massachusetts medical society


Mass. Medical Society Chief: Medicare ‘Data Dump’ Unfair To Docs

Earlier this month, the federal government released a great torrent of data about Medicare payments to individual doctors — tens of billions of dollars to over 880,000 health providers. Media coverage tended to highlight a small number of doctors who received big shares of the Medicare money, though it also included cautions that there could be good reasons for high payments.

Like many other national and state medical societies, the Massachusetts Medical Society opposed the release of raw data without explanation. Here, Dr. Ronald Dunlap, current president of the MMS, argues that the data may be sowing confusion and doing more harm than good.

By Dr. Ronald Dunlap
Guest contributor

Transparency in health care is a worthy goal, but, like any major undertaking, the success of the effort depends on how it’s done.

When the Centers for Medicare and Medicaid Services released its list of $64 billion in Medicare payments to individual physicians in 2012, it fell short of its goal in helping consumers understand how care is delivered through Medicare.

Dr. Ronald Dunlap, president of the Massachusetts Medical Society. (Courtesy MMS)

Dr. Ronald Dunlap, president of the Massachusetts Medical Society. (Courtesy MMS)

Provided without context and with little explanation, the payment data had the unintended consequences of creating confusion and misperceptions among patients. Here are a few examples why:

• The oncologists receiving some of the highest payments are in private practice, and the data did not note that reimbursements to these physicians include the costs of drugs and treatments as well as payments for physician services. (Oncologists employed by hospitals are not reimbursed for drugs; those are billed to their hospitals.)

• Eye physicians also received high payments, attributable to caring for a growing elderly population with vision impairments like macular degeneration, a condition requiring treatment with expensive drugs.

• In some cases, the number of reported services was misleading, and physicians had no way to review or correct erroneous information. One primary care physician in Michigan was credited with more than $7.5 million in payments. That physician, however, directs a Medicare project that includes 1,600 physicians, who each receive small payments every month. Similarly, a pathologist in New Jersey was listed as receiving $12.6 million, but those payments were spread among nearly 30 doctors.

• The data also omits information about a physician’s patient population, the level of their diseases or conditions, or how long treatments lasted. Nor do the payments reflect the quality of care provided or the demographics of the individual medical practices. A physician with a larger population of patients over 65, for example, will naturally have higher Medicare reimbursements.

Payments to physicians are just one part of health care spending, a complicated and highly variable undertaking that includes a number of variables: the cost of drugs, hospital services, imaging costs, overhead expenses, as well as provider salaries. Also to be figured in: cost controls set by the federal and state governments, added scrutiny by insurers and employers, the creation of new models of care like accountable care organizations, and thousands of billing codes that providers must use to file claims add to the complexity.

Physicians must also account for what is perhaps the biggest variable of all: the patient. Continue reading

Mass. Survey: Happy With Health Care, Concerned About Costs, ER Use Up

(Source: Massachusetts Medical Society)

(Source: Massachusetts Medical Society)

Last month, the Massachusetts Medical Society released its findings on how hard it is to get in to see a primary care doctor in the state. Reminder: Often pretty hard.

Today, the society dropped the second shoe of its state-wide data on the health care system: So how are we feeling about it?

Today’s bottom lines: We’re still generally very satisfied with the care we get, but man, those medical bills are high and ever higher. And emergency room use is up 6 percent — not something that is supposed to happen under health care reform. From the press release:

Seven years into health care reform, and despite longer wait times for appointments with physicians, Massachusetts residents remain as satisfied with the health care they receive as they were before reform began and are finding access to the care they need without difficulty, according to a public opinion poll released today by the Massachusetts Medical Society, the statewide association of physicians.

The poll, seeking the opinions and perceptions of Massachusetts adults on a range of health care issues, also revealed that residents think the cost of care is the most important health care issue facing the Commonwealth, that residents have limited knowledge and unfavorable opinions of the new types of health plans and care models, and that more adults are using the emergency room for care.

The nuts and bolts:

The Society’s Public Opinion Survey of Health Care in the Commonwealth has been conducted periodically since 2003 as part of the Society’s continuing effort to gauge patient opinions of health care in the state. The 2013 survey was conducted by telephone May 14-16 and included 417 randomly selected interviews with adults 21 and over. Major findings:

Top Concerns: Cost and Affordability
When asked to choose among cost of care, access to care, and quality of care, 78% of respondents say that the cost of care is the most important health care issue facing Massachusetts today. When asked a separate, similar, open-ended question, 45% indicated that affordability is the most important issue.
65% of residents believe their health care costs are more expensive than last year, including 28% who think they are “much more expensive” and 37% who believe costs have increased “somewhat.” Continue reading

Mass. Med Society Chief: Reform Means Patients Have To Change, Too

Massachusetts Medical Society President Richard Aghababian (Courtesy of MMS)

Massachusetts Medical Society President Richard Aghababian (Courtesy of MMS)

There was no time to really talk in the State House hubbub before Gov. Deval Patrick signed the new health cost control plan into law on Monday. But the president of the Massachusetts Medical Society, Dr. Richard Aghababian, shared a quick line that intrigued me, something about how health reform means that patients have to change, too. We continued the conversation today; here it is, lightly edited:

So what did you mean at the State House, that the cost-control era will involve new responsibilities on the part of the patient?

My thoughts are that if the citizens of Massachusetts want to control the costs of health care, not only do we have to change doctor-hospital-nurse behavior but we also have to change patient behavior. If we want to be leaders in this movement toward getting more people covered and improving the quality of health care outcomes, we as individuals all have to participate.

I would think, in particular, that under this next phase of health reform, doctors will be bearing more financial responsibility for their patients’ health, but so much of their patients’ behavior is out of their control…

What could undermine this undertaking is if doctors and all health care workers work very hard at improving their efficiency and trying to obtain the best outcomes possible for their patients, and the patients don’t cooperate. And cooperation involves taking the best care possible of themselves, and if they have an illness, taking the medications as prescribed for them, exercising or eating properly as prescribed and, very importantly, reporting their progress accurately to aphysician.

If people don’t do what they should, don’t take responsibility for their own health, should they be penalized?

For example, if you’re a diabetic and you’re monitoring your blood sugar with a home device, or if you’re hypertensive and you should be monitoring your blood pressure, write down what the numbers are when you take the measurements and bring that in to the doctor to review with you. If the doctor gives you instructions about Physical Therapy or eating properly, either ask for written instructions or write something down that you can use to remind yourself. Or bring a friend to help you understand and remember your instructions. And lastly, keep a log of what you are doing when it relates to whatever treatment has been suggested; write down what you’ve done.

Are you planning a guide on how to be a better patient? Continue reading

Latest Report On Access To Mass. Doctors: Mostly Stable Condition

(Lucia Sofo via Wikimedia Commons)

The latest report on access to medical care in Massachusetts is looking just about half-full — or half-empty, depending on your disposition. The good news is, the waiting times to see Massachusetts doctors are not generally getting worse, and some even slightly improved. The bad news is, it can still take a month or more to get an appointment — and only about half of primary care doctors are taking new patients. Half of residents surveyed say affordability is the biggest issue in health care.

WBUR carries the AP report here, including:

Access to primary care doctors in Massachusetts improved slightly in 2012, although about half still say they aren’t accepting new patients, according to a Massachusetts Medical Society survey released Wednesday.

The survey found 51 percent of internists and 50 percent of family doctors say they are taking new patients. That’s a small improvement from last year, when 49 percent of internists and 47 percent of family doctors were accepting new patients. Continue reading

Mass Docs Not Exactly Ready For Global Payments, Survey Finds

(Sonarpulse/wikimedia commons)

There’s a sense of inevitability about global payments here in Massachusetts. While intense debate continues about how effective this lump-sum, per-patient budgeting system really is, there’s no doubt that it’s starting to take hold.

So it’s slightly unnerving that a survey conducted by the Harvard School of Public Health for the Massachusetts Medical Society found that only 29 percent of doctors said they were ready to enter into such payment arrangements, and less than half believe that global payments will reduce medical spending.

The latest MMS survey, which we covered earlier here (the survey has just now been finalized) included “572 physicians, 290 who work in solo or small single-specialty practices, and 282 who work in larger, multi-specialty groups or groups connected to hospitals.”

Her are some more key findings:

–While 67 percent of respondents reported having access to computer systems for managing some types of clinical information, only 7 percent said they had computer-based systems that permit clinical information exchange, communication, and management both inside their group and with physicians and hospitals outside of their group.

–Only 29 percent reported that their group is ready to enter global payments contracts, and only 21 percent said their group is both ready to enter such contracts and large enough to provide comprehensive care, Continue reading

Two Leading Pediatricians: For Children’s Sake, Tax Soda

At the State House this morning, pediatricians and other health-promoters concerned about obesity officially launched a concerted campaign against sugary drinks and candy. Central to their efforts: a bill to remove the sales tax exemption on soda. Here, two leading Massachusetts pediatricians lay out their arguments.

By Dr. Lynda Young and Dr. Barry Zuckerman

Thirty years ago, a typical pediatrician in Massachusetts might see a single obese child in their office every day or so. Now we see as many as five a day and another four to five who are overweight.

Some of these young patients are already suffering from the health effects of obesity: high blood pressure, heart and liver issues, or Type II diabetes. If these trends are not reversed, many of these children will be destined to live shorter lives than their parents.

‘As pediatricians, we have never seen a medical problem of the breadth and scope of obesity.’

As pediatricians, we have never seen a medical problem of the breadth and scope of obesity. Over the last 15 years alone, obesity rates in Massachusetts have doubled, with one in every three children now either overweight or obese, leaving the state with the 33rd worst childhood obesity rate in the nation. Meanwhile, obesity-related medical costs will add some $1.8 billion a year to the Commonwealth’s already strained health care system.

Preventing and reversing the obesity crisis has become a paramount medical concern for pediatricians across the Commonwealth. As physicians and physician-educators, we see the devastating impact of obesity every day, despite our daily warnings to patients, their families and the public about the importance of taking immediate action to prevent unhealthy weight gain.

One opportunity before us right now is legislation to eliminate the tax exempt status on soft drinks and candy. Nearly fifty years ago, when Massachusetts adopted a sales tax, it decided to exempt the sale of food items. Other essentials of daily life, such as clothing, were exempted as well.

Of course, this was years before the obesity epidemic began to sweep the country. Today, soft drinks can hardly be considered essential food items. To the contrary, overconsumption of sugary beverages has become a major threat to public health, and obesity-related conditions will likely eclipse smoking as the leading preventable cause of death. Continue reading

Major Battle Over Assisted Suicide Brewing In Mass.

A London hospice patient

Mark my words: There’s a great big battle brewing in Massachusetts over helping terminally ill patients commit suicide.

That’s not an original thought; in fact, a post last month on the New Old Age blog at was headlined “The Next Death-With-Dignity Battleground” and described energetic efforts to put the issue on next year’s Massachusetts ballot.

But the signs are multiplying that the battle is indeed on its way. The group behind the ballot initiative, Dignity 2012, gathered nearly 80,000 residents’ signatures, which seems to be a comfortable margin over the 70,000 or so needed to put a measure on the ballot. And this weekend, delegates at a major meeting of the Massachusetts Medical Society voted to reaffirm their opposition to physician-assisted suicide, according to a society press release. It begins:

The Massachusetts Medical Society, the statewide association of physicians with more than 23,000 members, today voted to reaffirm its opposition to physician-assisted suicide, with its House of Delegates voting by a wide margin to maintain a policy the Society has had in effect since 1996.

Opposition to physician-assisted suicide was part of a larger policy statement that includes recognition of patient dignity at the end of life and the physician’s role in caring for terminally-ill patients. The policy was approved by more than 75 percent of the Society’s delegates.

Lynda Young, M.D., president of the Society, said that “Physicians of our Society have clearly declared that physician-assisted suicide is inconsistent with the physician’s role as healer and health care provider. At the same time we recognize the importance of patient dignity and the critical role that physicians have in end-of-life care.”

Stephen Crawford, spokesman for Dignity 2012, responds that the measure as proposed — the full language is here — is not about “physician-assisted suicide.”

“What this question will allow under Massachusetts law,” he said, “is for terminally ill patients to ask their doctor to prescribe life-ending medicine. That is not physician-assisted suicide in the sense we traditionally think of it. These are self-administered drugs.” Continue reading

Why Romneycare Is No ‘Dead Hooker,’ Even With The Latest Doctor Wait Times

I was watching Bill Maher interview Gov. Deval Patrick the other night, and one of his questions made me shout with laughter. Why oh why, he asked, does former Gov. Mitt Romney act as if being linked to the Massachusetts health reform he helped put into place is such a political liability it’s like “being chained to a dead hooker?”

The “dead hooker issue” is particularly germane today for two reasons: Romney is scheduled to give a major speech today in Michigan about health care (See today’s sage report by WBUR’s Fred Thys on how the issue is playing in New Hampshire.) And the Massachusetts Medical Society has just put out its latest survey results on how long patients here must wait to see doctors. Opponents of Romneycare-style health reform are spinning the slight lengthening in wait times as further proof that the reform is bad here, and will be worse nationally.

But in The New Republic, senior editor Jonathan Cohn writes here in a piece titled “Defending Romneycare (because Romney won’t do it)” that he sees quite a different spin.

…The report tells a far more complicated story, one that may not have much (if anything) to do with health care reform. And since Romney himself isn’t making this case–I assume he just wishes the whole topic would go away–let me give it a shot.

While the long waits for physician services in Massachusetts seem real enough, the very same survey reveals that the long waits existed before Romney’s law took effect in January, 2007.

He shares some graphs of gastroenterology and internal medicine wait times, and says:

Reported wait times go up and down, year to year, which is precisely the sort of statistical noise you’d expect from a survey that relies on small samples size and the non-scientific testimony from physicians. Evidence of longer waiting times since the introduction of Romney’s plan seems thin, at best.

Elsewhere, it appears that primary care physicians (although not specialists) are becoming less likely to see new patients. And that’s certainly worrisome. But that decay was also underway before the Massachusetts reforms: It doesn’t appear to have accelerated starting in 2007.

His bottom line: Continue reading

Patrick To Doctors: I See Your Winks And Nods

Call me a muckraker, but I thought Gov. Deval Patrick sounded a bit peevish at one point today when he spoke to more than 200 doctors who’d come to the State House to lobby their legislators.

He’d just laid out his determination to proceed with the next, cost-containing stage of health care reform, despite the great complexity of the challenge. (He phrased it much as he did at Harvard recently — here’s that text.) Then he told the doctors that he saw them exchanging looks across their tables, “the furtive glances you’re casting, winks and nods. Let me tell you, we are going here, to integrate accountable care organizations, we are going there together.”

The video is above. He concludes:

“We have got to deliver on what is ultimately a values statement, and that is that health is a public good, and everyone in this commonwealth deserves access to adequate, cost-effective care.”

The Massachusetts Medical Society, which organized the doctors’ visit to the State House today, is arguing for a dozen main elements in Patrick’s proposed payment reform, as expressed in talking points that the society distributed to the visiting doctors today. They include:

-Physician directed authority: Physicians will make most of the clinical decisions under a new health care model, so it’s only logical that they are at the center of decision-making, both at the public policy level and the clinical level. Continue reading

State Medical Society Just Says No: To Podiatrists, Midwives and Optometrists

The Massachusetts Medical Society was busy today trying to block a slew of health bills that would give certain providers, ranging from naturopaths to nurse midwives and physician assistants, greater authority and scope in their practices. (And thereby, theoretically, diminish the power of physicians).

The Society’s opposition to the nine bills before the Joint Committee on Public Health, “is based on its belief that, should these bills be enacted, diminished patient safety for Massachusetts residents could result,” the organization said in a press release. Here are a few of the legislative proposals they oppose, in their own words:

— House 2367 – An Act to Create a Board of Registration in Naturopathy – Saying that naturopathy is “a hodge-podge of nutritional advice, home remedies, and discredited treatments,” the MMS opposes a bill that would make naturopathic doctors licensed health care providers in the Commonwealth.

–House 1476 and Senate 1145 – Acts Relative to the Registration of Podiatrists – These are identical bills that would extend the scope of practice of podiatry beyond the diagnosis and treatment of the foot to include the ankle and the leg below the knee. The MMS said “this is an unfortunate example of non-physicians seeking to practice medicine without having to undergo the educational and training requirements demanded of all medical doctors or orthopedic surgeons.

–House 2348, House 2357, and House 3163, Acts relative to optometric patient care – These bills would expand the practice of optometrists by allowing them to prescribe oral therapeutic medications. MMS opposes these bills because there is sufficient access to ophthalmologists to treat any eye disease and that optometrists are seeking to expand their business at the expense of their patients.
“Doctors of optometry are not medical doctors” the MMS said, and “optometry is a different profession from the treatment of disease.”

–House 2369 – An Act Relative to Enhancing the Practice of Nurse Midwives – The Medical Society opposes this bill because it repeals the existing legal structure for nurse midwifery as practiced in Massachusetts for decades and “severs the connection between nurse midwives and obstetrician gynecologists and eliminates a requirement to work with a hospital-based team.” The Society said it believes that the existing statutory requirements contribute to our good outcomes, convey a public protection benefit and have no negative impacts whatsoever on patient choice to work with nurse midwives. “If the decision were to be made for the best interest of children,” the Society concluded in its testimony, “the decision would be clearly not to support legislation designed to eliminate or minimize physician participation in obstetrics.”

–House 1520, An Act Encouraging Nurse Practitioners and Physician Assistants of Primary Care and House 1477, An Act to Streamline Health Care Services by Allowing Nurse Practitioners to Verify Medical Papers and Records – The bills seek to eliminate the word “physician” from current state statutes and instead use the term “provider,” raising the issue of the statutory role of physicians in patient care. While it would eliminate the word ‘physician’ from statutes, the bill offers a nebulous definition of primary care provider to the public health laws of the Commonwealth. The bills also strike out the current law requiring that the name of a supervising physician be listed on prescriptions of physician assistants…”

Are there any nurse midwives, podiatrists or physician assistants out there who care to respond? Please…