Mass. doctors urge caution as state ponders shift to global payments

The state's Legislature will consider recommendations to move physicians away from a fee-for-service system.

By Emily Berry — Posted Aug. 10, 2009

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A state panel has recommended that the health care system in Massachusetts should work under a global payment model, and now the state Legislature must decide if that advice becomes binding policy.

Commission members and other advocates of a global payment system say they can see a way past the problems that made many doctors reject capitation decades ago.

The Massachusetts Special Commission on the Health Care Payment System released final recommendations in June, setting out a five-year time line for every payer in the state, including Medicare and Medicaid, to adopt a global payment system for virtually every physician, hospital and caregiver. The commission's recommendations are now in the hands of the state Legislature's Joint Committee on Health Care Financing.

The panel also said payers should help bear the cost of the switch rather than asking primary care physicians to pay for the technology to work successfully under global payment.

The state's largest health plan, Blue Cross Blue Shield of Massachusetts, in 2008 began offering a global payment contract that it calls an "alternative quality contract," and already several large groups have signed on. The contract has a capitated per-patient base rate augmented by quality-based pay-for-performance.

In response to the recommendations, the Massachusetts Medical Society released a statement saying, "Moving Massachusetts health care providers to a new payment model must be done carefully, deliberately and thoughtfully, and must provide physicians with significant support and resources to ensure success."

MMS President-elect Alice Coombs, MD, said the final recommendations' language allows for exceptions and lays out requirements for successful global payment, such as risk adjustment and pay-for-performance incentives, that would differentiate this from the old capitation. Even then, she said, not every doctor will be able to make the transition.

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