The health information technology sector could come out a big winner if recommendations from the Health Care Payment System Commission are implemented.
In testimony before the healthcare reform financing committee on Beacon Hill, JudyAnn Bigby, secretary of the Executive Office of Health and Human Services, told the joint legislative body that better HIT systems are critical to the kind of collaboration across physician networks needed to implement a switch to a global payment system.
The hearings, held in a sweltering and jam-packed basement hearing room at the Statehouse, were meant to solicit public comment on recommendations made by the commission in July, when it released a 77-page report advocating for changes to the way healthcare is paid for in the Bay State. Among those recommendations was a call to switch from a fee-for-service model — in which doctors are paid per procedure by insurance companies — to a global payment system, whereby physicians are paid an annual fee per patient by insurance companies.
To make the switch, the report calls for the creation of “Accountable Care Organizations,” made up of hospitals, physicians and non-clinician providers that will “manage both the provision and coordination of care for the full range of services that patients are expected to need.”
But even the architects of such an ambitious plan admitted there are still major questions to answer.
One of those issues is the lack of infrastructure for physicians from different hospitals and care facilities to coordinate care. Alice Coombs, president-elect of the Massachusetts Medical Society and a member of the payment reform commission, said that more than 60 percent of physician practices are one- to two-doctor offices and would be hard-pressed to make the necessary investments in electronic medical records. Coombs called for the state to provide assistance to make the transition easier for those small practices.
Leslie Kirwan, the outgoing secretary of the Executive Office for Administration and Finance, added that there’s a need for government, payers and providers to “share the responsibility” for things like training and HIT.
But adding costs when the state is once again facing a quarter-billion-dollar shortfall in tax revenues, especially when there’s plenty of federal money flying around for EMR implementation, might mean the gravy train stops a little short of the station. Especially considering the dire financial assessment given by Greg Sullivan, the state’s inspector general, who said that insurance premiums have skyrocketed by as much as 50 percent in the past three years.
“It’s safe to say the free market has not done an effective job,” Sullivan said, calling the increases a crisis that must be addressed immediately.
Sullivan said the plan currently on the table does nothing to keep costs down. Only government intervention, he said, can provide the kind of regulation required to clamp down on runaway cost increases, and he called for the state to mandate that insurance companies get approval from the government and the state attorney general’s office before implementing rate increases.
“Government has the responsibility that insurance remain affordable,” Sullivan said.
The recommendations from the committee are expected to take five years to be implemented, if approved.