Health Payment Reform Requires Cautious Effort

With the release of the House and Senate bills last month (see story, page 17), we now have two detailed legislative approaches to health care payment reform.

We at the Mass. Medical Society recognize the need to bend the cost curve in Massachusetts, and we will continue to work with the House, the Senate, and the governor for the remainder of the session to ensure that the final legislation aligns with the following principles.

We assert that the market is working, and has already been doing an effective job controlling the growth in the cost of health care over the last two years. The most responsible approach to continuing this trend would be to empower this market-led approach.

A market approach would afford us the best chance of ensuring that patients’ access to care is preserved, that the delivery of quality health care is supported, that we continue to foster innovation, that we maintain the viability of physician practices, and that we protect the jobs of the many thousands of people who work in health care — without disruption or interruption.

We support an approach that establishes a reasonable cost-control goal over a reasonable period of time. If these reasonable goals are not met, then a detailed review would be initiated, which would inform a set of targeted actions to fairly address the causes of the problem. Any benchmark below the annual growth in the state’s economy is too aggressive.

This is a very complex system. Massachusetts is already among the nation’s leaders in designing new models for the delivery of health care. State legislation should foster the innovations that are currently underway. It should allow us the opportunity to learn what works, and provide the flexibility to make corrections when needed. This is an imprecise science, and no one has done anything like this before. This must be a gradual learning process, conducted in a non-punitive environment.

We also need to be mindful of the risk that a new statutory framework could add administrative burdens on providers and payers who are already staggering under the weight of administrative mandates, many of which add no value to health care. We must simplify, not complicate, the administration of health care.

Finally, we are pleased to see language modeled on the University of Michigan’s ’disclosure, apology, and offer’ approach to resolving patients’ claim of medical malpractice. This would lead to the faster resolution of cases, increase openness and honesty between patient and provider, allow for provider apologies, reduce the incidence of defensive medicine, and help control and reduce costs. We believe this model would vastly improve the experience of patients with an unanticipated medical outcome, and better foster a culture of safety in our health care system. –

Lynda M. Young, M.D. is president of the Mass. Medical Society.

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