1. Physician Registration - concern over size of physician group required to register and oversight entity
Rationale: Both pieces of legislation seek to require registration of physician groups that take risk citing concerns around practice failures, lack of reinsurance etc. There have been various proposals around the number of physician in a contracting unity that should be exempt from registration. The House has 25 and the Senate has 5. The MMS has repeatedly argued that the number needs to be larger.
House Section 67 Senate Section 14
2. Physician Cost/Data Reporting- onerous physician reporting cost and charge information to the state and to patients
Rationale: While the MMS supports increased transparency on behalf of the insurers, increased reporting of cost information to the state will be burdensome for physician's office staff. Moreover, there are concerns over validity of the information, liability over misinformation, and the practicalities of physicians communicating such information at the request of the patient during office visits.
House Sections 105 and 106, Senate Section 14
3. Governance Oversight.
Rationale: The state agency must include Mass Medical Society representation. There must be first hand clinical experience at the table as critical decisions effecting patient care and health care delivery are being made. If they want acceptance there must be trust and an assurance that the insight of the medical community is being included through direct representation, not just in an advisory capacity.
House Section 98 Senate Section 162
4. Importance of Physician Team Leadership and Accountability in all Settings.
Rationale: In settings such as medical homes, limited service clinics and ACO's , physician leadership of a comprehensive integrated care team is essential for quality of care, efficiency and maintenance of patient treatment plans.
House Section 97 Medical Home Definition Senate Section 162 ACO standards
5. Health Care Spending Benchmark is too aggressive
Rationale: Spending Benchmark. COL previously recommended we maintain a number at least GSP with an upward adjustment moving forward of GSP +1. The MMS recommends continuing with the recommendation and oppose a negative number and oppose staying at GSP into the future. We also recommend that the future number be reevaluated after 5 years.
House Section 121 Senate Section 162
6. Expansion of physician profiling information by Medicine Board
Rationale: The MMS is opposed to allowing the Board of Registration in Medicine to include on physician profiles all employment actions for reasons related to competence or character without any system of appeal. Perpetual inclusion of all employment actions for reasons related to competence or character without any system of appeal is unfair to physicians and patients.
Senate Section 88A House Section 267
7. Electronic Health Records - requirement for meaningful use as a condition of licensure and interoperability
Rationale: This requirement is premature as the federal definition of meaningful use and timelines for compliance by physicians is changing. The MMS opposes tying compliance to physician licensure, and interoperability may not be an available option for all physician organizations across all medical specialties and geographic regions of the Commonwealth.
House Section 84 Senate 87 Meaningful use; Senate Section 29 Interoperability House Section 124 limited to ACO's/
8. Significant expansion of Determination of Need (DoN) requirements
Rationale: The House bill would expand the scope of DoN requirements for physician owned ambulatory surgery centers, resulting in stifling of physician entrepreneurialship, new technologies and innovative services, and requiring a DoN for transfer of ownership. Also, it does not eliminate the current moratorium on DoN's for freestanding ASC's, thus perpetuating an unlevel playing field for ASC's and hospital outpatient departments under the DoN program.
House Sections 47-54 Senate Section 52
9. Luxury Tax - House bill assesses hospitals, physician organizations and ASC's a 10% luxury tax for services provided at a price that exceeds the median statewide price by 20%.
Rationale: This language comes dangerously close to rate setting, will involve the Commonwealth in the finances of physician's office practices, and will be administratively burdensome in terms of reporting data to determine cost and charges.
House Section 121
10. Expansion of Limited Service Clinic's and promotion of such as a point of access for healthcare services.
Rationale: The scope of services available at limited service clinics is currently defined by DPH regulations. Similar language in the House and Senate bills would expand those services to include the diagnosis, treatment, management and monitoring of acute and chronic diseases. Moreover, the MMS opposes the Senates inclusion of language to promote limited service clinics as a point of entry in the health care system.
Senate Section 60, House Section 240
