MASSACHUSETTS RADIOLOGICAL SOCIETY 2010-11
Edward J. Brennan, Jr. Esq.
Health care payment reform has moved to the top of the political agenda on Beacon Hill, as Governor Patrick begins his second term and a new Legislature convenes.
Health Care Payment Reform
State leaders view the high cost of health insurance a barrier to job development and economic growth, and a contributing factor to the State’s budget deficit due to the high cost of the Medicaid program and health insurance for public employees. There is also concern that health insurance affordability will undermine the Commonwealth’s universal health access law of 2006 which mandates that every resident, who can afford it, have health insurance. The landmark law is viewed as a great success with 97.4% of residents now having health care coverage, and the U.S. Census reports that Massachusetts has the lowest rate of uninsured in the nation.
The issue of health insurance cost is not new. Two years ago a legislatively established Special Commission on the Health Care Payment System recommended that the fee-for-service payment system be replaced by a prospective global payment system built around accountable care organizations (ACOs) consisting of physicians, hospitals and other clinical providers, and such integrated systems would become the predominant form of provider payment in the Commonwealth. The Commission found that fee-for-service rewards service volume rather than outcomes and efficiency and is a driver of health care costs.
The Commission’s recommendations lay dormant during the last legislative session in part because of recognition that a radical change of the health care payment system would be complex and controversial. However, after the Legislature adjourned its formal sessions at the end of last July, an agency within the State’s Secretariat of Health and Human Services, the Health Care Quality and Cost Council, convened a Committee on Payment Reform Legislation to begin the process of developing “decision points” that could be developed into legislation to implement comprehensive health care payment reform that would be filed with the new legislature in 2011.
Payment Reform Goals
The Committee on Payment Reform Legislation has met since August in an attempt to develop “decision points.” The discussions have been long on generalities but very short on specifics. The Committee held a public forum in December and MRS president John Dubrow, M.D., FACR submitted testimony cautioning against a radical revamping of the payment system without careful consideration with input from all medical specialties. Any change in the payment system should be voluntary and subject to negotiation, and first tested through pilot programs. As this report goes to print, the expected enabling legislation or summary of specific proposals to be included in legislation have yet to be disclosed. Thus, we are unable to give you a precise understanding of the magnitude of the impact such legislation will have on your practice and your patients. What we do know is that “goals” have been identified by the Committee which could be included in legislation. The goals are as follows:
- Provide for the creation of payment methods that will decrease total expenditures, or at least the rate of growth in expenditures, for health services in the Commonwealth and improve the efficiency, effectiveness and quality of its health care delivery systems.
- Assist with transforming health care payment methods over a five year period from fee-for-service to global and other payment alternatives (“Global Payment Methodologies”) for the provision of health care services.
- Standardize, across all payers in the Commonwealth, reimbursement principles based on value rather than volume of services, risk adjustments and payment methodologies.
- Assist with transforming over a five year period the way health care services are delivered in the Commonwealth by delivering most care through accountable care organizations (“ACOs”) comprised of connected or integrated groups of health care providers.
- Promote tools for communication, information-sharing, contracting and integration of the health care delivery system that will support clinicians’ ability to engage in best practices and have knowledge of all health events relative to their patients
- Ensure engagement of patients and consumers, purchasers, providers, and payers of health care services in the policies developed to achieve health care delivery system and payment reforms.
- Support and evaluate pilot programs and other demonstrations or experiments in delivering integrated care under alternative payment models.
- Achieve transparency of payer and provider payments, clinical, quality, and other related information and ensure such information is publicly available.
- Protect quality of and access to health care services
- Assure choice of primary care provider and ACO, for all residents of the Commonwealth.
- Assure that health care cost savings are shared among consumers, providers, payers, employers and other purchasers.
The MRS, as well as the Massachusetts Medical Society and other medical and hospital organizations, have expressed concerns about a mandated one size fits all approach. As reported by Dr. Dubrow, MRS has strongly voiced concerns in testimony submitted to the Committee. Payment reform legislation is expected to be filed soon. The devil is always in the details and the details will no doubt be controversial and likely will lead to a long protracted political debate on Beacon Hill. The MRS will take a very active role in representing the interests of diagnostic radiologists and radiation oncologists, as well as your patients, in the debate on health care payment reform. As specific proposals emerge, MRS leadership will keep you informed of challenges, and will call upon members, as needed, to contact legislators on behalf of radiology and your patients.
Medicaid Fees:
The Division of Health Care Finance and Policy announced emergency regulations to be implemented Jan. 1, 2011 that cut Medicaid fees for most physician services. For radiology the cuts average 7.28% or an estimated decrease of $2.16 million. Screening mammography will not suffer any cuts. The total cut for all physician services is expected to be $11 million. This appears to be part of an effort to cut fees for all Medicaid providers (other non-physician providers are having their rates cut, some to a greater degree) to address the state’s budget shortfall.
Respectfully submitted,
Edward J. Brennan, Jr.
Counsel