The Massachusetts Medical Society (MMS) wishes to be
recorded in opposition to H.608, “An Act Relative to Health Policy Commission
Reviews of Scope of Practice Proposals”.
This bill would allow the Joint Committee on Health Care
Financing to refer bills or unfiled proposals related to any “proposal that
would change the authority of a health care provider to provide certain health
services”, to the Health Policy Commission (HPC) for review, evaluation, and
recommendation. The proposed legislation allows the HPC to report whether the
“legislature should vote to enact the scope of practice proposal as submitted
to it by the committee, or as amended by the commission.” There is no power for
the HPC to find any proposal not worthy of consideration. Once recommended by
the HPC, the Committee has no discretion whatsoever and the bill automatically
is placed on the calendar even if significantly rewritten by the HPC. This
process drastically restricts legislative discretion and jurisdiction for
virtually all bills affecting the delivery of healthcare throughout the
remainder of the legislative process.
The Medical Society encourages the Committee on Health Care
Finance to oppose this bill and to retain the important procedural processes
that are stripped away by this bill. Maintaining proper checks and balances,
including the right and responsibility to amend bills in committee, and encouraging
informed floor debate in both branches are vital components of the democratic
process that are particularly important when dealing with scope of practice
issues that acutely affect how health care is delivered to patients in
Massachusetts. Bills affecting the health and safety of patients should be
subject to greater, not lesser scrutiny by the legislature.
The Medical Society welcomes a fair, objective,
patient-centered review of scope of practice legislation. We believe that any
scope of practice determination by the legislature would be aided by objective
data. Physicians strongly value evidence-based practice, and welcome the
legislature’s promoting the same in these determinations.
A data-driven analysis by the HPC is only helpful to the
legislature if the data is neutrally evaluated and properly contextualized. The
Medical Society believes that the current factors mandated in this bill for the
Health Policy Commission to review scope of practice bills and proposals are
severely flawed. The factors that the HPC is required to consider will lead to
biased reports and recommendations that could lead to legislative actions that
affect the quality of care provided in the Commonwealth. For example, cost
effectiveness as the first factor listed, whereas “value”, or quality divided
by cost would be a more thoughtful directive. Other factors related to patient
protection remain absent, such as the quality and depth of education and training,
as well as considerations of patient protections such as board oversight (i.e.,
rigor of licensing and investigatory infrastructure) or long-term quality
metrics.
For these reasons, we urge you to oppose H.608 as written.
