Massachusetts Medical Society physicians joined several health
care providers Thursday in urging the State Legislature to move
carefully in adopting a new payment model for physicians and
hospitals.
MMS President Mario Motta, MD, said, "If we move too quickly and
rattle the tree too abruptly, you're going to have physicians fall
out of their practice like leaves on a tree." His comments came
during a three-hour hearing held in a packed committee room in the
basement of the State House.
Motta said that while some physicians work under a global
payment system, it's never been tried before on a system-wide
basis. "There are many unknowns and unpredictable effects that
could happen," he said. "For that reason, we are strong advocates
for establishing pilot projects for these innovations."
But, Motta noted, "Coordinated care is better than fragmented
care. We want to support innovations that move us in that
direction. It's better for the patient, and it's better for our
health care system."
MMS President-Elect Alice Coombs, MD, was a member of the
commission that studied alternative payment models in the state.
She said, "A new payment model is worth looking into if, and only
if, there is adequate time, support and preparation for physicians
making this enormous transformation."
Coombs told the committee about the concerns she's heard from
physicians statewide about global payments. "Most of all,
physicians have been saying, We've tried this before. It was called
capitation, and it didn't work."
She said physicians ask how they will be protected against undue
financial risk, whether physicians will get adequate resources to
provide the right care, and whether patients will trust a global
payment system. She said the Legislature must address these and
other issues before implementing a new payment model.
Coombs also added an "urgent plea" for naming practicing
physicians to any oversight authority for payment reform. "One
thing we learned at the commission," she said, "is that the voice
of the practicing physician is absolutely essential to developing a
system that will work."
Most other health care providers testifying also urged a
careful, deliberate implementation, including representatives of
family physicians, Cambridge Health Alliance, and the Massachusetts
Hospital Association.
Others disagreed. The outgoing secretary of Administration and
Finance for the state, Leslie Kirwan, said, "Standing still or
inching forward is in fact falling back." Marylou Buyse, MD,
president of the Massachusetts Association of Health Plans, said,
"We don't have the luxury of five years."
Dolores Mitchell, executive director of the state agency that
purchases insurance for state employees, said payment reform "may
be our last best hope" for controlling health care costs.
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