Health Reform

Recapping a Busy Year: MMS Health Care Advocacy in 2014

Posted in Annual Meeting 2014, Electronic health records, Health Reform, meaningful use, Medical Marijuana, Medicare, Payment Reform on May 15th, 2014 by MMS – Comments Off on Recapping a Busy Year: MMS Health Care Advocacy in 2014

Ronald W. Dunlap, MD, president of the Massachusetts Medical Society, kicked off the Society’s 2014 Annual Meeting with a review of five significant advocacy issues from the 2013-14 year:

  • Medicare payment
  • ICD-10 deadlines
  • Regulatory overreach
  • State regulations on EHRs
  • Medical Marijuana


Perspective: CMS Release of Physician Payments

Posted in Health Policy, Health Reform on May 7th, 2014 by MMS Communications – Comments Off on Perspective: CMS Release of Physician Payments
DSC_0003 Dunlap 4x6 color 300 ppi_edited

MMS President Ronald Dunlap:   perspective needed on Medicare payments.

When the Centers for Medicare and Medicaid Services (CMS) last month  released its physician payment data for 2012, the agency described it as a major step forward for health care transparency, and CMS administrators and Congressional representatives alike extolled the virtues of making such information public.

The proposed action wasn’t without controversy. Prior to its release, nearly 100 national, state, and specialty medical societies signed on to a letter sent in September 2013 to CMS citing physician concerns about the release of raw data and opposing its release, saying it “should be limited for specific purposes and with appropriate safeguards.”

The letter further stated that the societies welcomed “the opportunity to work with CMS to improve meaningful and appropriate access to this information and recognize the potential value and importance of Medicare physician claims data,” and it encouraged CMS to partner with physicians to develop policies that will “promote the reliable and effective use of this information” and cited many concerns physicians had about releasing the data.

CMS released the raw data on April 9, and, predictably, news coverage was widespread across the nation.  The Wall Street Journal wrote that “The trove of Medicare data released Wednesday shows a wide cast of characters in the top ranks of the highest-reimbursed doctors, and reveals as much about the limits of the newly public billing records as it does about medical practice.”

The New York Times noted the limits of the data as well, writing that “Many other doctors worried that the data released was incomplete and often misleading. In some cases, enormous payments that seem to be going to one doctor are actually distributed to multiple others. But the data tables do not reveal that the money was shared.”  Much of the news coverage in the Commonwealth focused on local physicians receiving large payments.

Reaction from physicians was mixed; some were outraged, some were surprised, some were resigned to the data’s release as part of the continuing trend in transparency.  CMS released the data with a minimum of explanation, saying only that there may be legitimate reasons why doctors get high Medicare payments. But physician payments, from whatever source, are part of the highly complex nature of health care spending and require some perspective for better understanding.

MMS President Dr. Ronald Dunlap offers such a perspective in this commentary, published May 2 on WBUR’s CommonHealth website.


MMS 2014 Public Health Leadership Forum: The Impact of Health Care Reform on Health Care Disparities

Posted in Health Reform, Payment Reform on April 7th, 2014 by Erica Noonan – 1 Comment

The key to lessening health care disparities lies in better data collection, pay-for-performance systems that properly measure and reward improvement, and technology that engages patients in their own treatments, according to according to a panel of experts featured at the 2014 MMS Public Health Leadership Forum.

The presentation, “The Impact of Health Care Reform on Health Care Disparities,” was hosted by MMS April 4 in collaboration with the national Commission to End Health Care Disparities.

As one of the first states to pioneer universal health coverage, the nation is looking to Massachusetts for ideas and solutions as this year’s implementation of the Affordable Care Act is expected to bring millions of previously uninsured patients into doctors’ offices, said MMS President Ronald Dunlap.

Massachusetts has lower-than-average rates of disparities in key health areas such as infant mortality, hypertension, obesity and adult diabetes.  But access to primary care physicians in certain regions of the state remains a problem, as do Medicaid payment models that dis-incentivize physicians, said Dr. Dunlap.

Dr. Joel Weissman

Joel Weissman, PhD

Can Pay-for-Performance Create Equity?

Among the most promising tools for bridging the gaps are new payment models that measure and reward reductions in disparities, said Joel Weissman, PhD, Deputy Director and Chief Scientific Officer Center for Surgery and Public Health at Brigham and Women’s Hospital.  “No information means no improvement,” he said.

But most current pay-for-performance models are not effectively addressing disparities and creating incentives that could reduce them.  “Not only do we need to know more about measures that are “disparities-sensitive”, but how to select measures that are ready to have an impact on clinical practice, and how to represent differences in a statistically meaningful and policy-relevant way,” Weissman said.

Dr. John Moore

John Moore, MD

Patient Empowerment Through Technology

Grassroots approaches to health, including personalized patient engagement and “navigators,” who help patents cut through red tape to get social services are already helping reduce disparities in some areas.

John Moore, M.D., CEO and co-founder of Twine Health, said the new health models must also include the patient as “an active participant.”  The old-fashioned paternalistic doctor-patient relationship is fading away, he said. Patients of the future will set their own health care goals and meet them using technology and peer support.

The approach has already worked, he said, citing his study published in 2013 in the Journal of Clinical Outcomes Management that found hypertension controlled in a group of patients for less than 30 percent of the average annual Medicare cost for the same outcome.

Sonia Sarkar

Sonia Sarkar, MPH

Making Physician Advice Actionable in the Moment

Another effective disparities-reducing program has been Boston-based Health Leads, which connects patients to advisors who will coordinate the nitty-gritty details of social services and enter the information on a patient’s EMR for physicians to track and follow-up, said Sonia Sarkar, the company’s chief of staff to the CEO.

The program has partnered with major medical centers in Boston, Providence, Baltimore, Chicago, New York and Washington D.C. and helps them close disparity gaps for patients without resources to get or remain healthy. Connecting patients at risk of disparities to needed food, heat, child care, transportation or other services makes “the doctor’s advice actionable in the moment,” Sarkar said.  “It insures health care delivery is centered around health.”

See the full forum agenda and download the presentations here.

–Erica Noonan

The President’s Podium: Physician, Inc.

Posted in Health Policy, Health Reform, Leadership, Payment Reform, Regulation on March 18th, 2014 by MMS Communications – Comments Off on The President’s Podium: Physician, Inc.

By Ronald Dunlap, M.D., President, Massachusetts Medical Society

In my first post on this site last August, I called attention to a survey of DSC_0003 Dunlap 4x6 color 300 ppi_editednearly 3,500 physicians that found that 60 percent of physicians would not recommend their profession as a career.

I suggested that the finding was not surprising, as the high level of discontent within our profession is due mostly to the growing business and administrative requirements of medicine that we must meet and maintain. As we began our medical careers, few of us thought we would become “providers” in the health care “industry.”

The March edition of our member newsletter, Vital Signs, recognizes this reality with the theme of The Business of Being a Physician.  My President’s Message in that issue said “we cannot pretend that we can divorce ourselves from the financial realities battering the health care industry.”  Like it or not, the establishment of business principles in the profession of medicine long ago stopped being a trend; it has been a reality to an increasing extent, and is now widespread.

The business and financial aspects of medicine weigh on all of us. They threaten the viability of many practices and push physicians to make hard choices about their profession and careers.  They intrude into the physician-patient relationship, steal time from engaging our patients, and erode the control we should have over how we practice medicine and how we care for our patients.

The legislative, regulatory, and commercial mandates and requirements continue to increase. Some of these changes are positive; some not so much so. Collectively, however, they present enormous challenges.

At the Federal level, the Affordable Care Act has set regulations on such areas as quality reporting, physician ownership and referrals, medical homes, accountable care organizations and payment practices.  The presence of the Independent Payment Advisory Board, despite its inactivity, still looms, and the explosion of billing codes, known as the ICD-10, is scheduled to take effect later this year.

At the state level, legislative efforts such as Chapter 224 have added more requirements: insurance regulations governing such newly-named entities as “Risk-Bearing Provider Organizations,” proficiency with electronic medical records, and price transparency, just to name a few.  Regulations and requirements from insurers and regulators further add to our administrative load.

We are being inundated with compliance measures and calls for metrics and analytics and other databases, even when many practices are ill-equipped to provide such information given inadequate or nonexistent health information technology systems.

The Medical Society continues to speak out on these issues. In testimony before the Massachusetts Health Policy Commission in February, I pointed out that the rising number of requirements asked of physicians takes time away from patient care, adds to administrative demands, and raises the costs of practicing medicine.  I further said such requirements will drive small to mid-sized practices to merge or align with larger entities that have the ability to meet such requirements and that this could lead to further consolidations and higher costs in the health care market –a phenomenon already well underway in the Commonwealth.

On the national level, rising physician frustration with the direction of medicine is leading more of our colleagues into the political arena. A New York Times report of March 8  noted that “a heightened political awareness and a healthy self-regard that they could do a better job, are drawing a surprising large number [of physicians] to the power of elective office.”

Such political activism by physicians is rare at the state level.  Whether more physicians in national office, while a hopeful sign, will affect change remains to be seen. But it is likely to alter one critical dynamic: bringing added weight to the voice of physicians in the conversation about health care.  That is a key development.

It is imperative that those who propose changes to the practice of medicine recognize and understand how the consequences of those changes – intended and unintended – will affect the practice of medicine.  Who better to tell them than those of us on the front lines of patient care?  We must accept that we’re now part of an “industry” and that the “business of medicine” is here to stay due to cost constraints. It is necessary however, for physicians to have an unmistakable and conspicuous voice in how that business operates.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine.   

Medical Price Transparency Law Rolls Out: Physicians Must Help Patients Estimate Costs

Posted in Health Reform, Payment Reform on January 3rd, 2014 by Erica Noonan – 15 Comments

Massachusetts physicians and hospitals are now required by law to provide cost information for procedures and services to patients who request it.

The new price transparency regulations became effective for physicians and hospitals on January 1, 2014.

Health insurers have been required to provide information on cost estimates for office visits to physicians and specific tests and procedures since October 2013.

Additionally, the provider must give patients any information—such as CPT codes—that their insurer needs to calculate what their out-of-pocket costs will be.

The new requirement is part of an ongoing rollout of Chapter 224, sweeping payment reform legislation passed in August 2012 that seeks to improve health care quality while reducing costs through various strategies, including alternative payment methodologies and increased price transparency.

What Physicians Need to Do •	Provide the patient with the CPT codes for all anticipated services and procedures. Patients will provide those codes to their health plan to obtain the contracted costs for the professional services, facility fees, and out of pocket costs related to the request. Patients should also be given the phone number of the facility’s billing office, which may be able to provide additional information about facility costs. •	Cooperate with health plans’ requests for further information in a timely fashion, to help the health plans make the most accurate estimates possible for your patients.

State officials have said they hope the new rules will transform the health care industry by allowing patients to easily obtain medical cost information and comparison shop for their care.

The law states that if asked by a patient, a health care provider must disclose the allowed amount or charge of the admission, procedure or service, including the amount for any “facility fees” required within two working days. The law defines “allowed amount” as the contractually agreed amount paid by a carrier to a health care provider.

The law also compels providers who participate in networks to provide “sufficient” information about the proposed procedure or service to allow a patient to use the network’s toll-free telephone number and website established to disclose costs.

According to guidelines to carriers issued in mid-December by the Division of Insurance, insurers are expected to communicate with providers, after securing patient permission, to obtain enough information to determine price information and cost data.

“It is anticipated that providers will cooperate with carrier requests to provide such information to consumers and carriers should endeavor to give providers a reasonable time within which to provide the information,” the memo said.

The Massachusetts Office of Consumer Affairs and Business Regulations has compiled a directory of websites and phone numbers at the health plans to help consumers  get the precise estimates of the total of a specific service or procedure, including out of pocket costs.

The MMS has developed a sample information form that physicians and practice staff can fill and give to patients, which can then be given to insurers.

Although the new law has dramatic implications, many consumers seem so far unaware of their new rights to cost information.

Blue Cross Blue Shield of Massachusetts has been averaging less than three a day, according to Bill Gerlach, director of member decision support. Physicians may experience a similar trickle of requests, but as the law becomes better known among patients and more of them move to high deductible plans, that may change, say some observers.

Many physicians are also just learning about the new requirement and wonder how it will work on a day-to-day practice level.

Partners In Internal Medicine’s George Abraham, M.D., worries that patients will get so frustrated by the multiple phone calls they’ll have to make to gather the various cost components that they’ll just give up.

“On paper it looks great. We’ve increased transparency, but in reality it’s mired in red tape,” said Dr. Abraham. “It could take days for patients to get all the information they need. It’s not user-friendly.”

Atrius Health said it hopes its providers—and patients—will have a fairly easy time getting health care cost information. It has implemented a software program that gives providers easy access to not only their own charges, but also information from the insurance company about patients’ out-of-pocket costs.

“It provides a one-page report for patients that tells them how much we typically get reimbursed by the plan and what the deductible and co-pay would be—and where they are in their deductible—based on the insurance product,“ said Chief Medical Officer Richard Lopez, M.D.

There are a few caveats, to the Atrius system, however. It is populated with insurance data from only the state’s largest insurers and, as with other practices, lacks cost information for providers outside the Atrius organization. He conceded that most physician practices do not have the resources to implement something similar.

Bruce Leslie, M.D., of Newton Wellesley Orthopedic Associates, said he supports the intent of the new price transparency law, and even sees a potential upside for community practices like his.

“We suspect our costs are less than [those] at the big academic centers so this could be a good marketing opportunity for us,” said Dr. Leslie.

Vicki Ritterband, Vital Signs Staff Writer

Why Does Massachusetts Health Care Cost So Much? Here’s What the Health Policy Commission Thinks

Posted in Health Policy, Health Reform on December 20th, 2013 by MMS – 1 Comment

It was no surprise when the Health Policy Commission reported this week that Massachusetts health care spending is much higher than the national average.

But physicians, health care leaders and others should take note of what commission believes are the causes of our high costs. Just as in medicine, diagnosis informs treatment.

Without commentary or endorsement, and as concisely as we can, here’s a summary of what the commission said in its preliminary report

  • Massachusetts is No. 1 in the country for personal health care expenditures:
    • Massachusetts: $9,278 per person
    • U.S.: $6,815
    • That’s a difference of 36%
    • If you adjust the data for our older population, broad access to care, and higher overhead costs (wages, rent, supplies, etc.) the difference is still 20%.
  • For private health insurance patients:
    • Hospital spending is 42% higher than the U.S. average
    • Long term care spending is 31% higher
    • Professional services spending is 24% higher (physician, clinical, dental and other services)
    • Spending on drugs and medical durables is about equal
  • For Medicare patients, spending is 9% higher than the U.S. average
    • Hospital care spending is 90% higher than the U.S. average
    • Long term care spending is 53% higher
    • Professional services spending is 35% lower
  • For Medicaid patients, spending is 21% higher than the U.S. average
    • Factors explaining the difference include the health status of enrollees, breadth of benefits, and higher reimbursement rates than the national average
    • Hospital care spending is 31% higher than the U.S. average
    • Long term care spending is 73% higher
    • Professional services spending is 5% higher
  • Why do we spend more? Higher utilization and higher unit prices
  • Hospital utilization
    • Inpatient admissions: 10% higher
    • Average length of stay: 7% lower
  • Outpatient  utilization
    • Patient visits, excluding emergencies: 72% higher
    • Outpatient surgeries: 27% higher
  • Why are prices higher? Higher fee schedules, and more care is delivered in higher-priced settings
    • Using claims data, fees paid by commercial payers, Medicare and Medicaid are higher than the national average
    • Portion of Mass. discharges from major teaching hospitals: 41% 
    • Portion of U.S. discharges from major teaching hospitals: 16%
  • Massachusetts outperforms national average on many quality benchmarks, such as
    • Childhood immunization rate
    • Low birth weight
    • Cholesterol management for patients with CV conditions
    • Controlling high blood pressure
    • Patient safety

Want more of the numbers? Here’s the commission’s preliminary report (pdf, 37 pages).

Its final report is due in January.

The President’s Podium: Mass. Medicine, After Cost Control

Posted in Board of Medicine, Electronic health records, Electronic Medical Records, Global Payments, Health IT, Health Policy, Health Reform, Regulation, Uncategorized on December 9th, 2013 by MMS Communications – 1 Comment

By Ronald Dunlap, M.D., President, Massachusetts Medical Society  

Massachusetts entered its second phase of reform with the 2012 passage of DSC_0003 Dunlap 4x6 color 300 ppi_editedChapter 224, cost control legislation officially titled “An Act Improving the Quality of Health Care and Reducing Costs Through Increased Transparency, Efficiency and Innovation.”

While the first phase, Chapter 54 passed in 2006, was indeed landmark legislation and served as the model for the Affordable Care Act, Chapter 224 alters the state’s health care industry perhaps like no other law.

The changes this law brings are vast, from payment reform to giving the Attorney General new powers in the health care marketplace. Although 224 does include some benefits for physicians (medical malpractice reform for one), other provisions pose significant challenges, particularly for physicians in small practices. Here are two that raise concern.

Health Information Technology (HIT) One of the biggest challenges presented by Chapter 224 is its embrace of health information technology. Physicians will be required – as a condition of licensure – to demonstrate proficiency in all aspects of health information technology by January 1, 2015.

While MMS supports HIT and recognizes its intent to improve patient care, this provision of the law could severely disrupt medical care. Because the statutory language creating the requirement is tied to Federal standards of “meaningful use” (which in turn is tied to participation in Medicare and Medicaid), it raises concerns that strict interpretation of this provision would lead to denial of license renewals for some 26,000 physicians.  Our state has a high certification rate for meaningful use, with more than 14,000 physicians having met stage 1 requirements, but nearly 40,000 physicians have a Massachusetts license, and most are not included in the population targeted for meaningful use certification.

Additionally, the costs of establishing HIT can be huge. The outlay for such items as implementation, maintenance, software and hardware upgrades, conversion to Federal ICD-10 codes, training, and data conversion could approach well over half a million dollars for some practices while not including the “opportunity loss of income” from decreased productivity.  While the law allows for assistance to providers for HIT, the level of help is unknown, and the financial burden can be crippling to small practices.

The law further requires all providers to implement fully interoperable electronic health records that connect to the statewide health information exchange by January 1, 2017 (a goal not in sight) and imposes penalties for noncompliance. These technologies are not only critical for physicians to practice medicine, but also to participate in quality measurement programs.  The specter of this kind of commitment to HIT, however, with its financial outlay, is certain to make physicians pause and think, especially those close to retirement.

MMS has had lengthy discussions with the Board of Registration in Medicine (responsible for implementing the HIT requirement) and has testified in support of legislation to delay this requirement and provide relief to physicians. Our voice has been heard, and we are hopeful such relief will be forthcoming.

Data Collection and Reporting Chapter 224 is equally enthusiastic about data collection and reporting.  It creates a “provider organization registration program,” requiring organizations to provide detailed information about their operations: costs, financial performance, utilization, total medical expenses, and patient referral practices, among other information.  This data is hard to extract from many EMR systems.

This information will be collected by the Center for Health Information and Analysis (CHIA), a new independent state agency created by 224 that takes over most of the responsibilities of the Division of Health Care Finance and Policy, which was abolished by the law. Physician groups are now required – for the first time – to submit such data. The law contains language focusing on the reporting on risk-bearing groups while exempting smaller groups, but the applicability of this language has not been fully tested yet, so it isn’t clear how reporting requirements will be enforced and upon whom.

On a promising note, CHIA Executive Director Aron Boros told our House of Delegates at the Interim Meeting on December 6 that CHIA’s goal is to gather “reliable and meaningful” information through an “engaged transparent operation.”  He believes his agency must be “transparent, open, and collaborative” to build credibility.

The law also stipulates that by January 1, providers must disclose to patients within two working days of their request, how much a proposed procedure or service costs and what the health plan offers as payment.

I am not optimistic that physicians will be prepared within a month’s time to inform patients about specific or estimated costs for all procedures. We are encouraging legislators and the Health Policy Commission to implement the law incrementally, by considering the most expensive procedures first.

HIT and data collection/reporting requirements are but two areas that Chapter 224 dramatically changes. These changes, coupled with constant concerns over Medicare reimbursements as well as added requirements such as those imposed by ICD-10 codes, continue to strain physician practices.

What policymakers and regulators must keep in mind is that, even in a highly sophisticated medical environment like Massachusetts, no less than 64 percent of our physicians are in practices with fewer than 25 physicians. Policies and regulations that burden these practices and reduce their viability will not only affect the quality of care but will also reduce health care access for Massachusetts residents.

The President’s Podium appears regularly on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine. For a section by section analysis of Chapter 224, click here.  


Interim Meeting Ethics Forum: Ethics in ACOs

Posted in Accountable Care Organizations, Ethics Forum, Global Payments, Health Policy, Health Reform, Interim Meeting 2013, Payment Reform on December 6th, 2013 by MMS Communications – 2 Comments
Susan Dorr Goold, MD

Susan Dorr Goold, MD

The accountable care organization (ACO), loosely defined as a group of providers that accepts responsibility for the total care of a patient and is accountable for high quality care and the cost of care, is a rapidly growing concept whose aim is to reduce the rising costs of care and improve quality.

While the emphasis on ACOs has focused on cost and outcomes, less attention has been paid to the ethical considerations of delivering care within such a structure.  As the ACO continues to evolve, what are the ethical issues that physicians might face as they practice medicine?  Do healthcare institutions, as well as individual providers, face ethical issues as organizations? And how might ethical considerations influence payment structures?

These are some of the issues discussed at the Ethics Forum, held on the first day of the 2013 MMS Interim Meeting of the House of Delegates.

Presenting were Susan Dorr Goold, MD, professor at the University of Michigan and Chair of the American Medical Association’s Council on Ethical and Judicial Affairs, and Philip F. Gaziano, MD, chairman and CEO of Accountable Care Associates, a Springfield-Mass. based healthcare management company.

In two presentations over two hours, delegates heard perspectives on the practical and ethical challenges in making a transition to an ACO, who providers are accountable to and for what within an ACO while maintaining their first loyalty to the patient, conflicts of interest that may arise, and ways to protect patient autonomy while practicing in an ACO.

Some highlights from the presenters:

Dr. Goold, in a presentation entitled Strengthening Patient-Physician Trust in Accountable Care Organization, examined the elements of personal and organizational accountability that lead to strong physician-patient relationships.  Professionals, organizations and patients all have a responsibility in strengthening trust, she said: professionals with a duty to “seek trust from patients” based on openness and honesty, patients by being truthful and to trust wisely, and organizations as “moral characters” in modern society.

Dr. Gould also outlined the challenges to trust in physicians (patient expectations, requests, and demands) and health care institutions such as hospitals and payers (safety of personal information, treatment decisions, fair and prudent use of resources). She concluded with the notion that physicians and healthcare institutions have “moral responsibilities in health care” to include advocacy, competence, fairness, and honesty, among others.

Dr. Gaziano’s Ethical Considerations in Accountable Care Organizations focused on the payment considerations with ACOs, comparing fee-for-service to global payments (payments based on Relative Value Units) to Quality Value Units, a new designation created by his firm that provides the advantages of tracking and reporting in real time, predictive value, and the tracking of quality and budgets. He also addressed physician concerns: why ACOs are different from earlier cost-saving attempts like HMOs and opportunities within the new system of ACOs such as payments and managing budgets.

The presentations of both physicians are available on the MMS website here.


2013 MMS Oration: Engage Patients to Transform Health Care

Posted in Health Reform, Interim Meeting 2013, MMS Oration on December 6th, 2013 by Erica Noonan – Comments Off on 2013 MMS Oration: Engage Patients to Transform Health Care

Moving from a provider-centric delivery system to one that engages and activates patients is key to transforming health care in the United States, said David L. Longworth, M.D.

The transition to a new paradigm of care requires many changes in practice — from working in more collaborative physician-led teams to better use of predictive analytic data by physicians to guide care decisions, said Dr. Longworth, Associate Chief of Staff for Clinical Integration Development at the Cleveland Clinic.

But the most crucial  step left for physicians is to better motive patients to stay as healthy as possible, he said.

“We have a unique opportunity as a physicians to fix what has been broken for so many years,” he said. “Patients are (now) partners with us. No longer are we delivering care to passive individuals.”

Dr. Longworth delivered the Massachusetts Medical Society’s Annual Oration, “The Imperative of Patient Engagement in the Era of Healthcare Reform and Practice Transformation”  at the organization’s 2013 Interim Meeting on Dec. 6.

The Oration is a Society tradition dating back more than 200 years, and features a physician-leader speaking on an issue pertinent to current medical practice.

Dr. Longworth said that engaged and activated patients are more likely to accrue fewer health care costs, experience fewer hospitalizations, emergency room visits and hospital readmission.

These better outcomes are quality measures that physicians can’t ignore under new value-based compensation systems, he said.

Not only must physicians engage their patients  more effectively, they must also improve their interpersonal and coaching skills.  Patients who rated their physicians as more empathetic, had better health outcomes in managing chronic disease, Dr. Longworth said.

— Erica Noonan

2013 MMS Interim Meeting Opens With Call to Protect Smaller Practices

Posted in Health Reform, Interim Meeting 2013, Payment Reform on December 6th, 2013 by Erica Noonan – 1 Comment

Massachusetts Medical Society President Ronald Dunlap, M.D. opened the 2013 Interim Meeting with a call for the organization to support small and mid-sized physician practices during an unprecedented push towards clinical and financial alignment statewide.

“I believe that if a physician or a practice wants to maintain a meaningful degree of professional autonomy, they should be able to do so. Becoming employed by a large system is not for everyone,”  said Dr. Dunlap in his President’s Report to the MMS House of Delegates. “In fact, it is not even necessary.”

Oversight may be needed to ensure that hospitals continue to maintain relationships with affiliated, as well as  employed physicians, and do not attempt to use their market power to dictate terms to independent physician groups, Dr. Dunlap said.

The MMS  plans to continue its outreach on clinical integration challenges facing physicians this into the coming year, Dr. Dunlap said.  The Society’s Physicans Guide to ACOs, created earlier this year, has become one of the most popular documents ever posted on the MMS website.

“We will work hard on the advocacy front to ensure that the rules of the game give everyone the opportunity to be successful — to ensure that we’re not all stuffed into a single model that cannot possible work for everyone,” said Dr. Dunlap.

More than 150 physician HOD representatives traveled from around the state to Waltham on Dec. 6 for the two-day Interim Meeting. They will vote on a number of  formal resolutions, and craft MMS policy for the coming year.

The Delegates also welcomed Aron Boros, Executive Director of the Center for Health Information and Analysis, a state agency created to collect and distribute meaningful health care cost data under Chapter 224, the payment  reform law of 2012.

“The chief health care complaint in Massachusetts truly is affordability,” Boros said.  The cost of health care in Massachusetts is  well above the national average because of  a complex delivery system that withholds information about price and cost from patients and physicians, he said.

The lack of accurate and meaningful data on outcomes and provider quality means the health care system is too often treated like an “all-you-can-eat buffet.”

Beginning in 2015, Boros said, CHIA and the state’s Health Policy Commission will become directly involved with health plans and providers whose health care costs grow faster than the state’s economic growth rate of 3.6 percent annually.

– Erica Noonan