withholds are funds set aside during the year to serve as an incentive to meet financial or quality benchmarks.

Last week, in similar comments, the American Medical Association recommended substantial changes in the regulations. Separately, leaders of the Mayo Clinic, Cleveland Clinic, Geisinger Health System and Intermountain Health criticized the regulations. One official at Mayo said, “There’d have to be substantial revisions for us to participate.”

Health Reform Principles Stress Balance Between Patient Choice and Economic Reality

Posted in Accountable Care Organizations, Annual Meeting 2011, Defensive medicine, Global Payments, Health Policy, Health Reform, Malpractice, medical liability reform, Payment Reform on May 22nd, 2011 by MMS – Comments Off on Health Reform Principles Stress Balance Between Patient Choice and Economic Reality

Spirited debate at the MMS House of Delegates Saturday led to the adoption of 18 principles on health care reform that the Society plans to share with local and national legislators.

The principle that dominated deliberations asserted that “health care reform must enable patient choice in access to physicians, hospitals, and other services while recognizing economic reality.”

Among the other principles adopted were the following:

  • Physicians must lead reform, keeping clinical decision-making in the hands of doctors and patients.
  • Reform must be flexible enough to account for different practice types and their variable readiness to change.
  • Fee-for-service payment should have a role in any system.
  • Physicians will need infrastructure support, especially for IT and hiring physician extenders.
  • Risk adjustment methods must incorporate physician input and account for illness burden and socioeconomic status of patients.
  • Transparency throughout the whole process is essential.
  • Patient education and accountability must be enhanced.
  • Professional liability and antitrust reform are crucial underpinnings to reform.

The complete principles are available at

Complete Annual Meeting coverage is available at

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 MMS Communications – Comments Off on Governor, House Majority Leader Not Exactly on Same Page at Doctors’ Day

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.”

Payment Reform: Issues to Consider

Posted in Global Payments, Payment Reform on January 28th, 2011 by MMS – Comments Off on Payment Reform: Issues to Consider

MMS President Alice Coombs appeared this week on WGBH’s news program, “Greater Boston,” to talk about payment reform in Massachusetts.

In her interview with Emily Rooney, Dr. Coombs said she’s concerned about the ability of small practices to make the necessary investments in technology and workflow to succeed in a global payment system. She also said that payments must appropriate risk adjustments for disease burden and socio-economic factors.

The complete segment is here.

AMA Releases Comprehensive Physicians’ How-To Guide on ACOs

Posted in Accountable Care Organizations, Electronic health records, Electronic Medical Records, Global Payments, Payment Reform on January 10th, 2011 by MMS – Comments Off on AMA Releases Comprehensive Physicians’ How-To Guide on ACOs

Photo by MyTudut via FlickrThe American Medical Association has released one of the most comprehensive resources produced so far to help physicians evaluate their options for practice integration, accountable care organizations, and other issues, following the passage of federal health reform last year.

The resource may also be helpful to Massachusetts physicians who are thinking about what statewide payment reform and ACOs could mean to them.

Here are some of the topics:

  • ACO governance issues
  • Partnering with hospitals
  • Partnering with health plans
  • CO-OPs and accountable care
  • Electronic health records and federal incentive payments
  • Managing anti-trust risk

The document is available from the AMA at no cost.

Download the document here. (.pdf, 112 pages, 781 kb)

Dr. Coombs: Physicians Must Examine Legal Issues Surrounding ACOs

Posted in Global Payments, Health Policy, Health Reform, Payment Reform on December 29th, 2010 by MMS Communications – Comments Off on Dr. Coombs: Physicians Must Examine Legal Issues Surrounding ACOs

Much has been written about Accountable Care Organizations and their potential to improve quality and reduce costs, but the legal issues physicians may face as they move to establish arrangements under this new model of care have received less attention.

In an essay in the January edition of Massachusetts Medical Law Report, MMS President Alice Coombs, M.D., outlines the major legal areas physicians must consider when approaching ACOs and urges careful deliberation to avoid unintended consequences.

“Putting aside the economic and clinical questions for a moment,” Dr. Coombs writes, “it’s clear that physicians face substantial legal issues with any ACO design. Physicians – particularly solo-practitioners and those in small practices, who make up the majority of physicians in our state – should proceed with caution, and likely considerable legal help, when approaching ACOs.”

Among the key areas she cites are the corporate practice of medicine, anti-trust and anti-kickback laws, self-referral and the Stark Law, risk-bearing issues, and professional liability. Increasing the complexity for physicians, she adds, is the fact that laws at both the state and Federal levels apply to most, if not all, of these considerations.

While not suggesting that physicians are averse to ACOs, Dr. Coombs says “The varied nature and structure of our current medical delivery system underscore the notion that one size doesn’t – and won’t – fit all as we move to new models of care.  The legal issues may not be insurmountable, but are many and considerable. ”

Read Dr. Coombs’ essay here

MMS Physicians Adopt Policy on Payment Reform, Health Care Spending, Preauthorization, Physician Recruitment, Bullying, Tobacco, and Gambling

Posted in Global Payments, Health Reform, Interim Meeting 2010, Payment Reform on December 4th, 2010 by MMS Communications – 1 Comment

Amid spirited debate, the MMS House of Delegates adopted several new policies Saturday, including the following:

  • To advocate for multiple, innovative approaches to health care financing in any payment reform legislation;
  • To develop and offer training for health care providers aimed at preventing self-harm, suicide, and disability arising from bullying. Delegates acknowledged the special need for such training with regard to the lesbian, gay, bisexual, and transgender community, and those questioning their sexual orientation or gender identity;
  • To join like-minded organizations in advocating for the removal of tobacco products and tobacco advertising from locations near cash-registers and counters in retail establishments;
  • To educate about the potentially adverse public health effects of gambling, and to advocate for revenues dedicated to addiction treatment if casino gambling moves forward in Massachusetts;
  • To ask the AMA Council on Science and Public Health to develop policy on the use of full-body airport scanners;
  • To take the position that preauthorization decision-making regarding medically necessary services and treatments is the de facto “practice of medicine,” and that such decision-makers are liable for bad outcomes and subject to malpractice actions;
  • To adopt principles for health care expenditures that include, but are not limited to, the following:
    • A committee of physicians, Massachusetts residents, and others to make conflict-free, transparent recommendations about how health-care dollars should be spent
    • Frequent reviews of aforementioned recommendations
    • Malpractice reform to promote adoption of guideline recommendations
  • To improve recruitment and retention of physicians in Massachusetts, especially primary care doctors, by exploring the expansion of student loan repayment programs.

State Sets Dec. 2 Public Hearing for Comments about Payment Reform

Posted in Global Payments, Payment Reform on November 24th, 2010 by MMS – Comments Off on State Sets Dec. 2 Public Hearing for Comments about Payment Reform

If there’s something you want to tell state officials about payment reform, Dec. 2 is your chance to speak up.

The Massachusetts Health care Quality and Cost Council yesterday scheduled its long-anticipated public hearing on payment reform for next Thursday, Dec. 2 , at 12:30 p.m. on the campus of the UMass Medical School in Shrewsbury.

The Council said it’s interested in comments about three topics (quoted verbatim here):

  • Establishment of Integrated Provider Organizations: What is your idea of a more integrated provider organization?  How do we transition to this service model? What consumer protections should be provided to members of integrated provider organizations?
  • Payment Methodologies: What are your concerns about the current payment system? What payment models/methodologies and financing mechanisms might the Committee and the Council consider?  What consumer protections should be provided by these models in the redesigned payment system as well as in the transition period?
  • How should quality performance standards for Integrated Provider Organizations be set, monitored, and evaluated?

Comments may be submitted in writing, or orally in person. However, oral comments will be limited to three minutes in length.

For more information on the hearing, its location, and instructions on how to register for the meeting, read the full notice on the Council’s website.

Governor to Sign Health Care Bill Today

Posted in Global Payments, Health Reform, Mass. Legislature, Payment Reform on August 10th, 2010 by MMS – Comments Off on Governor to Sign Health Care Bill Today

photo by churl, via flickr.comGovernor Patrick is scheduled to sign the Legislature’s small business health care bill today at the State House at 2 p.m.

The bill contains a number of important and reasonable provisions to moderate the rising cost of health care for small businesses. We’re hopeful that these measures will protect the gains we have made in improving health care access in our Commonwealth.

At the same time, we are mindful of the work that remains ahead, including the Legislature’s stated intention to reconvene on payment reform legislation next year. While we support such an inquiry, we urge the Legislature to proceed cautiously.

The global payment model has been implemented in some self-contained health systems across the country, but has never been implemented anywhere on a statewide basis.

While some elements of our health care system might move to a global payment system in a relatively short time frame, the vast majority of physicians and hospitals will find any transition to be fraught with significant technical, logistical and clinical challenges.

We worry about the unintended consequences of moving too fast, without appropriate checkpoints, milestones, or without elements that incorporate and preserve the great diversity of our health care system.

As the Legislature moves forward, it will be critical for all stakeholders – especially patients, physicians and hospitals – to be involved in the design and development stages of any new health care model.

Alice A. T. Coombs, MD
President, Massachusetts Medical Society

Payment Reform: Not This Year

Posted in Global Payments, Health Policy, Health Reform, Payment Reform, Payment Reform Commission, Uncategorized on July 4th, 2010 by MMS Communications – Comments Off on Payment Reform: Not This Year

The push to payment reform for health providers has apparently stalled, at least for this year, according to a report in today’s Boston Globe, which described the main reason for the delay as “disagreements among key officials, legislators, and providers over how best to control health care spending.”

Despite consensus among many that the current fee-for-service system contributes to escalating costs, and a recommendation from a state commission one year ago that the state adopt a new payment system quickly, Senate President Therese Murray told the newspaper that she will not file legislation to change the system this year as she originally planned. Ms. Murray attributed the delay in part to the “logistical and political complexity of changing a system that has been in place for decades,” according to the Globe report.

The Special Commission on the Health Care Payment System (which included current MMS President Alice Coombs, M.D. as a member) has recommended that the state move away from a fee-for-service system to one of  “global payments,” which offers providers a set payment for all of a patient’s care for a year.  Yet Ms. Murray told the Globe that global payments may not be right for all providers. Health care “is a huge portion of our economy and workforce, and we don’t want to negatively affect our economy,” she said.

According to the Globe story, drafts of legislation on health care cost control have been passed between the Patrick administration and Senate leaders, but full agreement is yet to be reached on specifics.

The Globe story also said that the Massachusetts Hospital Association “plans to release a detailed plan this month for establishing a board to oversee the transition to a new payment system.”