Health Care in Mass. Is a ''System in Transition''

MassMed.org
Stanley C. Rosenberg

Vital Signs Speaks with Stanley C. Rosenberg

Vital Signs sat down recently with Stanley C. Rosenberg, the new president of the Massachusetts Senate, to talk about the upcoming legislative session, ongoing state health care reform, and what Massachusetts physicians can expect from Beacon Hill in the year to come.

BY ERICA NOONAN, VITAL SIGNS EDITOR, 
and RONNA WALLACE, MMS LEGISLATIVE CONSULTANT

VS: Can you talk a bit about what Massachusetts doctors might expect in general from the Senate and you as Senate president?

Rosenberg: I like work environments where people are encouraged to have a seat at the table and participate very actively and robustly in the conversation. My hope is that we will build coalitions both inside and outside the Senate to develop a robust agenda and strong legislation to address the issues of the day.

We have a Republican governor, that’s a new dynamic for most of the [Senate] members. We are going to have a divided government, a Republican Governor and a Democratic legislature. But I think we are going to be able to work extremely well because Mr. Baker has a lot of experience both inside and outside government, and he is a very collegial fellow himself. I had the chance to work with him when I was Ways and Means chair and he was secretary of Administration and Finance and we did a lot of good stuff together. So I see no reason that we aren’t going to be able to continue.

[Physicians] should expect an open door from me. Listening and working with people on the front lines in the system, those are the people who know what is happening, and we want to hear from them.

Health care is more than a third of the state budget. It’s one of the five largest industries in Massachusetts, so we have to be really attentive and careful about what we do.

VS: Could you describe what you see as your main health care legislative priorities in the coming year?

Rosenberg: We need to fully implement the reform piece that was started a few years ago and from what I am hearing, it is going reasonably well and people are settling in. There is still a lot more to come out of the Health Policy Commission.

Priority one is to continue to implement those new statutes and new components and be open to new ideas that other people want to put on the table. We still have [a] couple more years ahead in terms of implementing, but it doesn’t mean we can’t start to think about what might need to be done two and three and four years down the road, and I would encourage people to come in and tell us not only how they see the implementation of Chapter 224, but also what else they think might need to be done. This is a system in transition, so we want to hear from people who are working in the system how is it going and what’s next?

VS: What are some of the main challenges you’ll face as you move forward on health care legislation?

Rosenberg: Finances. It’s always the bottom line. One of the top two or three things in every meeting with business or trade associations or individual businesses is the cost of health care.

We are well above the national average, but our quality is also extremely high. We know what the cost drivers are... The most significant research and teaching capacity in the world is right here in Massachusetts. That adds cost, but is something a lot of people feel needs to be protected because it’s bringing world-class quality and we are creating so much of what is spread [through]out the rest of the country and [the] rest of the world. People don’t want to compromise that, but they are also concerned about our ability to sustain the costs associated with that.

VS: There have been many new state and administrative mandates for physicians in recent years, such as Electronic Health Record/Meaningful Use regulations, more mandatory CME requirements, expanded Prescription Monitoring Program mandates, and others. Do you think there have been too many of these?

Rosenberg: They will have to play themselves out and we’ll have to see if they produce positive results. We don’t sit around here dreaming up new rules and regulations; we are sitting around here trying to solve problems. We come up with a solution that we hope is fair and reasonable and we need to see it play out. There are times when a solution does not work and we have to be honest with ourselves at that moment and review and revise, but we can’t get to that point until there has been a good faith effort to implement change.

Doctors need be patient and play some things out. My hope is that they were involved in the process and had a strong voice, even if it didn’t come out exactly as they might have liked.

VS: There are many non-physician health care groups attempting to change the laws and practice without physician oversight in making diagnoses and providing services that stretch or exceed their training. The MMS is advancing legislation that favors physician-led health care teams as the best way to work collaboratively in expanding access to care. How will you approach scope-of-practice issues?

Rosenberg: My approach has always been in issues like this [to ask] what’s the norm? What are other people doing? Has it worked? Sometimes as an innovation state, we are first. But if there are many other states doing things, if we are very different than how other state are doing things we have to ask why.

I love teams. I love collaboration. When you have teams there are times when you have to have someone in charge, and there are times when leadership can come from anywhere on the team. Well-managed teams provide the best results. We are an innovation state so we can be first, and we can be early [in whatever we do.] We just want to make sure that whatever we decide, we do well.

 

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