First in Massachusetts


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Subtitle: What we learned about health care reform and our members that could help you." Presentation to the ASAE Health Care Association Conference: Nov. 8, 2011

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  • The Massachusetts Physician Practice Environment Index (Massachusetts Index), a statistical measure of the factors that affect the delivery of patient care from physician practices, declined 0.9 percent in 2010. It was the Massachusetts Index’s 16th decline in the last 17 years. During the same period, the statistically comparable U.S. Physician Practice Environment Index (U.S. Index) declined by 0.5 percent. The continued deterioration in the Massachusetts Index in 2010 resulted primarily from increases in two weighted variables; these were:Professional liability insurance premium ratesPercent of physicians 55 years of age and over The deterioration in the United States Index in 2010 resulted primarily from increases in two weighted variables; these are:Percent of physicians 55 years of age and overCost of maintaining a physician’s practice
  • Physician labor markets in Massachusetts tightened over the past year with family medicine and internal medicine continuing to trend toward severe and critical labor market shortages. Current data from the practicing physician survey demonstrate that eight of the 18 physician specialties studied met the criteria for critical or severe labor market conditions. This is a decrease from 2010 when ten specialties were in short supply. Emergency medicine, neurology, and vascular surgery were in shortage last year but have dropped off the list this year while neurosurgery was added to the list of specialties in shortage.Nine specialties have been operating within tight or tightening labor market conditions for the past three to six years: family medicine, internal medicine, dermatology, neurology, urology, psychiatry, general surgery, orthopedics, and vascular. For all practicing physicians in the MMS Physician Workforce Survey, it is clear that since 2008 the special problems of an inadequate recruitment pool as well as the degree of difficulty to fill vacancies have lessened. This rather sharp fall off is, without question, significant, but one must not lose sight of the fact that roughly one half of the physicians are stating that recruitment is a problem. For the physicians this remains a special labor market issue that will simply not go away. Both recruitment and retention of physicians in the state remain difficult: 55 percent of physicians had difficulty filling vacancies, and 52 percent believe the pool of applicants is inadequate. While recruitment time over the past three years has improved somewhat -- 44 percent of physicians in 2011 say time to recruit has increased versus 49 percent in 2010 -- the mean time to recruit a physician is 12 months or more for nine of the 18 specialties examined. 38 percent of physicians reported retention becoming more difficult. For the first time in the ten years of the Medical Society’s Workforce Study, as many physicians are as satisfied (42.3%) with the practice environment in Massachusetts as are dissatisfied (42.3%). While this is a result of more physicians expressing satisfaction with the environment, it remains that less than half of all physicians are satisfied with the practice environment.
  • The 2011 MMS Physician Workforce Study indicates a trend towards longer wait times for new patient appointments across Massachusetts. Four of the seven types of specialties included in the study report longer wait times than last year, two remained statistically the same, and just one reported a shorter wait time. Specialists reporting longer wait times include orthopedic surgeons (26 days, up from 17 days), gastroenterologists (43 days, up from 36 days), OB/GYN (41 days, up from 34 days) and family medicine (36 days, up from 29 days). Internists are the only specialists reporting significant shorter wait times compared to last year, although at 48 days on average they still have the longest waits. Last year the average wait to see an internist for a new patient appointment was 53 days.  The number of offices accepting new patients remained relatively stable since last year. Internists (49%) and family medicine physicians (47%) continue to be the least likely to be accepting new patients. Orthopedic surgeons (97%) and gastroenterologists (95%) are the most likely to be accepting new patients.
  • This demonstrates the extreme pressure facing the state budget in recent years.When the recession hit, billions of tax dollars suddenly disappeared – while expenses such as Medicaid and education were increasing.There was unbearable pressure to act.These numbers include all revenues – taxes, fees, and other income
  • First in Massachusetts

    1. 1. First in MassachusettsWhat We Learned About HealthCare Reform and Our Members That Could Help You
    2. 2. The Political LandscapeAfter Universal Access• 2006: Access addressed; costs not addressed (Chapter 58)• 2008: Anything and everything to do about costs: The anticipated and the unanticipated (Chapter 305)• 2010: Rate regulation (Chapter 288)• The Attorney General’s report• Medicare payment updates• Debt ceiling problem
    3. 3. Research and Process• Comprehensive research: physician workforce, access to care, quality and the practice environment – Did not address the important issue of cost of care• Feedback gathered from physicians on practice issues and patient concerns (surveys and interviews)• Leadership forums with national experts ( e.g. Elliott Fisher, MD)• Frequent discussions with MMS leadership and key stakeholder decision makers about universal access to care
    4. 4. MMS Physician PracticeEnvironment Index110.0 101.4 101.8 101.1 100.0 100.4 99.3100.0 102.2 100.9 100.0 98.3 96.3 92.9 91.6 94.5 90.0 92.1 88.7 91.0 85.9 84.3 86.4 81.7 U.S INDEX 83.9 80.0 78.9 77.8 77.8 77.9 77.6 80.8 77.0 77.6 78.4 76.5 76.4 74.6 75.3 74.2 73.5 72.8 70.0 MA INDEX 60.0 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
    5. 5. MMS 2011 PhysicianWorkforce Study Dermatology Severe Family Medicine Severe General Surgery Severe Internal Medicine Critical Neurosurgery Severe Orthopedics Severe Psychiatry Critical Urology Critical• Recruitment and retention of physicians in the state remain difficult – 55% of physicians had difficulty filling vacancies – 52% believe the pool of applicants is inadequate – 44% say time to recruit has increased – 38% reported retention becoming more difficult• For the first time in the 10 years of the study, as many physicians are as satisfied (42.3%) with the practice environment in Massachusetts as are dissatisfied (42.3%)
    6. 6. MMS 2011 PhysicianWorkforce Study Average New Patient Wait Time (days) 48 Internal Medicine 53 43 Gastroenterology 36 41 OB/GYN 34 36 Accepting New Patients Family Medicine 29 28 Cardiology 26 97% 26 Orthopedic Surgery 95% Orthopedic Surgery 17 95% 24 Gastroenterology 90% Pediatrics 24 85% OB/GYN 88% 2011 2010 82% Cardiology 88% 73% Pediatrics 80% 49% Internal Medicine 51% 47% Family Medicine 46% 2011 2010
    7. 7. Internal Processes• Task Force on Health Reform – 2005 to the present – Universal Coverage to Cost Drivers
    8. 8. Internal Processes• Task force principles – Support for universal insurance coverage – Support for individual and employer mandates – Bi-modal approach to expand public and private payer responsibilities• MMS served on state commissions• MMS leadership met with legislators & administration
    9. 9. Internal Processes• State asks MMS to gather physician feedback: focus groups on payment reform/global budgets• One size doesn’t fit all• Voluntary participation – Infrastructure support – Transparency – Proper risk adjustment – Risk management skills – Patient expectations – Good data from the payers – Patient incentives – Anti-trust reform – Malpractice reform – Culture and leadership
    10. 10. Health Reform ContinuesWith the Focus on Costs• New commission on payment disparities• MMS asked to again hold focus groups with physicians for solutions• MMS educational forums address cost of care• ACO Solution Center – MMS creates new center to support physicians regarding the changing paradigm in health care reform
    11. 11. Getting the Word Out
    12. 12. Key Audiences Legislators Members Persuade Educate
    13. 13. Our Membership PCPs Specialists Loved It Not so much
    14. 14. The Road Show• Why it’s important• Share research• What it could mean to them• The political realities
    15. 15. Key Driver: Private Sector Costs600 Per Capita MA Health550 Expenditures: 550 in 2020500450400 Per Capita350 MA GDP: 337 in 2020300 MA Wage and Salary:250 325 in 2020200 MA Consumer 1991=100 Price Index150 (CPI): 224 in 202010019 119 219 319 419 519 619 719 820 920 020 120 220 320 4 0520 620 720 820 920 020 120 220 320 420 520 620 720 820 9 20 9 9 9 9 9 9 9 9 9 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 11920 Per Capita Health Expenditures Per Capita GDP Average Wage and Salary CPI Boston Source: Payment Reform Commission/Mass. Dept. of Health Care Finance and Policy
    16. 16. Key Driver: State Revenues$ Billions Fiscal year Source: Mass. Taxpayers’ Foundation * Estimate
    17. 17. Key Driver: Variation in PricingSource: Mass. Office of the Attorney General. Examination of Health Cost Trends and Cost Drivers. March 16, 2010
    18. 18. What We Used
    19. 19. The Commission Reports
    20. 20. On The Road Again
    21. 21. More Content
    22. 22. The Governor’s Pitch …
    23. 23. ... and ours
    24. 24. Doctors’ Day
    25. 25. What We Learned …• Getting the membership engaged on costs - Give them a voice (Focus groups, etc.) - Let them debate - Feed back to them what they say (Communications) - Convincing the members on issues that will/will not work - Repeat early and often• Develop mechanisms to continuously evolve as outside forces change• Engage external stakeholders on members’ issues• Coalitions remain important
    26. 26. Contact InformationCharles Alagero, Esq. Frank Fortin, CAEVP and General Counsel Chief Digital Strategist and(781) 434-7001 Communications (781) 434-7099 ffortin@mms.orgElaine Kirshenbaum, MPH @frankfortinVP, Health Policy, Planning andMember Services(781) 434-7223ekirshenbaum@mms.orgDownload this presentation at