Responding to media reports that it had thrown its support behind the state's proposed global payment system dictating physician reimbursements, the Massachusetts Medical Society has quickly clarified its position adopted at its House of Delegates Interim Meeting.
Specifically, MMS does not want to convey the message that it fully supports the accountable care organization delivery model, which has garnered significant favor among many Massachusetts policymakers as a payment reform solution. Rather, the society said, it is one option to be considered along with others in regards to physician reimbursement.
Among other policy decision delivered at the meeting, MMS said it would advocate for multiple, innovative approaches to healthcare financing, regardless of any payment reform legislation that the state may introduce. "There must be diversity in payment systems in the sense that one size does not fit all," said MMS President Alice Coombs.
The society's greatest concern, according to Coombs, is the disparity among providers that would easily integrate into an ACO environment and others that lack the appropriate technology or funding to adopt the ACO framework, including a global payment system.
"We support the notion that an integrated healthcare delivery system is a good thing," she told HealthLeaders. "However, there are physicians within our membership that lack the infrastructure to be able to transition into an accountable care organization at this stage. We encourage a pluralistic compensation system to include fee-for-service, salary, and limited pilot studies that utilize global payment system."
In addition to small practices, MMS indicated that payment reform exceptions would need to be put in place for safety net providers. "A high percentage of their patient population is Medicaid and Medicare," Coombs said. "As such, they have very narrow margins whereby every time there is a Medicare cut, they're whole practice is threatened."
MMS expressed additional concerns about the ACO model, saying in a statement that it remains an untested method of healthcare financing and can pose unintended consequences that can impair the physician-patient relationship.
The society also cautioned against ACOs becoming so large they would control the state's healthcare system and have to power to include or exclude stakeholders at will. "Without heterogeneity in accountable care organizations, it won't foster the diversity that's necessary to deal with the different patient circumstances in Massachusetts," Coombs said.
State legislators that are pushing a global payment system are most interested in curbing healthcare costs, according to Coombs, who sees the society's role as helping policymakers see the whole picture. "Our objective as providers is to look at quality, access and cost," she said. "If you do not address quality and access, you will actually see costs rise as individuals skip visits to a primary care doctor and wind up in the emergency room."