There’s No Cure-all for Health Care Costs in Massachusetts

Now that universal health coverage has been established in the Commonwealth, leaders in the public and private sectors are tackling an even more difficult problem: cost control.

One approach, favored by the Patrick administration, is to change the way doctors and hospitals are paid. The governor is preparing legislation to phase in a new payment system by which providers are given an annual or monthly budget (often called a global payment) to care for patients. To receive these payments, providers would have to join accountable care organizations (ACOs), which would be responsible for all the care a patient needs.

The theory is that a model like this in Massachusetts would result in better coordination of patient care, with improved quality, at a lower cost. That remains to be proven. So, while everyone agrees that current rates of spending are unsustainable, moving to a radically different payment system must be done with a careful and deliberate review of many issues.

One size will not fit all. We at the Mass. Medical Society favor a pluralistic approach to address the diversity that exists in Massachusetts. Some providers may make the transition relatively easily. Others could do it with assistance; some may not be able to do it at all. That’s why the act of joining an ACO must be a voluntary act for all providers. Patients across the state are vastly different, too, so we need to try many different approaches to reform. We can’t be fixated on a single system or organizational model for everyone.

This has never been done anywhere on a statewide basis. Given the notorious complexity of health care, we must be vigilant for unintended consequences because I am certain there will be many.

This is a radically different way to run a practice. The capability of physicians and hospitals to move to a new payment system varies widely. According to state data, 62{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of practices in Massachusetts have only one or two physicians. If they want to move to global payments, they will need lots of help with technology and training, as well as practice-management assistance.

And let’s not forget the patients. Most want to keep their doctor, and they treasure the freedom to make their own decisions about health care. If a new payment model is to succeed, patients must understand it and trust it will meet their needs. This issue cannot be neglected.

Everyone understands that the status quo in health care cannot hold. But reforming health care is an enormous, complex undertaking. The provider community respects the urgent need to reform health care expeditiously. Experiments are desirable, but providers are virtually unanimous in urging a prudent approach. As best we can, we must ensure that any new models are sound, evidence-based, and serve the best interests of patients.v

Dr. Alice Coombs is president of the Mass. Medical Society.