The
Massachusetts Medical Society, representing over 25,000 physicians,
physicians-in-training, and medical students, appreciates the opportunity to
provide comment to the Health Policy Commission and the Joint Committee on
Health Care Financing as it deliberates a potential adjustment to the state’s
health care cost benchmark. MMS encourages retainment of the current benchmark
at 3.1%, as it maintains an aggressive goal of intentional cost containment
below even prevailing rates of health care inflation. MMS supports the
continuation of ambitious benchmark goals in the hopes that our state will
continue to provide even higher-value care, and, importantly, that relative
cost savings will be appreciated by all patients in the form of constrained or
reduced out-of-pocket expenditures. We
hope that this coming year will bring yet another report of strong cost
containment efforts: the Medical Society was pleased to see the initial
assessment of total health care expenditures per capita of 1.6% for the
2016-2017 period. Also encouraging to MMS, as detailed below, were the
significant contributions to this strong cost containment metric by the
physician community.
Physicians
Drive Cost Containment
The
Medical Society has watched with great interest how exactly Massachusetts has
achieved many successes in health care spending over the past several years. We
have scrutinized the sub-analyses of the HPC over the past many years to better
understand some drivers that have led to eight straight years of spending under
the U.S. rate of growth. We have been heartened to see the role of physician
spending in cost containment: in 2016,
physician spending rose just 1.7%, and it has grown at an even lower
rate—1.2—in 2017. This has meant that physician spending has represented just
under 8.0% (2016) and 8.4% (2017) of total spending increases over the past two
years. Physicians have been part of the solution; driving the state’s total
health care expenditures towards attainment of the state benchmark.
To
further emphasize the strong role of the physicians in cost containment, the
Medical Society wishes to highlight the strengths of physician leadership in
healthcare provider organizations. In 2016, the HPC reported that an impressive
8 of the 10 largest managing physician groups reduced health status adjusted
(HSA) total medical expenditures (TME) for at least two of the three health
plans, and 2 of the 10 reduced TME for all three plans. In other words, when
physicians bear more responsibility for overall patient management, they can
actually effectively contain total spending, even in categories such as
hospital and pharmacy costs that are ballooning at the aggregate level. This
bodes well for the future as physician groups are increasingly reimbursed under
alternative payment models (APMs) that emphasize PCP and specialist management
of total patient costs or costs for specific episodes, such as a surgery.
This
year, MMS noted national studies indicating that physician-led ACOs spend
14-25% less per patient than ACOs led by academic medical centers, and achieve
high quality marks. Hypotheses about the drivers of these savings seem to be
confirmed in part by analyses in this year’s HPC Cost Trends Report which shows
various cohorts in physician-led organizations showing higher rates of PCP
visits and lower rates of potentially avoidable ED visits.
Comments on HPC
Policy Priorities
The
Medical Society read with interest the policy recommendations of the HPC
contained in this year’s Cost Trends Report. Of particular interest was the new
Recommendation #1 addressing administrative complexity and Recommendation #2
which included several new sub-policy recommendations. The Medical Society
shares HPC’s commitment to address administrative complexity. Not only does the
physician community see administrative complexity as a driver of unnecessary
expense in health care, but it can also be a driver of physician burnout. In
fact, this year, in conjunction with the Massachusetts Health and Hospital
Association, the Harvard T.H. Chan School of Public Health, and Harvard Global
Health Institute, the MMS authored a white paper entitled, “A Crisis in Health Care:
A Call to Action on Physician Burnout.” Burnout among the nation's physicians
has become so pervasive that the paper, authored by Dr. Ashish Jha, MMS
President Dr. Alain Chaoui, MMS President-Elect Dr. Maryanne Bombaugh and
others, deemed the condition a public health crisis. Recent evidence
indicates that nearly half of all physicians experience burnout in some form.
The consequences of burnout include reduced hours and professional exist- all
coming at a time when assuring an equate physician workforce is imperative. The
paper includes directives aimed toward curbing the prevalence of burnout among
physicians and other care providers, including the appointment of an
executive-level chief wellness officer at every major health care organization,
proactive mental health treatment and support for caregivers experiencing
burnout, and improvements to the efficiency of electronic health records. The
report also points to a variety of stakeholders including Health Plans and
Governmental agencies at the state and national level to take an active role in
reducing Prior Authorization, documentation and measurement requirements. The
burden and associated costs of these items are burying practices and often do
not add to improved patient care. MMS
urges the Health Policy Commission to pay close attention to the connection
between administrative complexity and physician burnout. If not addressed,
physician burnout has the potential of jeopardizing the great strides made in
Massachusetts to broadly extend access to high-quality care across the state.
In
addition, MMS has made addressing pharmaceutical drug prices a top priority.
Not only has MMS noted the HPC’s successive annual reports showing pharmacy
costs as a leading driver of health care costs in Massachusetts, but practicing
physicians regularly note the daily frustrations of trying to ensure their
patients have affordable access to prescription medications. MMS will continue
to advocate for even great transparency and data reporting to HPC, CHIA, and
the Attorney General’s office by pharmaceutical manufactures and pharmacy
benefit managers. MMS urges HPC to not only focus research and policy toward
the high-cost of new market entrants, but to also consider the significant
failures of the generic market to keep costs reasonably low.
Moving Forward
on High-Value Care
MMS
is optimistic that there are many opportunities for evidence-based approaches
to further supporting high-value, patient-centered care. MMS has again filed
legislation to ensure that patients are no longer responsible for out of
network bills that may result from unavoidable gaps in coverage. In addition,
MMS sees great opportunity in the thoughtful continued promotion of alternative
payment methodologies. MMS urges however, continued close attention to the
proliferation of competing quality metrics that physicians are required to
report on, and by which physicians are evaluated. MMS supports recent calls for
alignment and consolidation of such measures.
MMS
appreciates the opportunity to offer these comments and looks forward to
continuing to work with the Health Policy Commission and the Joint Committee on
Health Care Financing on promoting broad access, high-quality, affordable
health care to all patients in Massachusetts.
