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Massachusetts Shows Us Again: Health Reform Ain't Easy

Last July, a Massachusetts panel seized on a radical idea to rein in rising health costs: Pay doctors and hospitals buffet style - one price per patient, no matter what they consume - rather than à-la-carte fees for each and every service.

But that’s perhaps too radical for the time being, a top state lawmaker said last week.

Citing political opposition and technical challenges, state Senate President Therese Murray, a Democrat,  told the Boston Globe she would wait at least until next year to move legislation on the change after "going around in circles" with policymakers for months.

Backers of the plan urged quick action to fight off health costs that were already among the nation's highest and rising as fast as 8 percent a year. But, the current, à la carte system, known as fee-for-service, is profitable for many doctors and hospitals.

The first-of-its-kind plan was devised by a commission including state officials, lawmakers and representatives of insurers, hospitals and doctors, who all agreed the current system is unsustainable. Instead of getting paid for each procedure or office visit, doctors and hospitals would team up to take responsibility for a patient's health for an annual or monthly fee.

The concept is also reflected in a goal of the new national health law, which lets doctors and hospitals band together to save money.

So, why the Bay State delay? The commission left the details to the legislature. Now, some of the same folks who backed the plan are squabbling over the fine points, such as whether patients' choice of physicians would be limited, and who, exactly, would set the annual fees, and a host of other questions.

A member of the commission, Harvard economist Nancy Kane, told the Globe, "There are parties that obviously prefer the current payment system to go on as long as possible, because they make money off of it. And they use that money to create political influence."

But another member, Lynn Nicholas, president of the Massachusetts Hospital Association said it's not her members. "We don’t want anyone to use the excuse that this isn’t going forward because the hospitals don’t want it to," she said.

State Senator Murray said she still hopes to introduce a bill next year.

But the payment issue isn't the only reason health watchers are watching Massachusetts closely. As a refirn forerunner, its battles with insurers and how it handles a doc shortage are being scrutinized, too.

Copyright 2023 Kaiser Health News. To see more, visit Kaiser Health News.

Christopher Weaver
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