*/
BOSTON – In February, Massachusetts Gov. Deval Patrick announced a plan to overhaul its healthcare payment and delivery systems. The proposed legislation is intended to control rising healthcare costs and improve patient care.
"The healthcare industry knows that rising cost increases (over the past decade) are unsustainable and we have to change the healthcare delivery and payment system," said David Martin, the director of healthcare policy and strategies for the executive office of Massachusetts' Health and Human Services Department. "Reforming the process is essential, and while the bill we have crafted is very strong, it will surely benefit from more discussion and fine tuning."
The highlights of the bill, "An Act Improving the Quality of Health Care and Controlling Costs by Reforming Health Systems and Payments," include:
· Encouraging the formation of accountable care organizations by providing standard criteria;
· Providing benchmarks, standards and guidance for the transition to integrated care and global payments;
· Allowing the Division of Insurance to look at more criteria when reviewing rate increase requests from carriers and providers;
· Giving the attorney general the authority to monitor ACOs so that no antitrust violations occur;
· Offering transparency in the areas of payer and provider costs, provider payments, clinical outcomes and quality measures, among others;
· Reforming medical malpractice in order to de-emphasize defensive medicine and reduce lawsuits; and
· Creating an 18-member advisory council to include a variety of voices from the community, such as providers, carriers and organized labor.
A Boston-based nonprofit advocacy group, Health Care for All, is reviewing the 52-page bill.
"It's like an onion – we keep peeling back the layers," said the group's private market policy manager, Georgia Maheras. "As a coalition, we're looking at the structure of the bill – the core pieces. We want to make sure the quality standards are appropriate and that the risk adjusters are figured out correctly to ensure people aren't unnecessarily denied care. By our own reading of it, the bill has a good start on that."
Maheras said she's pleased with some of the consumer protections the bill offers, including having consumers on the advisory council and having transparency of payer and provider costs.
"Transparency is so important if you want to make a change in the system," she said. "This will enable consumers to get a lot more information."
Physicians are encouraged by the proposed changes to medical malpractice – in particular, the move away from defensive medicine, said Alice Coombs, MD, president of the Massachusetts Medical Society, a professional organization for doctors. They're also pleased that there seems to be room for adaptability – there's a recognition that practices are not one-size-fits-all.
The one thing physicians are concerned about, though, is that they have a voice on the advisory council.
"We'd like to have an authoritative, deciding position on the council," Coombs said. "Doctors are on the front lines, so (they) should have some weight on the council. Cost is important, but quality more so."