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Physician Health Insurance Ratings
"I've heard the extremes of the argument about using
administrative data to report quality on providers, not just
individual physicians but even individual institutions. I do think
there are limits to administrative data that were systematically
designed for billing and reimbursement purposes and not to measure
quality. So I understand that.
"However, I do think that there is enough
evidence that some good can come from understanding some of those
data when you have certain principles in place to make sure that
they accurately reflect quality as much as you can. So, I think
being clear about how many things you need to count in order to
make a statement that a number or a measurement is valid… is very
important.
"I think that understanding the implications of what you're
measuring and that it really reflects something that is clinically
important is a principle that anybody who is reporting these types
of data should take into account. I think that understanding that
the way that our health care system is designed right now,
individual providers often don't always have control of specific
entities that are the levers that would influence a particular data
point that is being reported.
"I know that in the practice where I used to be, one of the
measures being reported on for patient satisfaction was whether or
not they could find parking. Obviously the physician has no control
over that so you couldn't use a low score for your practice because
the parking was terrible as a way to incent physicians.
"That's obviously a very extreme example of something over which
a provider has no control so you can't really use that. I'm not
suggesting that anybody does, but there are other things that you
can imagine that a provider has no control over that might be an
indication of a patient's experience with the system. That needs to
be fixed and somebody should be incented to fix it.
"Those types of issues everyone should be talking
about and it would be nice if we could come to some kind of
agreement across all the entities… [on] the principles that we
could adhere to in order to give confidence to providers and the
public that the information being reported is actually good and
relevant.
"The whole point of having transparency is not just to point a
finger at a provider and say you're good or you're not good. But it
should also be to let them know where they can do better. So, if
the data is not reported back to providers and given to them in a
form that is actionable then we're missing an opportunity to
actually improve quality. The whole point of this should be, you
have enough information to say where can I do better and the
information should be helpful in helping physicians to understand
that."
Massachusetts Health Care Reform
"A lot of people who have expanded access to these
subsidized health plans are presenting for care, and they're people
who have not been getting routine care… they present and they have
all these problems that are really quite expensive to care for
because they haven't been getting the care they need…
"I'm hopeful as Massachusetts continues its effort to make sure
that people have universal coverage that we'll see that leveling
off and that if people enter the system at an earlier time and we
pay more attention to both prevention, wellness, and early
diagnosis of treatable chronic disease… [we may be able to] avoid
some of the expensive treatments for chronic disease complications
that we see."
Access and Workforce Issues
"One of the other challenges of implementing provisions of
Chapter 58 is access to primary care.
"I've heard from some providers that those in the community,
especially in different parts of the state, do have more access,
and they want people to understand that they are open to new
patients and are willing to see people. People should not just
assume that because everybody's talking about this problem that
they shouldn't even try to access care. But I do understand that
there's an issue, especially in the more populated parts of the
state, or in areas like the Cape where there already was a problem.
And we need to deal with that.
"We advocated for the funding that would allow community health
centers to try to attract more primary care physicians… That
program provides up to $75,000 in loan repayments for providers who
agree to work in the community health centers for at least three
years. I'm also meeting with a group of people who are primary care
providers or advocates for primary care to look at more short term
things that we could do, like make it easier for nurse
practitioners to act as primary care providers in particular
settings, and to see if there are things that we can do in the way
we pay for primary care services that would make it easier for
primary care providers to practice.
"Some of the initiatives the Medical Society has thought about,
like partnering medical students with providers in the community so
they can really see what its like to practice primary care, are
really important… Most residency training doesn't really give young
physicians an accurate outlook of what it's actually like to
practice medicine because it's so hospital based.
"In terms of primary care, for many internists, the hospitalist
movement has really attracted people who otherwise would have been
going into general internal medicine. So, I do think the Society's
efforts to get students out into the community to see what it is
really like to practice outside of the hospital setting is very
important."
Disparities in Health Care
"We know a lot about where disparities exist. I would say
that while there's a lot of recommendations about how to eliminate
disparities, there isn't as much data as I'd like to see on what's
successful… I think that monitoring the quality of care that
different populations see or experience will be helpful in
understanding how to address disparities. So I think that recent
regulations that require hospitals to report to the Division of
Health Care Finance and Policy…will help us to be able to describe
where disparities exist and feed the information back to
institutions…
"I think the institutions are in the best positions to
understand why they may have disparities in their own institutions
and to develop strategies to address those. Solutions will entail
cooperation and collaboration across private, governmental bodies,
and also requires institutions to think about how their services
are organized, because some of these disparities may simply be due
to systems issues that have to do with having interpreters or a
certain type of health educator.
"Eventually what I'd love to see [are] partnerships with health
care providers and community health or public health entities so
that they're looking at the whole continuum of health care and
public health initiatives that would be successful in addressing
disparities."
MassHealth
"We want MassHealth to efficiently serve a population of
people who have very complicated lives, because many of them have
multiple crises and other priorities related to housing or school
for their kids…
"I'm very hopeful the new MMIS system will allow us to cut down
on some of the inefficiencies in the system. I'm very concerned
about the rate of denials for claims… There are also issues that
I'm not sure any type of revamped computer system will allow us to
address when you look at the details of the federal requirements.
But I do think there are more efficiencies that we can gain, and
I'm very hopeful this new system will help us."
Physician Involvement in the Political Process
"I think it's important for physicians in general to be
more active in the whole discussion around health care reform…
While there certainly are several physician advocates who have
strong voices, I would like to encourage physicians to be more
active in the discussion and the dialogue. They have so much to
offer in terms of what their practice experience suggests about
health care.
"I know that part of the problem is time. A lot of the meetings
where we invite the public to give input are in the middle of the
day and during the workweek. That's not a great time for
physicians…but I just think their voices need to be heard
more."
