ASPS Acts in Massachusetts to Protect Plastic Surgeons

This month, the Massachusetts legislature continued to work through a backlog of health care issues created by recent squabbles between the state's Senate and General Assembly. The Joint Committee on Public Health discussed a bill that would require new physician practices performing office based surgery to obtain an extremely costly certificate of need (CON), while the Joint Committee on Financial Services held a hearing on a bill that would require insurance companies developing physician quality measures to adhere to certain legislated standards.

Office Based Surgery — Certificate of Need

ASPS worked with the Massachusetts Medical Society, which was able to provide background and details about their local efforts, and developed comments to the Joint Committee on Public Health strongly opposing the CON bill. The increased burdens this bill carries would make it harder and harder for solo practitioners and small practices to survive, would drive up the cost of health care delivery, and would decrease patient access to care.

More specifically, this bill would broadly define a new category of health care facility, namely a "specialty health care provider". This new category would require many new physician office practices to be licensed as a clinic and obtain a CON prior to initial licensure. Many physicians and clinics will simply not have the time and resources it requires to obtain a CON, which could make the effects of the growing national physician shortage more acute in Massachusetts.

Insurance Company Quality Measure Development

ASPS weighed in on a second bill in Massachusetts, H.B. 906, which would require insurance carriers to adhere to legislated guidelines when developing physician performance evaluation programs. ASPS communicated to the legislators that although physician rating and tiering systems are not ideal representations of quality care, the bills efforts to ensure that any such systems follow reasonable standards is a positive development.

ASPS voiced that the legislation should support the notion that physician performance should be evaluated in a manner that is unbiased and is relevant to physician's specialties and practices. ASPS specified that performance evaluation programs should: 1) be required to allow for sufficient physician review prior to publication of the results used to develop their ratings; 2) allow for physician input into the initial structure of program components; and 3) require insurers to be collaborative and transparent.

ASPS, also suggested amendments to the bill that would: 1) expand a provision requiring meaningful input by independent practicing physicians to ensure that specialists are tapped to provide input when questions arise about specialty-specific or specialty-intensive quality or resource use measures; and 2) include additional protections for specialists for whom meaningful, adequate and relevant quality measures have not yet been developed.

Both bills were heard for discussion only on December 8 and, consequently, were not called for a vote. ASPS's government affairs staff continues to monitor these issues in state legislatures to ensure that the voice of Plastic Surgery is heard.