Massachusetts pressing for shift to global payment system

More than a year after a special commission recommended that all Massachusetts insurers leave behind the fee-for-service health care payment model, state officials are pressing for legislative action as soon as January 2011. Physicians with the state medical society are again warning against ushering in change too quickly.

At a Sept. 21 meeting on national health reform, the state's secretary for health and human resources, JudyAnn Bigby, MD, said she expects legislation to be drafted and introduced as early as January that would shift the state to a global payment system. Such a system would pay physicians a flat montly fee per patient, adjusted for each patient's health status and other factors.

Proponents say this would improve health and hold down costs because it would encourage doctors and patients to focus on overall health and move away from a fee-for-service system, which Gov. Deval Patrick's office described as encouraging the "overuse and misuse of services."

Massachusetts Medical Society President Alice Coombs, MD, a critical care specialist and anesthesiologist who practices in Weymouth, Mass., said physicians are most concerned that adoption of a new payment model be voluntary for doctors. Those who want to transition to global payments should be given time to adopt electronic medical record systems and make other changes to their practices to prepare for the change, she said.

Physicians want to make sure that any pay-for-performance scoring under a new global payment system is properly risk-adjusted.

"This is something that's going to take a whole lot longer than three months," Dr. Coombs said. "We have encouraged the slow consideration of all the issues."

Public discussion of adopting a new statewide health care payment system had waned since July 2009, when the Massachusetts Special Commission on the Health Care Payment System, of which Dr. Coombs was a member, released its recommendations. The group called for a shift to global payments for all its payers, including Medicaid, Medicare and private payers, leaving behind fee for service.

The next step is for the state Legislature to take up a bill that would translate those recommendations into policy, but that hasn't happened yet. Dr. Bigby said at the Sept. 21 meeting that a committee of the state Health Care Quality and Cost Council will draft a bill that could be introduced as soon as the next legislative session starts on Jan. 5, 2011. The payment commission recommended a five-year transition from fee for service to global payments.

In the meantime, Blue Cross and Blue Shield of Massachusetts started contracting with major medical groups under an "alternative quality contract" that features capitated payments paired with pay-for-performance incentives.