Annual Letter from MMS President James Gessner, MD, to Society Members

Members of the Massachusetts Medical Society,


As the year draws to a close and I near the halfway point of my year as president of the Medical Society, I’d like to take a few moments to provide you with my thoughts looking forward.

At the recent 2016 House of Delegates Interim Meeting, I presented a scrapbook to my predecessor, Dr. Dennis Dimitri. In reviewing the extensive media coverage, correspondence, and events that represented his tenure, I realized just how much can happen in one year. That’s why I think it’s important to keep in touch with you all.

Without question, 2017 is going to usher in some dramatic change, both across the country and here in the Commonwealth. In January, a new Administration will mean completely different oversight at the U.S. Department of Health and Human Services, as well as its payment arm, the U.S. Centers for Medicare and Medicaid Services (CMS). And we – along with the rest of the medical community – are learning what this new oversight will look like.

I’ve long urged the membership of MMS to engage in advocacy, and now is the right time to do so. This will be especially important in the coming months, as the Affordable Care Act (ACA) will surely be the target of serious scrutiny. We are a leading voice for physicians and for the patients we serve, so we must remain committed to supporting comprehensive insurance coverage and access to health care for all our patients.  Our support for the ACA as well as our own state health care law is unwavering, and looking forward, we have an important role to play in ensuring that any improvements to the law are patient-focused.  At the same time, I anticipate that we will find common ground with the new Administration on issues that directly impact the practice of medicine, including support for graduate medical education, the implementation of MACRA (more on this later!), and true interoperability for electronic health records.

As always, in addition to the new Administration, we will continue our work on behalf of our patients and our honorable profession with our Massachusetts Congressional Delegation, national and state medical societies, and patient advocacy organizations.  As physicians, we cannot stand by and let others make decisions that impact our patients. We must continue to make ourselves heard, and I encourage MMS members who are concerned about the future to engage even more directly with the Medical Society.

Of course, CMS is going to play a large role in many of our lives in the coming years as we move forward with implementation of the Medicare Access and CHIP Reauthorization ACT of 2015, or MACRA. We know that a lot of doctors in the Bay State are worried about what MACRA means to them, but we can’t stress enough to you all that this new payment model is a dramatic improvement over the Sustainable Growth Rate (SGR) formula, which was imposing double digit annual cuts on payment rates.

When CMS released the proposed rule on MACRA earlier in the year, we at the Medical Society shared your reservations. We provided extensive feedback to the government regulators, and we worked closely with our counterparts at other societies, including the American Medical Association. We invited CMS Acting Administrator Andy Slavitt to meet with a primary care physician and his staff in their medical office, allowing him to see up close what meaningful use regulations really meant to a small practice here in Massachusetts. In the end, our efforts paid off. The final rule, released in October, provides more flexibility, more time for implementation, fewer reporting burdens, and more options than the earlier rule had laid out.

We now have a two-track system that maintains a fee-for-service option while laying the groundwork for quality-related bonuses. Most importantly, we have a transition period that will allow you to make the choice that is best for your practice. We will continue to provide you with educational materials in the coming months, but for now, you may be interested to look over the presentation from our Interim Meeting, which very clearly explains the future of reimbursement under the MACRA final rule.

A new Administration and a new payment system: there are a lot of goings-on at the federal level!

But let’s not forget that here in Massachusetts, we are also working hard to ensure that the voice of the physician and the patient are heard in public health debates.

As you all know, Election Day 2016 saw the passage of ballot Question 4, which legalized recreational marijuana in the Commonwealth. The Massachusetts Medical Society opposed this initiative from a public health standpoint. However, with the passage of the law comes a responsibility: that we work with state policymakers and regulators to ensure that implementation of legal recreational marijuana in Massachusetts reflects policies to protect the public health.

The day after Election Day, we announced our intent to be collaborative. Then, at our Interim Meeting on December 3, delegates adopted a resolution that the MMS support policies that would:

  • Prevent youth access to marijuana, including restrictions on marketing and advertising to those under 21 years;
  • Direct the state to conduct and publish research on the clinical and public health effects of recreational marijuana;
  • Prevent impaired driving due to recreational use of marijuana;
  • Promote education about the health effects of recreational marijuana;
  • Set safety and quality standards for both recreational and medical marijuana; and
  • Direct adequate funding for health and public health interventions related to marijuana.

The resolution also instructs the MMS to create an evidence-based resource tool to help physicians respond to patients with questions about marijuana, and to work with the Massachusetts Association of Health Boards and other stakeholders to develop model regulations for cities and towns to use as they determine their approaches to commercial and recreational marijuana. In the meantime, we’ve released a brochure about marijuana’s impact on pregnancy, fertility and breastfeeding, available here.

Hosting the Interim Meeting in December is an important way for us to evaluate what matters most to MMS members, and to use that information as we chart our paths forward into each new year. This year’s Interim Meeting was no exception. With resolutions focused on mitigating climate change, addressing the high cost of drugs, affirming the rights of all patients to receive equal care in the face of discrimination, and supporting medical students who are Deferred Action for Childhood Arrivals recipients to continue their training, we see that MMS members are more than physicians: you are dedicated members of your communities.

That’s why we will also be taking a stand regarding sports-related concussions and advocating for schools to maintain a supply of EpiPens. We also recognize that at both the state and national level, there has been increased discussion about the question of terminally ill patients being prescribed medicines to allow them to end their lives. MMS policy currently opposes this particular form of aid in dying. At our recent House meeting, the delegates supported conducting a MMS survey of our members’ current views on this issue.

I would be remiss if I failed to discuss the opioid epidemic, which continues to disproportionately impact our state. Since the early days of this crisis, we have worked hard to establish that physicians – once seen as part of the problem – are an important part of the solution. Recent data have shown that since the relaunch of MassPAT, the prescription drug monitoring program, daily searches of the system have quadrupled. By attacking the crisis on both ends – working to reduce dependence and helping to promote access to treatment for those who are dependent – we can make a real difference in the lives of people across the state.

One parting thought: according to the MMS mission, we are directed to work for the “health, benefit and welfare” of the people of Massachusetts. To that end, we are continuing to develop an understanding of the role that social determinants of health play in the lives of our patients. We will continue to be a voice for our patients as we work to educate the state authorities about how addressing social determinants can lead to healthier, and happier, lives.

We are proud to help support each of you and your patients today and in the days that come.

Happy New Year,

James S. Gessner, MD
President, Massachusetts Medical Society



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