Massachusetts Payment Reform Starts To Get Exciting (Honest.)

I know, the very words "payment reform" are enough to put a normal person to sleep. I used to be like that, too. But toward the end of yesterday's meeting of the state's Committee on the Status of Payment Reform Legislation, I started to experience a weird, creeping excitement as the import of the proceedings sank in.

To people truly in the know, this may be old news, but here's my dawning epiphany: "Whoa. They are really seriously intent on virtually getting rid of the fee-for-service system* in Massachusetts in the next five years. There's still a great deal to be worked out, but they are actually batting around the idea of mandating the end of fee-for-service. And even on this incredibly diverse panel of all kinds of state players, there's an overwhelming consensus that the current health care system simply cannot go on."

I thought maybe I was over-reacting. But toward the end of the session, one panel member, David Matteodo of the Massachusetts Association of Behavioral Health Systems, confirmed my sense that big change was a'-coming. He called for making the change voluntary, saying, "We're talking about a huge cultural shift in the payment system we've known for 50 or 60 years here."

He didn't get much support, though. Dolores Mitchell of the Group Insurance Commission, who tends to be a gorgeously straight speaker, said making the whole shift voluntary would be "a long road to nowhere," and "our thrust ought to be 'This is the way we're going,' not 'Let a thousand flowers bloom with no end in sight.'"

"I think," she said, "we've just got to go for it."

What do you think? There will be a public forum on payment reform today in Shrewsbury (details here) and I'll keep you posted. Word is that more than 50 people have signed up — further proof, perhaps, that this stuff is heating up?

*What is fee-for-service? It's the system in which health care providers are paid for "piecework," for each procedure, and thus have an incentive to do more rather than less. The alternatives have names like "global payments" and "accountable care organizations," in which providers tend to be paid for overall care of a patient instead.

This program aired on December 2, 2010. The audio for this program is not available.

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Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



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