Massachusetts Medical Society: How the MMS Worked with the Legislature on Health Costs and Opioid Deaths

How the MMS Worked with the Legislature on Health Costs and Opioid Deaths

By Brendan Abel, JD, MMS Legislative Counsel

Tensions mounted as the July 31 conclusion of the 2017–2018 legislative session approached. In a departure from the last two sessions, major health legislation — a comprehensive health care cost and access bill and an opioid treatment bill — took center stage. The MMS engaged vocally on both bills as they moved through the legislative process. In the end, as the legislature wrapped up its session in the final hours of the last day of July, a best-case scenario unfolded: the problematic health care cost and access legislation fell apart and a favorable opioid bill was passed.

Cost and Access Legislation

Governor Baker and President Chaoui
MMS President Alain A. Chaoui, MD, joined Governor Baker at the signing of the CARE Act.

The MMS was engaged with the issue of health care cost and access for the entire two-year legislative session. Massachusetts has long had among the highest per capita health care costs in the country (though the rate of growth has been quite constrained over the past few years). There has been particular focus on the growing variation in negotiated prices between large academic medical centers and community hospitals, even after controls for quality and patient acuity. Unavoidable out-of-network billing, sometimes referred to as “surprise billing,” also emerged as a public policy issue.

After a legislative commission on price variation and a series of public listening sessions through early 2017, the Senate passed a comprehensive health care cost bill in November of last year. The MMS supported many provisions, including those related to telemedicine coverage and quality measure alignment. The Society expressed concern over other provisions, including across-the-board scope of practice reforms and an out-of-network proposal that would hand rate-setting responsibilities to the Health Policy Commission.

The House took up the issue of health care cost and access in early 2018, but was unable to release an initial proposal until June. Much of the bill was strongly opposed by the MMS, as its approach to stabilizing community hospitals drew funding from levying assessments on physician licenses, and taxes on ambulatory surgery centers, office-based surgery, and urgent care centers. The MMS issued a call to action urging physicians to contact their legislators to convey the potential harm to patients’ access to high-value settings of care. The MMS conveyed the concerns of the physician community, in meetings, testimony, and letters, and through coalition building with state and national stakeholders.

The Medical Society succeeded in passing amendments to improve the out-of-network billing provisions, but was unable to secure changes to the remaining provisions of the bill. The House passed its bill in the final days of June, allowing just a month for each branch to negotiate a compromise bill.

In the end, due in part to strong, broad-based advocacy from the Medical Society, medical specialties, and many other stakeholders, the House and Senate were not able to reconcile their bills in time. The House and Senate leadership plan to take up these bills again in January, and we will continue our staunch advocacy.

Opioid 2.0 Legislation

The Medical Society was also heavily engaged in the CARE Act, the second piece of comprehensive opioid legislation in Massachusetts in three years. The initial bill contained some concerning provisions, including a Prescribing Oversight Board and a proposal to create a 72-hour involuntary civil commitment in settings such as emergency departments. The MMS successfully advocated to instead tailor this legislation to address the heart of the changing opioid crisis, one that is now driven by increasingly poisonous substances such as fentanyl and carfentanyl.

Our efforts focused on policies to drive harm reduction, such as shoring up the standing order and Good Samaritan protections for naloxone, and a state-led study of supervised injection facilities. (The MMS has been appointed to this study commission, as well as to two other commissions in the bill.) The bill also expands access to medication treatment for opioid use disorder. The bill creates a pilot program to provide it in jails and prisons and emergency departments, and establishes and funds an innovative peer-to-peer physician education program for the care of patients with substance use disorder and patients with pain. In addition, the bill improves the existing process for the “partial fill” of opioid prescriptions — a tool that, like the peer-to-peer physician education program, was originally proposed by the MMS.

The MMS was proud to be one of the select invited guests to Governor Charlie Baker’s ceremonial signing of the bill. The Medical Society is hopeful that this legislation, which promotes evidence-based treatment and harm reduction rather than strict prescribing limitations, serves as a model of legislation throughout the country, and most importantly, will continue to turn the tide of the opioid scourge in the Commonwealth.

Tobacco, Alzheimer’s, and More

The MMS was engaged on dozens of other bills. The Medical Society, as a founding member of Tobacco Free Mass, was a proud proponent of the comprehensive legislation including increasing the sales age for tobacco from 18 to 21, adding e-cigarettes to the smoke-free workplace law, and prohibiting the sale of tobacco in pharmacies.

The MMS also helped craft a bill to improve care for people with Alzheimer’s, including striking language relative to a clinician’s requirement to notify families upon “implied consent” and securing strong liability protections for related communications.

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