Each Patient Counts: Massachusetts Medical Society Weblog

The Massachusetts Medical Society Blog Has Moved!

Effective October 15, 2009, the Massachusetts Medical Society blog moved to

http://blog.massmed.org

Please visit us at our new site for continuing updates, and subscribe to our feed there.

(All posts on this site have been exported to the new site.)

At the State House, MMS Leaders Urge Caution and Pilot Projects for Payment Reform

Massachusetts Medical Society physicians joined several health care providers Thursday in urging the State Legislature to move carefully in adopting a new payment model for physicians and hospitals.

MMS President Mario Motta, MD, said, “If we move too quickly and rattle the tree too abruptly, you’re going to have physicians fall out of their practice like leaves on a tree.” His comments came during a three-hour hearing held in a packed committee room in the basement of the State House.

Motta said that while some physicians work under a global payment system, it’s never been tried before on a system-wide basis. “There are many unknowns and unpredictable effects that could happen,” he said. “For that reason, we are strong advocates for establishing pilot projects for these innovations.”

But, Motta noted, “Coordinated care is better than fragmented care. We want to support innovations that move us in that direction. It’s better for the patient, and it’s better for our health care system.”

MMS President-Elect Alice Coombs, MD, was a member of the commission that studied alternative payment models in the state. She said, “A new payment model is worth looking into if, and only if, there is adequate time, support and preparation for physicians making this enormous transformation.”

Coombs told the committee about the concwerns she’s heard from physicians statewide about global payments. “Most of all, physicians have been saying, We’ve tried this before. It was called capitation, and it didn’t work.”

She said physicians ask how they will be protected against undue financial risk, whether physicians will get adequate resources to provide the right care, and whether patients will trust a global payment system. She said the Legislature must address these and other issues before implementing a new payment model.

Coombs also added an “urgent plea” for naming practicing physicians to any oversight authority for payment reform. “One thing we learned at the commission,” she said, “is that the voice of the practicing physician is absolutely essential to developing a system that will work.”

Most other health care providers testifying also urged a careful, deliberate implementation, including representatives of family physicians, Cambridge Health Alliance, and the Massachusetts Hospital Association.

Others disagreed. The outgoing secretary of Administration and Finance for the state, Leslie Kirwan, said, “Standing still or inching forward is in fact falling back.” Marylou Buyse, MD, president of the Massachusetts Association of Health Plans, said, “We don’t have the luxury of five years.”

Dolores Mitchell, executive director of the state agency that purchases insurance for state employees, said payment reform “may be our last best hope” for controlling health care costs.

Watch Dr. Motta's testimony (Length: 7:56)

Watch Dr. Coombs' testimony (Length: 6:40)

Additional Resources

• MMS News Release: MMS Physicians Testify on Payment Reform
• Text of Dr. Motta's remarks
• Text of Dr. Coombs' remarks

AMA Comments on 3 Issues In Senate Finance Legislation

The American Medical Association today released three brief position papers on three issues in the Senate Finance Committee health reform legislation, which the committee will likely vote on this coming Friday.

• Independent Medicare Commission
• Repealing Medicare's Sustainable Growth Rate (SGR) payment mechanism
• Resource Use Outliers

These documents are in PDF format, available on the AMA's Health System Reform website.

The MMS health care reform website is available here.

Payment Reform Hearing Set for Thursday; MMS to Testify

The state legislature's Joint Committee on Health Care Financing meets Thursday afternoon to hear general testimony about the payment reform commission's recommendations on global payments. The MMS will testify, along with many other specialty societies, hospital leaders and other health care stakeholders.

There has been no legislation filed yet, so there are no specific proposals for implementing the commission's recommendation. It's expected that each speaker will provide general thoughts about global payments. Undoubtedly, some will offer specific ideas for the legislation

We'll report on the hearing here tomorrow, and post our testimony to the MMS website.

Last Sunday's Boston Globe previewed the hearing with a front page story by Liz Kowalczyk. It outlined about the recommendations concerns from hospital and physicians leaders, including MMS President Mario Motta, MD. 

“It can’t be forced on everyone,’’ said Dr. Mario Motta, a cardiologist in Salem and president of the Massachusetts Medical Society, a lobbying organization for the state’s physicians. “You’ll force [doctors] out of business.’’

“This plan will never happen for everyone in five years; that’s an unrealistic dream,’’ he added.

For background information on the commission and its work, visit the payment reform section of the MMS website at www.massmed.org/paymentreform.

MMS Flu Advisory: Mass. Announces First Autumn Death from H1N1

The victim was a 55-year-old woman from Middlesex County with "multiple underlying health conditions."

Department of Public Health Commissioner John Auerbach's statement said, in part, “While most cases of H1N1 in Massachusetts and across the nation have been relatively mild, this news demonstrates once again how serious flu can be.”

Read the complete DPH announcement.

Follow the MMS Twitter feed.

Senate Committee to Vote on Health Bill Next Week

Just after 2:00 this morning, the Senate Finance Committee completed its grueling review of nearly 600 amendments to its health reform legislation. Its leaders hope to vote on the complete bill next week. The committee plans to vote on the full bill during the week of Oct. 12.

During its deliberations this week, the committee rejected two separate proposals to include a public health plan option. It also exempted 2 million more people from the individual mandate based on economic hardship, and reduced penalties for failing to comply with the mandate.

Thanks to the work of Sen. John Kerry and his staff, the committee also favorably modified a proposal that would have penalized patients and physicians in high-cost Medicare states like Massachusetts.

Read more about the committee’s deliberations.

MMS website: Health care reform updates and other resources

MMS Flu Advisory: September 30 Statewide H1N1 Webcast

The state Department of Public Health will host a webcast of its Statewide H1N1 Conference.

The webcast will be archived on the webcast web site for one year. The program will include an H1N1 situation update and outlook for the months ahead, and discussion of activities related to H1N1, clinical management, surge capacity, vaccination, DPH communications activities, school and university issues.

To view the webcast, visit: http://video.webcasts.com/events/pret001/32329/

If you have trouble with the link, please copy and paste it into your web browser.

Source: Massachusetts Department of Public Health (September 29, 2009).

Follow the MMS Twitter feed.

 

MMS Flu Advisory: New CPT Codes for H1N1 Immunizations

The AMA today announced two new CPT codes for the upcoming H1N1 immunizations. Coding from the AMA:

Use code 90470 to report H1N1 immunization administration and counseling. Code 90663 was revised by the CPT Editorial Panel to refer specifically to the H1N1 vaccine product. Both, revised code 90663 and Category I CPT Code 90470 are effective immediately.

For quick reference, the two codes are below:

90470-H1N1 immunization administration (intramuscular, intranasal), including counseling when performed

90663-Influenza virus vaccine, pandemic formulation, H1N1

For more information:

http://www.ama-assn.org/ama/pub/news/news/cpt-codes-h1n1-immunizations.shtml

MMS Flu Advisory: FDA Approves H1N1 Vaccine; Some Seasonal Flu Vaccine Shipments Delayed

The U.S. Food and Drug Administration has approved four vaccines against the 2009 H1N1 influenza virus. The vaccines will be distributed nationally after the initial lots become available, which is expected within the next four weeks. The state will be responsible for distributing vaccine to health care and public health providers. Massachusetts health care practices wishing to receive vaccine must complete an online registration by October 9. Click here to read the FDA press release.

Seasonal Flu Vaccine Delayed
Due to prioritization of H1N1 vaccine and other challenges, remaining shipments of seasonal flu vaccine may be delayed. The state Department of Public Health (MDPH) has received over 40% of its seasonal flu vaccine supply to date. Remaining doses are expected to become available over the next 4-6 weeks. The majority of doses are still expected by the end of October and all doses expected by early November. Additionally, doses of both state-supplied and privately purchased pediatric formulation vaccines (0.25ml pre-filled syringes for <4 years of age) have also been delayed. Currently, less than 30% of the state’s total supply is available now; the majority of doses are expected to be delivered by the end of October. 

Almost all of the influenza viruses currently circulating are H1N1.

MDPH Recommendations
MDPH recommends that all health care providers continue to vaccinate patients with seasonal influenza vaccine during routine visits and in scheduled clinics as supply allows.

Pediatric Providers
MDPH recommends that pediatric providers:

• Continue to vaccinate patients based on their available vaccine supply and formulation types.
• For infants who cannot now be vaccinated due to lack of current supplies, schedule vaccination appointments in late October, when MDPH expects supplies of both state-supplied and privately-purchased pediatric formulation seasonal flu vaccine to be sufficient.
• Plan for simultaneous administration of both seasonal and H1N1 flu vaccine starting in mid-late October. H1N1 flu vaccine will become available starting in early October. Young children are one of the highest risk groups for H1N1 influenza. Pediatric providers will be allocated some of the initial doses of H1N1 vaccine that become available in Massachusetts. Note: Doses of the intranasal H1N1 LAIV and seasonal LAIV must be separated by 4 weeks, but  you can administer H1N1 and seasonal vaccines simultaneously if one or both vaccines are the injectable vaccine.

School and Public Clinics
MDPH is recommending that large public clinics and school based flu clinics be delayed until mid October (and possibly into early November) unless there is sufficient vaccine on hand to meet the expected demand.  By mid-October, we anticipate vaccine supplies will be sufficient to mount large clinics efforts. 

MDPH is advising schools and public health departments to anticipate holding clinics for H1N1 flu vaccine starting in early November as well, and to consider offering both seasonal and H1N1 flu vaccine at these clinics.

Sources: U.S. Food and Drug Administration (September 15, 2009) and Massachusetts Department of Public Health (September 17, 2009).

Follow the MMS Twitter feed.

Senate Finance Committee Releases Health Reform Bill

The U.S. Senate Finance Committee today released its long-awaited health reform bill, "America's Healthy Future Act of 2009" (PDF).

This bill does not include an option for public health plan, but does allow the federal government create to exchanges that would allow consumers to shop for health insurance.

The bill does not offer a comprehensive fix of the Medicare physician payment formula, but it does replace the 21% fee cut scheduled for next year with a 0.5% increase.

Committee markup is expected to begin next week. Senate leaders hope to bring a bill to the floor for a vote by Columbus Day - less than a month away.

For more information on the Senate proposal and other federal health reform bills, visit www.massmed.org/healthcarereform

New MMS Workforce Study Shows Continued Shortages in Mass. Primary Care

The Massachusetts Medical society's 8th annual physician workforce study has found that while fewer physician specialties are operating under severe labor market conditions than in previous years, the situation in primary care continues to weaken. The report’s key findings include:  

• The primary care specialties of family medicine and internal medicine are in short supply for the fourth consecutive year.
• The percentage of primary care practices closed to new patients is the highest it’s ever been as recorded by the Medical Society.
• 7 of 18 specialties studied have been classified in short supply, 5 fewer than last year.
• The specialty of obstetrics and gynecology was found to be in short supply for the first time in the eight years of conducting the analysis, adding to primary care difficulties.
• Recruitment and retention of physicians remains difficult, especially at community hospitals and especially with primary care.
• The fear of being sued remains as a substantial negative influence on the practice of medicine, affecting access to and availability of physician services.

Read the study at www.massmed.org/workforce