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A MOVE IN THE RIGHT DIRECTION by David F. Torchiana, MD

This article is more than 11 years old.

The health care legislation introduced last month by Senate President Therese Murray contains some very positive policies that I hope will make their way into law: improving primary care access, testing the concept of a “medical home” and mandating adoption of technology that has been shown to improve quality, safety, and efficiency.

With an additional 300,000 people now insured thanks to the 2006 health care reform law, we need to make sure that their care is effectively managed. The Bank of America and the state have already made an important contribution – financing loan forgiveness programs for new primary care physicians (PCPs) who agree to practice in areas of high need. The Murray bill goes several steps further, authorizing the state’s medical school to increase its primary care class, offering more loan forgiveness, organizing recruitment efforts and dealing with housing affordability. It’s a balanced approach, also increasing loan forgiveness for nurses and expanding the role of nurse practitioners and physician assistants in primary care. Access is one of those problems we have to keep chipping away at to solve and President Murray’s bill knocks off a big chip.

Another creative idea for improving primary care is also in the Murray bill.

That’s the concept of a “medical home,” where primary care practices are supported not just for office visits to the doctor but for the effort that goes into longitudinal coordination of care as a team of providers. The Senate President’s legislation directs Medicaid to test the idea with a three-year demonstration that creates incentives for coordinated, comprehensive patient care through PCP offices. Other states and health systems are testing this — including Geisinger Health System in central Pennsylvania — with some success. In addition to improving patient care, medical homes could help us redesign primary care in ways that will appeal to the next generation of physicians.

Finally, the bill also proposes to sets deadlines for the statewide adoption of health information technology. Universal use of electronic health records by 2015 and computerized ordering by 2012 are both the right thing to do. This may be a financial burden for some hospitals, physician practices, and health centers. As a result, some financial support will be needed.

There is also a little noticed, but very important provision tucked into this section of the bill that requires a statewide standard for key administrative processes – like billing and coding. This could produce significant cost savings. One option is to follow Medicare’s policies. At the Massachusetts General Physicians Organization, if all of our multiple payers used Medicare policies we estimate we would reduce expenses equal to ten percent of our total revenue. Whether Medicare is the right template or not needs to be discussed but nothing should stand in the way of convergence and standardization as administrative costs are truly dollars wasted.

Given that the Murray proposal tries to strike the balance between competing priorities and stakeholders, there are inevitably provisions that are not as easy to support from the provider perspective. In a previous entry, I have shared my apprehension about legislating certain “never events.” There are some aspirations that we all share: that patients should never be harmed by medical care is one. Certain actions like wrong site or wrong patient surgery are both aberrant and preventable and should be singled out for attention. Infections are different – we can work to reduce their incidence and prevent them whenever feasible but as long as there is no known method that will lead to their eradication it seems fruitless to write laws that mandate the impossible.

I also worry that the increased layers of oversight proposed in the bill will lead to more burdensome regulation of health care providers but at this point everyone understands the cost pressures in the environment and accepts that all participants need to hold a line. Finally, overly stringent regulations around industry/provider relationships could threaten the healthy and appropriate research relationships that have brought us today’s medical advancements and consequently delay the next generation of progress. On the other hand, industry promotion of products direct to doctors with meals, trips and other gifts generates public distrust, raises costs and it benefits neither to continue down this path.

All in all, the Massachusetts Senate and Senate President Murray deserve our thanks and appreciation for putting all these important issues on the table, stimulating debate and, I hope, producing constructive and needed change.

David F. Torchiana, MD
Massachusetts General Physicians Organization

This program aired on April 11, 2008. The audio for this program is not available.

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