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"Responding to Payment Reform Proposals" by Bruce Auerbach, M.D.

A recent meeting of representatives from the Special Commission on the Health Care Payment System hosted by the Massachusetts Medical Society allowed physicians the opportunity to share their ideas on the topic of payment reform. As one of those in attendance, I was impressed by the time and energy the commission has devoted to gathering input from all stakeholders as part of this challenging process.

While unanimous consent about payment reform – even among physicians — is unlikely, I think we can agree on certain key principles.

First, all stakeholders should practice “principled negotiation.” Dr. Elliott Fisher, Director of The Center for Health Policy Research and Professor of Medicine and Community and Family Medicine at Dartmouth Medical School, defines that as a willingness to collaborate and to frame issues in a way that everyone will interpret as valid rather than self-seeking.

I think all participants in the dialogue would also agree that a redesigned payment system could promote better coordination of care, preventive care, and chronic disease management. Shortcomings in these crucial areas adversely affect patient health and drive up costs.

However, those reforms could take several years to show a return on investment.

If we compensate providers for better management of patients with diabetes, for example, fewer complications will arise down the road, but we won’t take a huge bite out of the disease burden or health care costs this year or next.

Circulating around payment reform are related issues that could yield shorter-term benefits. Eliminating non-value-added administrative tasks is one area. Another is weeding out counterproductive variability of care. However, medicine is an evolving science, so physicians must have the latitude to develop and refine evidence-based clinical standards in areas where agreement on best practices is lacking. And, where there is broad agreement, physicians should expect to be held accountable for following practices that have a solid evidence base.

Passing meaningful malpractice reform could also have a more immediate impact. Our recent study on defensive medicine – a practice driven by fear of lawsuits – identified cost savings of at least $1.4 billion a year if the liability climate changed. A bill filed by the Medical Society that would make provider statements of regret or apology inadmissible as evidence in legal proceedings would help to change the malpractice climate.

Physicians encourage the commission to move with all deliberate speed – quickly but carefully, but we also caution against a one-size-fits-all solution. The law of unintended consequences will raise its harmful head if hasty, inflexible changes to the payment system are made. For vetting purposes, the Medical Society favors a series of high-intensity pilot projects with different models, such as the advanced medical home programs under development throughout New England.

Physicians and the Medical Society remain committed to helping the commission and the Commonwealth arrive at solutions that will improve patient care, preserve the physician-patient relationship, and halt the spiraling costs of health care.

Bruce Auerbach, M.D. is President of the Massachusetts Medical Society

This program aired on February 20, 2009. The audio for this program is not available.

Martha Bebinger Twitter Reporter
Martha Bebinger covers health care and other general assignments for WBUR.

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