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Payment Reform
In July 2009, a special state commission issued a report recommending
that the payment system for compensating health care providers in
Massachusetts gradually evolve from the predominant fee-for-service
model to a global payments system.
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Overview and Background
Payment Reform Commission Resources
MMS Resources
MMS Stance
- Any efforts to introduce a new payment model must be
undertaken deliberately and carefully, to guard
against the risk of negative unintended consequences.
- One single payment model will not be successful in all types of
practice settings. One size will not fit all. Many
physician groups will have a great deal of difficulty making a
transtion, due to their geographic location, patient mix, specialty,
technical and organizational readiness, and other factors.
- While a global payment model could encourage collaboration among
providers, care coordination and a more holistic approach to a patient's
care, fee for service payments will likely be a subset of any global
payment system. Fee for service can have a positive value in the
payment for medical services.
- The incentives to transition to a new model must be
predominantly positive.
- Planning must be flexible, and accommodations must
be made to take into account the highly variable readiness of practices
to move to a new system.
- Physicians need assistance with the tools and expertise to succeed
in any new payment model. They will need the financial expertise to
manage risk, if the proposed new model requires risk-sharing and
gain-sharing. They will need technology support to invest in, install
and operate today’s and tomorrow’s information technology
tools.
- Funding must be adequate, and reimbursements must
be risk-adjusted for severity, socioeconomic status, and other risk
factors known to affect the outcome of care.
- Liability reform is essential to a successful
transition.
- Anti-trust relief: A new kind of integration among
physicians may be required to achieve the objectives of a new payment
model. To accomplish this, the legal barriers to such integration must
be removed.
- Administrative simplification is essential. Health
care is replete with administrative requirements that add little value,
which drains funds from the active delivery of care to patients.
- Quality measures: Measures must be uniform across
all payers, public and private.
- The alignment of patients, through education and
outreach, is critical to the success of any new payment model.
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