Mass. Legislature

Massachusetts Governor Candidates Discuss Health Care: Charlie Baker

Posted in Health Policy, Health Reform, Malpractice, Mass. Governor Campaign, Mass. Legislature, Payment Reform on September 27th, 2010 by MMS – 1 Comment

Charlie Baker, running for governor of Massachusetts, discusses his views on health care for the Massachusetts Medical Society. See other candidates’ videos, as they become available, at

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

From An Emotional Session, A Health Care Bill

Posted in Health Policy, Mass. Legislature on August 2nd, 2010 by MMS – Comments Off on From An Emotional Session, A Health Care Bill

state house 2Amid the frenzy and emotion over casinos, slot machines and other issues, the Massachusetts Legislature last weekend passed a 63-page health care bill (.pdf) that in part addresses small business health care costs.

But it was much more limited than an earlier House bill, which would have imposed an untested, complex and controversial system to control health care costs.

Rate control was addressed in the way lawmakers often deal with difficult issues – it was sent to a new study commission, of which the MMS will be a member. Its charge is to recommend policies “aimed at enhancing competition, fairness and cost effectiveness … through the reduction of reimbursement disparities.”

The concerns of small businesses were addressed in several ways.

The most significant is a provision that allows insurers to sell lower-cost products that either limit provider networks, or charge higher patient co-pays that are determined by tiered provider networks. These limited networks are available only to individuals or small businesses.

The premiums in these limited networks must be at least 12 percent lower than a comparable plan offered to the general population. The expenses of the plan may be reduced by (but not limited to) excluding providers who report lower quality measures or higher costs, and/or by increasing co-pays based on physician tiering. It’s reasonable to assume these networks may also reduce reimbursements to participating providers, because this is not prohibited.

But it’s very important to note that providers cannot be forced to participate in one of these limited networks, and providers cannot force insurers to include them.

Costs are addressed by giving the state insurance commissioner broad rights to reject rates that are deemed “excessive, inadequate or unreasonable.” Under certain conditions, the rates may also be “presumptively denied,” with insurers given the right to appeal.

There is also a very limited instance in which some mandated benefits can be excluded.

Of course, we have very grave concerns about any insurance plan that uses cost and quality data to place physicians into tiers.  In our lawsuit against the Group Insurance Commission and two health plans, we charge that their tiering program is grossly inaccurate and misleading to patients, as well as damaging and defamatory to physicians. That lawsuit is still pending in state court.

Further, the RAND Corporation just released a series of studies showing persuasively that the typical tiering program misclassifies physicians at alarmingly high rates and are “not ready for prime time,” such as for determining co-payment levels, limiting networks, or any other “high-stakes” purpose.

Also in the health care bill:

  • Small businesses are given the right to form association health plans and small-business group purchasing cooperatives.
  • Insurers, hospitals and physicians must comply with a host of new reporting requirements. Physicians, for example, are required to track and report quality data to the state annually. This is a new provision that we will study more closely, to determine its burden on small practices.
  • We’re pleased to see that the legislation set up a process to reduce physicians’ administrative hassles and costs. The bill requires:
    • Uniform standards for health plan credentialing of physicians
    • Uniform standards for determining patients’ eligibility in a health plan
    • Standardized provider appeals
    • Standardized prior authorization forms
    • A study of the feasibility of a standardized claims administration system
  • The state must establish a wellness program with incentives for its employees. The Commonwealth Connector must also establish one for its health plans.
  • It requires the state to create a pilot bundled payments program, covering at least two separate acute conditions or procedures. Some experts believe that bundling payments to hospitals and physicians would reduce waste in health spending.
  • There’s a new revolving loan fund for community hospitals and community health centers, but it doesn’t guarantee any initial seed funding.
  • In addition to the rate control commission, the bill creates several new study commissions. We have a seat on several of them. Their topics include:
    • Preventing falls by older adults
    • The development of uniform quality measures
    • The capital needs of community hospitals
    • The impact of patient “out-migration” from community hospitals, including when new facilities open in the primary service areas of community hospitals

“Grave Concerns” About House Health Care Bill

Posted in Health Policy, Mass. Legislature, Payment Reform on July 21st, 2010 by MMS – 1 Comment

state house right railThe Massachusetts House today unveiled its long-awaited health care cost containment bill, and it’s much more aggressive and sweeping in its scope than the bill the Senate passed several weeks ago.

Its central piece is a proposal to control insurer and provider rates. Here’s a section-by-section summary.

Here’s the statement by MMS President Alice A. Tolbert Coombs, M.D:

“We have grave concerns that the complexity of this bill, coupled with the short time left on the legislative calendar, fail to provide enough time for thoughtful analysis of the impact on the provider community, its ramifications on our patients’ access to care, and its effect on the economy of the Commonwealth.

“The legislation could also produce unintended consequences. For example, it could become more difficult to recruit and retain physicians and worsen already troubling physician workforce issues.

“We must also be careful that this legislation does not unnecessarily complicate our long-term efforts to improve health care. It’s important to be efficient, but we can’t starve the system of the resources that are absolutely necessary to invest in a sustainable, high-quality health care system.”