Massachusetts Medical Society: Comments to Conference Committee on State Health Care Cost and Access Bill

Comments to Conference Committee on State Health Care Cost and Access Bill


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.

Maryanne C. Bombaugh, MD

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