Mass. physicians urge caution on payment overhaul

A joint committee of state legislators is gathering feedback about the idea of ending the fee-for-service payment model.

By Emily Berry — Posted Oct. 29, 2009

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Physicians testifying at a state legislative hearing urged a careful approach to health care payment reform in Massachusetts.

The president and president-elect of the Massachusetts Medical Society testified before the Joint Committee on Health Care Financing on a proposal to overhaul payment for every doctor and hospital in the state to a "global payment" system, rather than the current fee-for-service model.

In this case, a global payment is defined as a capitated payment that is determined not just by the number of patients, but also by quality of care.

The Massachusetts Special Commission on the Health Care Payment System released its recommendations in June, calling for a five-year transition to per-patient payments that would cover care by hospitals and individual physicians.

The transition would require a waiver to convert the state's Medicaid and Medicare payments to a global model, as well as legislation to require other payers to adopt the new system.

There is no bill drafted yet and no deadline to pass it. The hearings were part of the information-gathering stage, said Kimberly Haddad, general counsel and senior health policy adviser to the committee co-chair, state Sen. Richard Moore.

Mario Motta, MD, a cardiologist in Salem, Mass., and president of the state medical society, suggested the state set up pilot projects before attempting a wholesale payment system switch.

MMS President-elect Alice Coombs, MD, a critical care physician and anesthesiologist who practices in Weymouth, was the only physician member of the special commission. She testified to the joint committee that physicians are concerned the global payment model is just a new name for the old capitation model, which many saw as a failure.

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