Society to Weigh in Frequently on Implementation of Chapter 305

The Massachusetts Medical Society was successful in significantly improving the comprehensive "cost control" bill filed by Senate President Therese Murray (D-Plymouth) last March (see Vital Signs, September 2008). But critical decisions still have to be made around the implementation of the law (Chapter 305 of the Acts of 2008), and the MMS will have an active role in that process.

The legislation created a number of new entities that will benefit from representation by the Society, and it expanded or re-established the roles of other entities that currently have MMS representation. In addition, the Society will participate in an array of hearings on topics ranging from patient safety to professional liability and restrictions on "gifts" from industry sources.

Payment and Workforce Issues
The MMS is a member of the Special Commission on the Health Care Payment System, which was created by Chapter 305. The commission's goal is to "investigate reforming and restructuring the system to provide incentives for efficient and effective patient-centered care and to reduce variations in the quality and cost of care." In a related provision, the existing MassHealth Payment Policy Advisory Board has had its mission expanded to include studying the need for increasing Medicaid reimbursement for "primary care physicians, nurse practitioners, and subspecialists who provide primary care services." The board has also been asked to provide input on establishing a Medicaid medical home demonstration project. Long-standing MMS involvement on this and other MassHealth boards has helped shape Medicaid reimbursement policies.

Many MMS-supported provisions regarding the physician workforce were incorporated in Chapter 305, including a loan-forgiveness program and the creation of a Healthcare Workforce Center at the Department of Public Health (DPH). The MMS is on the center's advisory council, which is charged with looking at disincentives to recruitment and retention across specialties, ranging from existing laws, regulations, and policies to contracting and reimbursement practices. The new law also mandates that all payers - including Medicaid - use standard claims forms and billing codes by 2012, eliminating considerable unnecessary paperwork. In addition, the MMS has a seat on the new Advisory Committee to the Division of Insurance's Bureau of Managed Care, which is charged with monitoring the implementation of that aspect of Chapter 305.

The new law also gives enhanced responsibilities to the Advisory Committee of the Health Care Quality and Cost Council, the Massachusetts Commission on End of Life Care, and the Health Disparities Council - all entities in which the Society is already represented.

Hearings, Hearings, and More Hearings
The MMS will also continue to monitor and comment at public hearings mandated by Chapter 305 and those designed to help establish regulations for new initiatives. For example, the legislation mandated that the Division of Insurance study the "costs of medical malpractice coverage" for health care providers, and the MMS has already testified at those hearings. Furthermore, the DPH indicated that it will move quickly in developing regulations relative to limiting "gifts" to health care providers from pharmaceutical and medical device manufacturers, as well as regulations regarding the reporting of and reimbursement for "serious reportable events" (see Vital Signs, October 2008). The MMS will testify at those hearings, as well.

- Steve Shestakofsky

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