MMS Comments on Senate Amendments to the FY 2015 State Budget

Following is the text of a letter sent on May 19, 2014, to Massachusetts state senators on the eve of its consideration of the FY 2015 budget:

The Massachusetts Medical Society would like to thank the Senate for its efforts to produce a fair and balanced FY 2015 budget for the Commonwealth.

The MMS Strongly Urges Your Support for Senate Amendment EHS 843, Relative to Meaningful Use of Electronic Health Records (Kennedy)

This amendment would modify a section of Chapter 224 of the Acts of 2012 requiring physicians to demonstrate Meaningful Use regarding proficiency in the use of computerized physician order entry, e-prescribing, and electronic health records, as a condition of licensure, beginning in January 2015.

While the MMS shares the legislature’s goal of widespread usage of electronic health records and e-prescribing, the current statutory mandate will have significant unintended consequences. According to the Massachusetts eHealth Institute, only 15,000 of the 27,000 physicians who live in Massachusetts and hold a Massachusetts license would be able to meet that standard. Most of the remaining physicians are, under law, ineligible for meaningful use incentives and could lose their license if this requirement remains in effect. For example, approximately 4800 medical residents and interns are one group who are ineligible for meaningful use. 

Without a doubt, the loss of more than 10,000 physicians would have a devastating impact on the health care system. This amendment will give the Board of Registration in Medicine more flexibility in implementing the meaningful use mandate by prioritizing physicians in direct patient care. Similar language exists in the House budget. 

The MMS Opposes the Following Amendments

EHS 935 Improving The Quality Of Health Care and Reducing Costs (Moore) 

This amendment would insert H.2009/S.1079 (Khan/Moore) into the Senate budget. That bill is currently before the Committee on Public Health where it is receiving active consideration. The amendment would bypass the committee process and allow advanced practice nurses (APN), including nurse anesthetists (CRNA) and nurse practitioners (NP), to practice independently, to order and interpret tests, and to prescribe, dispense, and distribute controlled substances  without physician supervision. Regulations would be developed by the Nursing Board, without input or oversight by the Board of Registration in Medicine. Currently, APNs must have physician supervision to prescribe and are allowed to order, but not interpret, diagnostic tests. 

The MMS is opposed to this bill as it is contrary to the physician-led, team based health care delivery model and a threat to patient safety. Physician led teams of multidisciplinary health care professionals have demonstrated a positive clinical impact for patients and the overall costs of health care.

Independent practice for non-physician health care providers is inconsistent with current health care delivery and payment models are heading in the opposite direction. ACOs and patient centered medical homes require integration and teamwork among providers to improve health care outcomes and reduce health care costs.

Independent practice for APNs would further compartmentalize and fragment health care delivery. A growing number of policy experts recommend team based approaches over solo and independent practice. Studies show that patients prefer physicians and physician led teams to APNs. A 2012 survey by the American Medical Association found that patients overwhelmingly want a coordinated approach to health care, with a physician leading the health care team. Another survey by the American Academy of Family Physicians found that 72% of Americans want a physician over a nurse practitioner. APNs are not currently required to participate in the Prescription Monitoring Program, or demonstrate meaningful use of electronic health records. Nor do APNs have as robust requirements for continuing medical education as do physicians.

EHS 937 Board of Registration In Medicine (R. Moore)

The MMS strongly seeks your opposition to EHS 937. This provision would eliminate the current majority of physicians on the Board of Registration in Medicine by reducing their number to four of the nine gubernatorial appointees. The Board individually reviews all license applicants in Massachusetts for medical and resident licenses. Physician training is necessary for making these important decisions and two attorneys on the Board currently serve to address non-medical issues adequately. The amendment would also make the Commissioner of Public Health the Chair of the Board. The MMS is concerned that this amendment downplays the medical expertise required of the Chair of the Medicine Board, and does not consider the availability of the Commissioner for the commitment of at least twenty hours a month at the Board, nor the value of this time commitment to the Board's mission. The Board of Registration in Medicine functions well in the Executive Office of Health and Human Services and adding a leadership role for current and future Commissioners is unwarranted.

EHS 927 Optometric Patient Care (R. Moore)

This amendment would allow optometrists - non-medical doctors – to prescribe all oral medications including narcotics for the treatment of ocular diseases, including, but not limited to glaucoma. Only a handful of other mostly rural states allow for such a broad scope of optometric practice. The MMS believes there is sufficient access to ophthalmologists to treat any eye disease and that optometrists are simply seeking to expand their business at the expense of their patients.

Thank you. 
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