Dear Conferee:
Thank you for serving on the
Conference Committee charged with reconciling H.4639, “An Act establishing the
Honorable Peter V. Kocot Act to enhance access to high quality, affordable and
transparent healthcare in the Commonwealth” and S.2573, “An Act furthering
health empowerment and affordability by leveraging transformative health care.”
Massachusetts
continues to see positive changes to the healthcare landscape, as evidenced by
attainment of the state’s total healthcare expenditures benchmark for the second
year in a row, and a seven-year trend of total spending growth rates below the
national average. Physicians in
Massachusetts play a central role in the state’s efforts on this front, and are
demonstrating an ability to successfully manage and contain total medical costs
as they continue to provide the highest quality of care for their patients.
However, despite our best
efforts, we appreciate that expensive health care costs take an ever-rising
toll on our patients. Rising premiums, cost-sharing, and constraints on
physician time imposed by increasing administrative burdens all point to the
need for thoughtful policies to promote a more efficient, high-value health
care system. Higher-value care allows for greater access to care for our
patients; a tenet of the Medical Society’s mission, as evidenced in our
approach to health care policy for years.
To that end, the Medical
Society urges inclusion of the following proposed changes to the bill’s
language, in an effort to improve telemedicine, to preserve the Prevention and
Wellness Trust Fund, to encourage greater transparency in pharmaceutical
manufacturing and sales, and to streamline quality measures, among other
provisions we have supported in detailed comments on previous iterations of
these bills.
The MMS wishes to be recorded in SUPPORT for
provisions in H.4639 relative for Out of Network services. (Section 105)
While not perfect, the MMS
supports the House Out of Network (OON) provisions and appreciates the floor
amendments that helped ensure a transparent and independent database,
authorized the Division of Insurance to ensure the fairest possible calculation
of “average rate”, and clarified the notification processes for same-day and
recurring OON appointments. However, we
ask that Conference Committee members consider the attached suggestions to
further strengthen this bill, including its formula, notification processes,
and dispute resolution provisions.
The MMS OPPOSES H.4639’s provisions to license and tax
Office Based Surgery Centers” (Section’s 66 and 77)
The House bill would require
non-hospital-based physicians who have long provided safe, high-value
procedures in their offices to be subjected to increased licensure regulations
by the Department of Public Health and to pay an annual 8.75% tax on the total
dollar amount of its assessed charges for commercial payers. Office based surgical centers could then also
be subject to restrictive, onerous and expensive Determination of Need and other
regulatory requirements applicable to health care facilities, as determined by
DPH. Physician’s offices are not clinics, and should not be regulated as
such.
The MMS is also concerned
that this tax would be assessed on the basis of charges, rather than actual
fees collected. Therefore, this formula would essentially tax physicians’
offices on possible, rather than actual, revenues generated, thereby setting up
a system that threatens practice viability and access to care for thousands of
Massachusetts’ patients. No other business in the Commonwealth is taxed on
accounts payable rather than collections.
Please see the attached fact
sheet with further information on the MMS’s concerns with this unnecessary,
costly and burdensome change that, if implemented, will force many physicians’
offices to offer a decreased range of services, close or sell to a larger
entity – outcomes which would decrease access and increase cost, threatening to
diminish the gains Massachusetts has made in reducing cost and improving
efficiency in the market. This tax has been proposed with the goal of funding
community health centers; however, this proposed mechanism would hobble, and,
in some cases potentially bankrupt, physician practices also providing
much-needed high-value care in community settings.
The MMS OPPOSES H.4639’s provisions to
tax Ambulatory Surgery Centers (ASC’s) (Section 77)
Section 77 of H.4639 would
impose the following tax on ASCs, urgent care centers, limited service clinics
and a new category of licensed providers called office based surgical centers:
"Each assessed specialty
clinic shall, in each fiscal year, pay to the executive office an amount equal
to 8.75 per cent of the total dollar amount of its assessed charges for
commercial payers. Each assessed specialty clinic shall be exempt from
contributing any percentage of the total dollar amount for its assessed charges
for public payers."
The MMS opposes the ASC tax
because it is excessive and, if passed, would make Massachusetts the only state
in the nation to tax ASCs on charges - monies the facilities may never receive
in full– instead of revenue. MMS is
concerned that such high, charge-based taxes will either close down ASCs
(jeopardizing access to surgical care in many areas of the state) and/or
significantly increase costs of surgical care, which will ultimately be borne
out in the premiums paid by Massachusetts families. A fact sheet with more
information is attached.
The MMS OPPOSES H.4639’s provisions to
increase licensure fees for physicians (Section 112)
The MMS urges the Conference
Committee to reject Section 112 of H.4639, which would impose a 25% physician
licensure fee increase for each of the next two licensure periods, as well as a
surcharge of $75 for each license. If
passed, physician licensure fees in Massachusetts would be the second highest
in the country, at more than $1,000 per year. The MMS
does not believe that the most prudent means by which to fund a Community
Hospital Reinvestment Fund is by increasing fees on other healthcare providers,
many of whom work at community hospitals, in community health centers, and in
small, geographically remote practices.
The MMS
OPPOSES the Scope of Practice Provisions in S.2573 (Sections 92-108)
S.2573 would allow
independent practice for nurse practitioners (NPs) and Certified Registered
Nurse Anesthesiologists (CRNAs) – even for prescriptive authority. It would also increase the scope of practice
for optometrists and podiatrists.
The MMS has consistently
advocated for the gold standard of physician led health care teams. Increased independence and/or scope of
practice for non-physicians should correspond with increased education and
training requirements.
Instead, the MMS supports a
scope of practice provision that appeared in Section 1 of H.4617, which would
have provided external review of scope of practice proposals by the Health
Policy Commission. We wish to note that a related amendment, adopted in Section
1 of House 4639, pertaining to external scope of practice review, is concerning
as it would bypass an important legislative waypoint which allows for public
discourse and committee scrutiny.
Thank you for your attention
to the comments of the Mass Medical Society and its over 25,000 physician,
resident and student members as we look forward to working with you to further
improve our model health care system.
Sincerely,
Maryanne C. Bombaugh, MD
