- HB1163 - AN ACT
ESTABLISHING A SPECIAL COMMISSION TO STUDY THE IMPLEMENTATION OF SINGLE PAYER
HEALTH CARE IN THE COMMONWEALTH (HOGAN)
- HB1194/SB683 - AN ACT ESTABLISHING MEDICARE FOR ALL
IN MASSACHUSETTS (SABADOSA/ELDRIDGE)
- SB618 - AN ACT ESTABLISHING A PUBLIC HEALTH
INSURANCE OPTION (ELDRIDGE)
- SB674 - AN ACT TO
ENSURE EFFECTIVE HEALTH CARE AS A RIGHT (CYR)
- SB697 - AN ACT
ESTABLISHING A PUBLIC HEALTH OPTION (LEWIS)
In the Health Care Financing Committee’s
consideration of the above referenced legislation, the MMS wishes to share the
following policies from our House of Delegates. We hope these adopted policies
will help inform legislators of the views of physicians on a broad range of relevant
approaches and issues relating to access to health care, payment reform and
quality assurance.
The following policies have been adopted, and in some
cases renewed under our sunsetting rules, over the past decade or more. The MMS
is proud of its role in supporting universal access to care, in becoming the
first state medical society to state that health care is a basic human right,
and in working to effectively implement these goals through our advocacy in a
manner that is consistent with our policies.
The Massachusetts Medical Society adopted the policy
on Health Care
as a Basic Human Right:
1. That the Massachusetts
Medical Society asserts that enjoyment of the highest attainable standard of
health, in all its dimensions, including health care, is a basic human right.
2. That the provision of
health care services as well as optimizing the social determinants of health is
an ethical obligation of a civil society.
The
Massachusetts Medical Society adopts the following Principles for Health
Care Reform:
1.
Physician leadership. Physician leadership is seen as essential for the
implementation of new payment reform models. Strong leadership from primary
care and specialty care physicians in both the administrative structure of accountable
care organizations (ACOs) and other payment reform models, as well as in policy
development, cost containment and clinical decision-making processes, is key.
2. One
size will not fit all. One single payment model will not be successful in all
types of practice settings. Many physician groups will have a great deal of
difficulty making a transition due to their geographic location, patient mix,
specialty, technical and organizational readiness, and other factors.
3. Deliberate
and careful efforts must be undertaken to guard against the risk of unintended
consequences in any introduction of a new payment system.
4.
Fee-for-service payments have a role. While a global payment model could
encourage collaboration among providers, care coordination, and a more holistic
approach to a patient's care, fee-for-service payments should be a component of
any payment system.
5.
Infrastructure support. Sufficient resources for a comprehensive health
information technology infrastructure and hiring an appropriate team of
physician assistants, nurse practitioners, and other relevant staff are
essential across all payment reform models.
6.
Proper risk adjustment. In order to take on a bundled, global payment or other
related payment models, funding must be adequate, and adequate risk adjustment
for patient panel sickness, socioeconomic status, and other factors is needed.
Current risk adjustment tools have limitations, and payers must include
physician input as tools evolve and provide enough flexibility regarding
resources in order to ensure responsible approaches are implemented. In
addition, ACOs and like entities must have the infrastructure in place and
individuals with the skills to understand and manage risk.
7.
Transparency. There must be transparency across all aspects of administrative,
legal, measurement, and payment policies across payers regarding ACO structures
and new payment models. There must also be transparency in the financing of
physicians across specialties. Trust is a necessary ingredient of a successful
ACO or other payment reform model. The negotiations between specialists,
primary care physicians, and payers will be a determining factor in
establishing this trust.
8.
Proper measurements and good data. Comprehensive and actionable data from
payers regarding the true risks of patients is key to any payment reform model.
Without meaningful, comprehensive data, it becomes impractical
to take
on risk. Nationally accepted, reliable, and validated clinical measures must be
used to both measure quality performance and efficiency and evaluate patient
experience. Data must be accurate, timely, and made available to physicians for
both trending and the ability to implement quality improvement and cost
effective care. The ability to correct inaccurate data is also important.
9.
Patient expectations. Patient expectations need to be realigned to support the
more realistic understanding of benefits and risks of tests and clinical
services or procedures when considering new payment reform models. Physicians
and payers must work together to provide a public health educational campaign,
with an opportunity for patients to provide input as appropriate and engage in
relevant processes.
10.
Patient incentives. Patient accountability coupled with physician
accountability will be an effective element for success with payment reform. An
important aspect of benefit design by payers is to exclude cost sharing for preventive
care and other selected services.
11.
Benefit design. Benefit designs should be fluid and innovative. Any
contemplation of regulation and legislation with regard to benefit design
should balance mandating minimum benefits, administrative simplification, with sufficient
freedom to create positive transparent incentives for both patients and
physicians to maximize quality and value.
12. Professional
liability reform. Defensive medicine is not in the patient’s best interest and
increases the cost of healthcare. In an environment where physicians have the
incentive to do less, but patients request more, physicians view litigation as
an inevitable outcome unless there is effective professional liability reform.
13.
Antitrust reform. As large provider entities, ACO definitions and behavior may
collide with anti-trust laws. The state legislature may be the adjudicator of
antitrust issues. Accountable care organizations and other relevant payment
reform models should be adequately protected from existing antitrust,
gain-sharing, and similar laws that currently restrict the ability of providers
to coordinate care and collaborate on payment models.
14.
Administrative simplification. Physicians and others who participate in new
payment models, including ACOs, should work with payers to reduce
administrative processes and complexities and related burdens that interfere with
delivering care. Primary care physicians should be protected from undue
administrative burdens or should be appropriately compensated for it.
15. The
incentives to transition. In order to transition to a new model, incentives
must be predominantly positive.
16.
Planning must be flexible. Accommodations must be made to take into account the
highly variable readiness of practices to move to a new system.
17.
Primary care physician. All patients should be encouraged to have a primary care
physician with whom they can build a trusted relationship and from whom they
can receive care coordination.
18.
Patient access. Health care reform must enable patient choice in access to
physicians, hospitals and other services while recognizing economic realities.
Fee-for-Service
The MMS
recognizes that fee-for-service and private practice medicine can be efficient,
ethical, and high quality medical care, with a long tradition of
patient-centered care and cost-effective care which keeps patients at the
center of treatment decisions.
The MMS,
when advocating for system reform, enthusiastically advocates for preserving
the viability of a private practice option, for the benefit of patients and our
members.
The
Massachusetts Medical Society (MMS) acknowledges the unsustainable escalation
of health care costs.
The MMS
will partner with other stakeholders to address system-wide mechanisms to
control the forces responsible for the escalation in health care costs. These
include among others:
a. improving
the market structure for medical services through transparency of price and
outcomes
b.
encouraging the development of guidelines in diagnosis and treatment of
conditions where evidence-based approaches are not yet available
c.
suggesting insurance reform mechanisms to reduce consumer purchase of
marginally-useful service, likely through higher copayment for such services
The MMS
encourages a pluralistic compensation system to include fee-for-service,
salary, and limited pilot studies that utilize global payment system.
The MMS
acknowledges that the fee-for-service system has positive value in the payment
for medical services.
The MMS
will continue its strong support for medical liability reform to reduce the
waste resulting from over utilization resulting from defensive medicine.
The
practice of defensive medicine is a major contributor to rising health care
costs and liability reform should be a priority in health care reform
legislation.
Ideal
Payer System
The
Massachusetts Medical Society (MMS) defines an ideal payer system and the
definition encompasses goals that include:
•
universal coverage of population;
•
coverage of preexisting conditions;
• accessibility
to everyone regardless of location or background;
•
portability for all medically necessary services; and
The MMS
definition of an ideal payer system encompasses comprehensive services, that
include:
• acute
and chronic illness care;
•
prevention of disease and disability by risk assessment and education to change
behaviors that may lead to disease or injury, early disease detection and
treatment: to prevent, diminish, compress, and delay its
disablements;
•
rehabilitation of disabled persons: to improve their function for work and
living;
•
immunization;
•
counseling;
•
unimpeded access to appropriate specialty and subspecialty care; and
The MMS
definition of an ideal payer system encompasses qualities, that include:
•
efficiency/cost-effectiveness;
•
equity/fairness, convenience and satisfying;
•
maximal patient and physician involvement, choice, mutual decision-making, and
respect;
• use of
appropriate technologies, scientifically assessed for the needs of patients;
•
continuous improvement efforts for better health care;
•
outcomes through: practitioner education, at the undergraduate, graduate, and
continuing medical education levels;
• research;
•
reorganization of processes of care;
•
professional self-management, internal to the practice;
• voluntary
participation of physicians and patients;
•
maintain freedom of physicians to contract directly with their patients;
•
individuals retain right to establish medical saving accounts and to purchase
catastrophic health insurance from insurer’s of their choice
•
maintain freedom of entry into the health insurance market; and
The MMS
definition of an ideal payer system encompasses characteristics for payment of
services and insurance, that include:
•
simplicity: uniform administrative criteria for eligibility and billing, single
forms, and a single open formulary;
•
accountability;
• consistency
in benefit coverage limitations related to scientific evidence and expert
opinion;
•
timeliness;
•
responsiveness: correction of defects; and
•
appropriate funding
Massachusetts
Health Reform Law
The
Massachusetts Medical Society (MMS) will continue its efforts in support of the
implementation of the Massachusetts Health Reform Law (Chapter 58 of the Acts
of 2006), working in concert with appropriate entities.
That the
Massachusetts Medical Society (MMS) take the position that our representative
on the Massachusetts Payment Reform Commission advocate for payment reform in a
manner that is consistent with the goals of access, quality, and cost, and that
payment reform include a model of fee-for-service medicine that allows the
patient and physician to be aware of the cost of interventions and the ability
to factor this into health care decision-making.
The
Massachusetts Medical Society (MMS) supports the achievement of universal
insurance coverage and adopts the five principles from the Institute of Medicine’s
report Insuring America’s Health: Principles and Recommendations:
i.
Health care coverage should be universal.
ii.
Health care coverage should be continuous.
iii.
Health care coverage should be affordable to individuals and families.
iv. The
health insurance strategy should be affordable and sustainable for society.
v.
Health insurance should enhance health and well-being by promoting access to
high-quality care that is effective,
efficient, safe, timely, patient-centered, and equitable. (HP)
The MMS
will continue to investigate options that work toward the goal of
achieving universal insurance coverage, that may include:
a. A
non-disruptive and evolutionary approach to improving our current health care
system, that is politically
and
economically viable and sustainable, and that includes quality and public
health components.
b. The
development of health care coverage products that are sufficiently comprehensive
to provide
meaningful
health care, and that are affordable and can be obtained through appropriate
purchasing pools
for
individuals or smaller employers.
c. A
bi-modal approach of expanding public and private payer responsibilities;
patients should have a choice between private and public financing.
d.
Efforts to enhance current enrollment of Medicaid-eligible individuals and
families, including appropriate opportunities through public and private
entities.
e. Both
individual and employer mandates, provided that affordable private health
insurance and/or
appropriate
subsidies are made available.
f. Collaboration
across all health care segments, including employers, health plans, health care
organizations, legislators, and the administration for the State.
g. A
single-payer health care reform as an option for achieving universal,
comprehensive, equitable, patient centered, sustainable, and affordable health
care for our patients.
The
Massachusetts Medical Society will utilize existing research and data to explore
various options for providing universal access to health care, including
single-payer, and convey this information to Society members.
The Massachusetts
Medical Society strongly asserts that the fundamental goal of any change to
the American health care system should be to provide universal access to
medical care for all Americans. Any
proposed change to the American health care system which will decrease the
likelihood of movement towards universal access to health care for all
Americans will be strongly opposed by the Massachusetts Medical Society.
