Seeking
Common Ground
Outreach
Effort Opens New Avenues for Communication, Cooperation With Mass.
Businesses
By
Tom Walsh
Amid
the bustle and clatter of Route 1 in Norwood stands Analog Devices,
a leading manufacturer of "precision high performance integrated
circuits used in analog and digital signal processing."
However
unlikely, it is also the spot where leaders of the Massachusetts
Medical Society launched their attempt to awaken important Massachusetts
audiences to the financial plight of the state's physician practices—and
the consequences of ignoring this serious problem.
Their
audience was not one to generally greet the MMS message warmly:
Indeed, it was a gathering of business leaders for a joint meeting
of the Associated Industries of Massachusetts (AIM) Health Care
Committee and the Massachusetts Healthcare Purchasers Group (MHPG).
AIM
describes itself as a non-profit, non-partisan employers' association
that focuses on issues and programs to help its members, and on
"improving the Commonwealth's economic climate."
MHPG
represents dozens of Massachusetts employers "working together
to increase the value of the health care we purchase" for
more than 2 million New Englanders.
Of
course, in the complex, house-of-cards structure of today's health
care system, what is good for physicians in their quest to save
their practices from financial ruin may or may not be good for
employers, who warily eye any threat to their own bottom lines.
The
40 or so meeting attendees arrayed around the table that day comprised
a group that shares MMS concerns about health care quality, access
and affordability but also holds concerns specifically with employer
cost issues. It was a group that is unlikely to smile on a solution
that may reach into employer pockets.
So
indeed, it was encouraging for the MMS officers to see nods of
understanding from several in the business audience as Medical
Society President Virginia T. Latham, M.D., told of practices
foundering as operational costs exceed practice income.
Acknowledging
the Problem
"In Massachusetts, physician practices are in a state of
crisis, besieged by the same revenue shortfalls that have been
afflicting every hospital...but without the reserves to draw on,
without the opportunity for fundraising, without the ability to
bargain from a position of strength and with minimal margins to
start with," Dr. Latham declared. "At the same time,
the average physician has seen reimbursements fall sharply—in
some cases up to 50 percent in the past three years—while
the doctor is seeing the same number or more patients."
The
fact that many primary care practices take in less reimbursement
income than they pay out to run the practice seemed to resonate
with this audience. That was especially evident when MMS leaders
explained that more than 85 percent of physician reimbursement
income is fixed either by government programs or HMOs.
Harry
L. Greene II, M.D., MMS executive vice president, said this fact
coupled with the high cost of living in Massachusetts is a double
blow to physician practices.
"In
other states, when the rent goes up, physicians can adjust their
fees. But here, with 85 percent of income fixed, we can't adjust
fees to compensate."
Still,
there were those in the audience that remained skeptical about
some of the MMS message. Paula Breslin, executive director of
MHPG, was one.
Skepticism
Lingers
In an interview with Vital Signs after the MMS presentation,
Breslin expressed doubt that physician compensation in Massachusetts
is among the lowest in the country. "Does that mean that
Mississippi and Alabama physicians are paid more?" she asked.
MHPG
is a leading voice in the state for health care cost control and
quality enhancement.
Breslin
also expressed skepticism about the conclusions of an MMS-commissioned
study by the Howell Group that found that the physician supply
in Massachusetts has not driven up health care costs. She suggested
that there are still too many specialists in the state, causing
a "misallocation" of doctors.
Drs.
Latham and Greene maintained that a growing number of Massachusetts
physicians have eschewed patient care for high-tech research positions,
administrative posts with health plans, or teaching. "We
have the data and we'll be glad to show it to you," Dr. Greene
said.
Ideas
Emerge
Later, speaking with Vital Signs, Breslin maintained that
Massachusetts residents "use more health care" than
people do elsewhere. She said people in Massachusetts continue
to want "big-gun" health care for small problems. She
said Boston's large teaching hospitals are probably the right
place to have triple-bypass surgery, but routine appendectomies
should be done at community hospitals to curb costs.
Suggesting
that better overall use of health care dollars could be a way
to help cure physician reimbursement ills, Breslin said, "I
want the patient to do some cost sharing."
Elliot
M. Stone is executive director of the Massachusetts Health Data
Consortium, Inc., a Waltham-based nonprofit that works with health
data to"improve health care" in the region. He said
that while he agreed with Dr. Latham that much waste had already
been removed from the health care system, there is still more
that could be done with that issue. "A dollar saved could
be a dollar put back into your pocket," he said.
Stone
said he has heard Massachusetts physicians say that processing
Medicaid patients is so complicated that doctors often don't bother
to bill for these services. The answer to this problem, he said,
may lie in reducing paperwork by better automating physician offices.
"We've
done a number of things to encourage that," said Dr. Greene.
"But many doctors just don't have the capital to invest in
automation. They don't have reserves or endowments. We want them
to do it, but getting the capital to invest is a real challenge.
Some of the practices are so tenuous financially they can't get
the loans they'd need."
The
Analog Devices presentation suggested a new avenue for cooperation
with the state's high-tech business community.
A
Shared Concern
Dr. Latham asserted that some doctors now spurn Bay State recruiting
efforts in favor of regions with friendlier financial conditions.
Charles
A. Welch, M.D., MMS vice president, told how the roster of physicians
in his practice has dwindled. "We can't hire anyone,"
he said. "Doctors can go to Michigan, buy a house for half
of what it would cost here and get twice as much in salary."
Laurel
Sweeney of Andover's Agilent Technologies, the global technology
company that spun off from Hewlett-Packard last year, said high-tech
firms share that problem. "People go to school here and then
they leave," she said. "We have parallel concerns."
Sweeney
said the long-term impact of this would not be good for the state's
economic development effort. "The governor has to hear this
from both of us on this," she said. "It sounds like
an opportunity for physicians to work with business groups to
look at why they are leaving the state."
Dr.
Welch and others said later that they were encouraged that the
meeting had produced an apparent opportunity to pursue such a
coalition.
In
the months ahead, the MMS officers will travel the state to present
to other business groups, such as local chambers of commerce;
professional organizations like the Boston Bar Association; and
trade groups, such as the Massachusetts Biotechnology Council.
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