Massachusetts Medical Society | Tiering and Pay for Performance

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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

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

Appealing Your GIC Tier Designation: What Physicians Can Do
(January 06, 2012)
Suggestions on how physicians can appeal their 2010-11 GIC tier designations.

An Update on the MMS Lawsuit Against the Group Insurance Commission
(September 22, 2011)
The MMS announces that it has ended its lawsuit against the GIC and its tiering program, following a ruling that removed the GIC as a defendant in the case.

MMS Testimony In Support of H 681 An Act Regulating Appeals Under the Group Insurance Commission
(June 07, 2011)
The Massachusetts Medical Society is in support of H 681 because it seeks to protects patients’ rights to appropriate coverage of medically necessary treatments and simplifies the administrative process for physicians in their advocacy for their patients.