Good morning. My name is Dr. Lynda Young. I am a
pediatrician and President of the Mass Medical Society. I am
here today to express the Society's strong support for H.279, "An
Act Relative to the Formation of Accountable Care
Organizations."
Both nationally and statewide Accountable Care Organizations
(ACO's) are being put forth as one way to reduce healthcare costs
and improve delivery. For physicians, ACO's present both
challenges and opportunity, but what we do know is that currently,
there are obstacles to physician's ability to compete in a world of
ACO's and global payments. This bill removes those obstacles
by addressing two important issues - Anti-Trust and expanded
medical peer review.
H.279 would provide an exemption from federal anti-trust laws to
allow physicians to collectively bargain with ACO's and health
insurers. This is important from both a business and a patient care
perspective. Physician groups will need the ability to
negotiate contracts with ACO's to provide patient care. And
equally, if not more important, patients will need health care
providers to be able to legally advocate for quality measures and
control of medical necessity decision making for ACO's to care for
patients effectively.
Under the federal "state action" doctrine, states can make an
affirmative decision to encourage competition by authorizing
collective bargaining by the myriad of independent physicians and
other professionals that are now forbidden to do so. The
doctrine requires that the state take an active role in supervising
the process to assure that the individuals do not engage in
anti-competitive behavior that hurts consumers.
This bill would accomplish the task. It establishes a
state policy to promote competition in the health care marketplace
and gives the Attorney General responsibility for making sure the
process works to the benefit of consumers through a two step
process:
- First, before engaging in any joint negotiation with a carrier,
health care professionals must form an accountable care
organization or obtain the Attorney General's approval to proceed
with the negotiations
- Second, no provider contract terms negotiated outside of an
accountable care organization under this act shall be effective
until the Attorney General approves the terms.
The second part of H.279 addresses the need to extend existing
medical peer review protections to ACO's. Under current law,
the proceedings, reports and records of a medical peer review are
confidential and exempt from discovery, but only in licensed
hospitals, nursing homes and HMO's. H.279 amends this statute
to include medical peer review committee's not solely affiliated
with such health care facilities. The rational for this
change is simple: We need peer review protections for all new
entities, not just the ones in existence 20 years ago.
Lastly, the MMS would like to be recorded in support for S.432,
"An Act Relative to Patient Care Access." This bill proposes
a comprehensive set of medical liability reform provisions,
including requiring expert witnesses in actions against physicians
to be board certified in the same specialty as the defendant
physician; granting the Board of Registration in Medicine authority
to review the testimony of expert witnesses from a clinical
perspective as to the standard of medical care; allowing for
periodic payments of awards over $50,000; eliminating joint and
several liability, and tying prejudgment interest rates to Treasury
Bills rates.
According to an actuarial study conducted for the Massachusetts
Medical Society, adoption of this legislation would be a major step
forward in reining in the increase in the cost of professional
liability insurance that has been facing Massachusetts
physicians.
The Medical Society would appreciate your support for both H.279
and S.432.
