Last week, I addressed the
membership of the Medical Society via a special video announcement to provide
an update about this incredibly busy, and likely impactful, state legislative
session, which will end on July 31st. In that address, I mentioned
one issue that is of particular concern: two separate health care cost and
access bills passed by the House and Senate, which are currently under final
negotiation and reconciliation by a six-legislator conference committee. We and
many others have provided extensive comment to the committee to highlight
provisions that we find concerning, including taxes on ambulatory surgery
centers and urgent care clinics, as well as fee increases and surcharges on
physicians.
I’d like to take a moment to highlight an issue covered in
all of the Medical Society’s testimony and comment on these bills that has
evaded mainstream attention: a proposal to regulate and tax “office-based
surgery.” This new category is defined as any procedure provided in a physician
office that requires at least moderate sedation. The affected physician offices
would be subject to new regulatory oversight such as DPH clinic licensure, and
they would be subject to an 8.75% assessment on all charges for office-based
surgery. If these provisions pass, the resulting changes will constitute the
first-ever breach of the physician office exemption from these aspects of DPH’s
purview.
The MMS has strenuously opposed this proposal. In a letter to
the legislature, the Society called this proposal an “unnecessary, costly and
burdensome change that, if implemented, will force many physicians’ offices to
offer a decreased range of services, close, or sell to a larger entity –
outcomes which would decrease access and increase cost, threatening to diminish
the gains Massachusetts has made in reducing cost and improving efficiency in
the market.” These provisions were put forth in a bill that purported to
increase access to health care throughout the Commonwealth. If passed, however,
these changes would have the opposite effect.
Every day throughout Massachusetts, physicians provide critical
procedures to patients in their offices, as a routine aspect of low-cost,
high-value, community-based care. From gastroenterology to oral surgery to
plastic surgery, physician offices — often in solo or small practices — regularly
provide procedural care to patients. Providing this care in physician offices
benefits patients, who do not need to travel to a hospital or other surgical
facility. It also benefits the health care system, as these procedures are
offered at lower costs without facility fees. We continue to believe that providing
these high-value, low-cost procedures at small physician offices should be
promoted, not discouraged.
The Medical Society believes that sufficient regulation
already exists for these procedures. Ambulatory surgical centers are already
regulated by the Department of Public Health. And all physicians practicing in
Massachusetts are under the oversight of the Board of Registration in Medicine.
The data show that surgical care provided in physician offices is of equivalent
quality to care provided in other settings. We therefore oppose this additional
regulation of office-based surgery.
If office-based surgery becomes subject to high taxation
rates and further regulation, patients will pay the price. I personally know
physicians who would be forced to stop providing surgical care if these
policies are passed as currently proposed. For some patients, there may be
another clinic or hospital down the street where their own doctor can provide
the care, albeit at a higher cost to the system. For others, this policy could
force that care to be provided by a different doctor. Some physicians’ offices
might even have to close their doors—a tragic outcome for both patients and
physicians.
I have also heard from many physician colleagues who have
already seen a movement of Massachusetts patients seeking care in New Hampshire
ambulatory surgery centers as a result of less onerous regulation. If these
taxes and assessments are passed as proposed, even more of our patients will
seek care across state lines.
I am pleased to report that many other stakeholders, including
many in the business community, have opposed these proposals out of concern
that they could raise costs and jeopardize access. In fact, this week, the
Boston Globe urged
a
more moderated approach to the legislation which would avoid these surcharges
and taxes, while the Boston Business Journal cautioned that
the proposal is “is flawed and ambiguous” and should be vetoed by Gov. Baker if
a version with these provisions reaches his desk.
We’re hopeful that the legislature will appreciate that
regulation and taxation of high-value settings of care is not a sound,
long-term solution to the Massachusetts health care delivery system.
Office-based surgery, as detailed above, is the perfect example of a setting of
care that should be supported, rather than penalized. We will continue our work
to promote and safeguard that care, in solidarity with our colleagues who
provide it, and with the patients they care for.
Alain A. Chaoui,
M.D, President, Massachusetts Medical Society
