Massachusetts law requires drug firm gift details, uniform billing codes

Washington -- A new law in Massachusetts will standardize health plan billing codes, increase disclosure of pharmaceutical company gifts to doctors and provide more support for attracting physicians to the primary care field, among other provisions.

Senate President Therese Murray, the bill's author, said the measure is an attempt to improve health care access and slow cost increases. "This legislation, through incentives for medical and nursing students, the adoption of uniform billing and electronic health records and [increased] transparency for consumers, achieves those goals," Murray said. Massachusetts Gov. Deval Patrick signed the measure into law on Aug. 11.

The adopted bill was generally supported by the Massachusetts Medical Society, said MMS President Bruce Auerbach, MD. Initially, a provision would have eliminated the possibility of drug industry support for accredited continuing medical education, a move the society opposed. So language was amended to require drug firms simply to report annually any gift, fee, payment or subsidy worth $50 or more given to physicians or other health professionals. The MMS supported the amended language.

But the Pharmaceutical Research and Manufacturers of America objected to the gift-reporting provision. PhRMA said the provision "could chill ongoing clinical research in the state" by revealing a drugmaker's arrangements with principal investigators of clinical trials. PhRMA also opposed a provision incorporating into law the state's code of conduct for marketing to health professionals. This will make adjusting that code in response to changes in federal law and private health plan policies more difficult than updating an informally adopted code, the association said.

The law also requires all private insurers and the state's Medicaid program to begin using the same billing codes by 2012. Health plans will spend a few million dollars to implement the changes, said Marylou Buyse, MD, president and CEO of the Massachusetts Assn. of Health Plans, which also supported the bill. "We have to do a lot of work."

Originally the law would have required insurers to use only Medicare codes, which raised concerns from the health plan association. "Medicare doesn't cover all of the issues that a commercial population would have to deal with," Dr. Buyse said. For example, Medicare does not have codes for certain vaccinations.

The new slate of codes will be based on the International Classification of Diseases, the American Medical Association's Current Procedural Terminology codes, and billing codes from the Centers for Medicare & Medicaid Services.

The new law also establishes a health care work force center in the Massachusetts Dept. of Public Health to track health professional shortages and suggest policy revisions to address these trends. That process will include identifying underserved areas to target physician student loan repayment programs as well as examining the capacity of medical schools to increase the number of both primary care physicians and nurse practitioners.