Massachusetts Medical Society Officers Testify on Payment
Reform
Physicians urge pilot projects for a careful, deliberate, and
thoughtful approach
October 8,
2009
Contact: Richard P. Gulla
rgulla@mms.org
(781) 434-7101
pager: (877) 820-9023
Waltham/Boston -- October 8, 2009 -- The President and
President-Elect of the Massachusetts Medical Society today testified
before the legislature’s Joint Committee on Health Care Financing
on the state’s proposed payment reform plan, saying that while
studying new ways to pay physicians and hospitals is worth pursuing to
control soaring costs, any such plan “has to be approached
carefully and deliberately.”
Mario Motta, M.D., President of the 22,000-member
statewide physicians association, said that “the kind of
transformation envisioned here has never been done anywhere in this
country on a system-wide basis. For that reason, there are many things
we don’t know about what could happen when you try to expand its
scope and application.”
Because of these unknowns, Dr. Motta said the physicians are very
strong advocates for establishing pilot projects for these innovations.
“We need to uncover the unintended consequences, learn from
mistakes, and adjust, before it’s rolled out to larger sectors of
our population,” he told the legislators.
Dr. Motta further said that today few physicians right now could make
a successful transition to a new payment model today, and that five
years probably won’t be enough time for the transition to be
accomplished. “We understand the urgency of the cost issue,”
he said, “but if we move too fast, many physicians won’t be
able to keep their practices open, and shortages that we are
experiencing in many specialties – including primary care –
will only get worse.”
He also suggested that a wider focus is necessary to resolve health
care problems in the state. “We cannot focus on payment reform as
the only answer,” Dr. Motta said. “We need to address
patient education, wellness and prevention incentives, defensive
medicine, administrative waste, and the over-concentration of our health
insurance industry.”
In closing comments, Dr. Motta said “physicians are committed
to working with you on these issues. We bring to the table energy,
creativity, and most of all, the direct experience of caring for
patients. We’re ready to work with you on creating something that
works for every stakeholder in health care.”
Dr. Alice Coombs, President-Elect of the
Massachusetts Medical Society and the only physician member of the
state’s payment reform commission, in complementing Dr.
Motta’s testimony, said that the health care system in
Massachusetts is too diverse to impose a single solution on everyone and
that the differences in specialties, physician practices across the
state, economic conditions, and even patients must be considered.
“Our physicians are telling us that one size does not fit
all,” she said.
Dr. Coombs also said that any new payment model must address several
issues, among them improving the status of primary care and providing
assistance and support to make any transition to a new payment model
easier such as with the establishment of electronic medical records. She
also said any new model must consider waste in the administrative
aspects of health care and the widespread costly and wasteful practice
of defensive medicine – two areas that could yield substantial
savings.
The most frequent comment from physicians, said Dr. Coombs, was that
the proposed new global payment system is a return to capitation, a
previous payment model that didn’t work for many
physicians.
Dr. Coombs said “the commission didn’t have the time or
resources to get into all of these concerns, but I believe the
Legislature has the opportunity and the duty to be more thoughtful and
comprehensive” to a new payment model.
She suggested that a good starting place for the Legislature would be
pilot projects on episodes-of-care – a model where payments are
bundled around a patient’s diagnosis, rather than allocated for
every single action. “This approach encourages the right
care,” she said, “while acknowledging that every diagnosis
is different.”
Dr. Coombs closed her testimony with an urgent plea that practicing
physicians be named to the oversight authority for payment reform, with
full voting rights and full power to make policy. “One thing we
learned at the commission,” she said, “is that voice of the
practicing physician is absolutely essential to developing a system that
will work. At the end of the day, physicians will be the ones expected
to work with a new system. It only makes sense that we help design it,
too.”
Additional Resources
The Massachusetts Medical Society, with some 22,000 physicians
and student members, is dedicated to educating and advocating for the
patients and physicians of Massachusetts. The Society publishes the New
England Journal of Medicine, a leading global medical journal and web
site, and Journal Watch alerts and newsletters covering 13 specialties.
The Society is also a leader in continuing medical education for health
care professionals throughout Massachusetts, conducting a variety of
medical education programs for physicians and health care professionals.
Founded in 1781, MMS is the oldest continuously operating medical
society in the country. For more information please visit www.massmed.org, www.nejm.org, or www.jwatch.org.
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