Massachusetts Medical Society: How Will the State Approach Health Care Reform in 2019?

How Will the State Approach Health Care Reform in 2019?

By Sarah Ruth Bates, MBE, and Brendan Abel, JD

Will the 2019 state legislature tackle health care reform with a scalpel or with a sledgehammer? The Society is hoping for the scalpel, an appropriately careful approach reflecting a period of restrained cost growth in the Commonwealth. During the 19-month legislative session, which starts in January, the MMS expects to shape policy on key areas of medical practice and will file some two dozen bills.

Where We Are

The past legislative session saw contradicting and comprehensive proposals to overhaul Massachusetts health systems in the name of cost savings and increasing patient access to care (see Vital Signs, October/November 2018). The upcoming session’s legislation will be informed, as always, by reports from the Center for Health Information and Analysis and the Health Policy Commission (HPC). This year’s reports showed health care cost growth in the Commonwealth at 1.6 percent, well below the HPC benchmark of 3.6 percent, despite high and rising costs relating to health plans and pharmaceuticals. Physicians continue to play a significant role in containing costs. The Society expects to weigh in with strong, data-driven advocacy on the following issues:

  • Pharmaceutical pricing: The MMS expects to support transparency throughout all stages of drug development and marketing.
  • Unavoidable out-of-network billing: The MMS plans to file legislation to protect patients from balance bills and to compensate physicians fairly.
  • Telemedicine: The Society will advocate for parity in insurance coverage and reimbursement across telemedicine and in-person care delivery.
  • Provider price variation: Legislators attempted last session to assess and reduce provider price variation among hospitals. The MMS will continue to closely monitor these proposals and assess their impacts on physicians and patients.
  • Scope of practice: The MMS will continue to speak up for parity in education, liability, and other relevant factors across independently practicing clinicians.
  • Social determinants of health (SDOH): As health care organizations continue to shift to the accountable care organization model, the MMS looks forward to joining fellow stakeholders in affirming the importance of SDOH in promoting and protecting the health of our patients, especially the most vulnerable ( see page 4).
Addressing pharmaceutical pricing has become a top priority for legislators, physicians, and researchers. Michael H. Sherman, MD, and Sharon Glaze Frazee, PhD, MPH, were among panelists at the MMS Public Health Leadership Forum on drug costs in October 2018
Addressing pharmaceutical pricing has become a top priority for legislators, physicians, and researchers. Michael H. Sherman, MD, and Sharon Glaze Frazee, PhD, MPH, were among panelists at the MMS Public Health Leadership Forum on drug costs in October 2018. Photo by Josh Rosenfeld.

The MMS plans to introduce a number of bills this session. Those legislative proposals include (and are not limited to):

  • Medical decision-making: The MMS has worked for several years with
    coalition of stakeholders on passing a state statute that would allow for the temporary appointment of a default decision-making agent for incapacitated patients who have not previously appointed a health care proxy. Massachusetts is one of a few states lacking such a statute, and its absence is costly. Every year, hospital systems must initiate guardianships for these patients, delaying their access to appropriate care and keeping them hospitalized. The MMS hopes to see this bill pass in the forthcoming session.
  • Maintenance of certification: The MMS plans to refile a bill that would prohibit the Board of Registration in Medicine from requiring that physicians obtain a Maintenance of Certification as a condition of licensure, reimbursement, or employment.

First Steps

The past session concluded at the end of July. All bills that did not pass have been discharged; to be reactivated, they need to be refiled by a legislative sponsor. The first order of business for the legislature will be appointing leaders and committee chairs. The Senate is now under the leadership of Senator Karen Spilka, and the House has the unexpected vacancy of its Ways and Means Chair. The MMS will pay close attention to appointments to Joint Committees on Health Care Financing; Public Health; Mental Health, Substance Use, and Recovery; and others.

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