Regulatory Update

Back to the Drawing Board for Revised BRM Regulations

The Massachusetts Board of Registration in Medicine (BRM) is restarting the process it began last fall of completely revising its regulations related to discipline, licensing, and patient-care assessment. In response to comments from the MMS, the Massachusetts Hospital Association, Partners HealthCare, the Massachusetts Association of Health Plans, the Council of Boston Teaching Hospitals, and others, the board pulled back its original proposal and issued a statement in November promising that “the public hearing process will be restarted.” You can read detailed testimony of the MMS and other concerned parties at www.massmedboard.org/public/reg_changes.shtm.

Board Chair Martin Crane, M.D., and Executive Director Nancy Audesse expressed concerns about the first draft of the regulations and a willingness to work with the medical community to craft practical regulations that will provide the framework for the board’s activities for many years to come. At a working session with its legal staff on January 18, the board planned for new hearings in late February and discussed many points from the aforementioned testimony, including an MMS suggestion to revise the BRM’s definition of the “practice of medicine.” We anticipate that this issue of Vital Signs will be distributed just as the board’s public hearing process and comment period are concluding.

The initial draft of the regulations seemed to lack consideration of the practical impact the proposals would have on hospitals and physicians. For example, the draft regulations required an increase in the mandatory minimum levels of malpractice coverage from the current $100,000 to $1,000,000. According to the board attorney overseeing the original redraft, fewer than 300 physicians carry $100,000 coverage, making the impact minimal. The MMS testimony pointed out both the logical reasons for such a low-coverage decision and the rights of physicians themselves to choose their own levels of coverage to protect their assets. The MMS has received assurances that the board will scrap this proposed regulatory change.

Other areas of concern included provisions that would affect teaching hospitals by requiring that:

• All physicians supervising residents be employed by the hospital
• Billing for residents’ services take place only when “direct personal supervision” occurs
• Temporary licenses be limited to services essential to teaching
• Minimum postgraduate training for a full license be increased by one year

Also of concern were proposed changes to disciplinary standards and processes, such as the discretion to review medical records without patient consent and summary suspension power for posing a “serious threat to the public” (as opposed to “presenting an imminent danger”).

In fairness to the board, it should be pointed out that the BRM regulations are lengthy and complex, with both positive and negative implications for physicians. The MMS applauds the board for not adopting wholesale the proposals presented last fall. The MMS is working hard to have meaningful dialog with the board. The final regulations, scheduled for implementation on July 1, will prove how successful we have been in this endeavor.

– William J. Ryder, Esq.