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Tiering and Pay for Performance

The MMS advocates to ensure that tiering, pay for performance programs and other public reports of physician performance are accurate and scientifically valid.

Overview and Background 


Details of the 2010 GIC Tiering Programs, by Health Plan


MMS Stance

  • Programs for monitoring the quality and costs of health care must include:  

  • Accurate and timely data
  • Focus on results that are directly attributable to the physician’s performance 
  • Analyses of data that are appropriate to the questions being addressed and are effectively risk-adjusted  
  • Effective steps to correct data inaccuracies or misinterpretations before data are released to outside parties: i.e., insurers, employers, or the public  
  • Public reports that are easily and accurately interpreted  
  • Incentives aimed at rewarding better physicians or hospitals based on important differences in clinical outcomes or the cost-effectiveness of care


MMS Achievements 

  • The MMS has filed litigation in Suffolk Superior Court, alleging that the state Group Insurance Commission’s “Clinical Performance Improvement Program” is misleading to patients, and inaccurately issues reports on the quality of care provided by individual physicians.



Recent MMS Action and Testimony

MMS Applauds AMA Letter to Health Plans on Physician Tiering

Letter signed by AMA and 47 state medical societies calls on health plans to reevaluate their physician profiling programs and demonstrate that they are accurate, valid and reliable.

AMA News Release: RAND Research on Physician Profiling

AMA Letter: RAND Research on Physician Profiling



Legislative Updates
MMS Legislative Update: MMS Expresses "Grave Concerns" About House Cost Containment Bill Restricted
MMS Legislative Alert: Please Call Senator Brown To Urge Him To Support HR 4213 Restricted
MMS Legislative Update: CMS Starts Processing Medicare Cuts while Senate's Six-Month Reprieve Awaits House Action Restricted

Read more updates...

Recent MMS Testimony
MMS Testimony Concerning Proposed Changes to the Prescription Monitoring Program, 105 CMR 700.000
MMS Testimony Concerning Proposed Regulations of the Board of Registration in Medicine, 243 CMR 2.00, Governing Licensing Provisions and the Practice of Medicine

Read More...

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