A new survey from the Massachusetts Medical Society reveals interesting divisions among doctors over plans to hold down health care spending -- and perhaps some words of warning for lawmakers.
More than half -- 58 percent -- of the 1,100 doctors who responded to the society’s survey this year said they would not voluntarily agree to treat patients under so-called global payments.
Global payments, which are considered one of the best hopes for saving money on medical care, put providers on a monthly per-patient budget for care. That’s a big change from the current fee-for-service system, which allows doctors and hospitals to bill for each separate service rendered to a patient, with few limits on the number of services.
Primary care doctors were more accepting of global payments than specialists; just 32 percent of specialists said they would voluntarily participate in the system.
These responses may be instructive for legislators, who are working to finalize legislation that could include strong incentives for global payments. They may have to be ready to mandate the change to a new payment system and provide financial assistance with the transition, or at least be prepared for an intense educational campaign to bring doctors around.
The medical society did not ask doctors why they’re skeptical, but preliminary findings from a separate survey of physicians, conducted by the Harvard School of Public Health, found that many doctors don’t have the computer systems necessary to manage clinical information and keep track of patients’ tests and hospital visits.
Dr. Lynda Young,cq president of the medical society, said the findings underscore the need for the state to move carefully towards a new care system. “While the medical society believes a shift to global payments and (accountable care organizations) may help in cost control,” she said in a written statement, “a one-size payment model does not fit all physician practices. Any shift to a new payment system must be made deliberately and carefully, to adjust for risk, be fully transparent, include proper quality measurements and data, provide sufficient resources for proper patient care, meet patient expectations, and avoid unintended consequences.”
For complete results of the survey, including information on which specialties are experiencing doctor shortages, go here.
Liz Kowalczyk can be reached at kowalczyk@globe.com.