It looks like Massachusetts regulators are are intent on bringing a next-gen form of capitation back, under a different name and a slightly different structure. While regulators say that this payment model is needed to rein in the growth in health costs, hospital leaders say this approach has the potential to wreak financial havoc among hospitals if rolled out too quickly.
This summer, a commission recommended that both private and public health plans in the state drop the fee-for-service payment system. Instead, it argued, insurers should pay providers standardized per-patient annual fees known as global payments, designed to cover care for the entire year--and suggested that the change could be rolled out within five years. The state's proposal also assumes that doctors and hospitals who score high on quality measures would get extra payments.
To manage global payments, doctors and hospitals would have to join into larger entities known as accountable care organizations, which would hopefully coordinate patient care so efficiently that they'd be able to stay within budget for their patient population.
To make sure hospitals don't get flattened by these changes, the state hospital association wants to see several changes in the proposal, including rules protecting providers from risks they can't control or afford (such as a major swine flu outbreak), extra pay for providers treating low-income patients and for teaching hospitals bearing training costs, research and 24-hour trauma services. They also want to be sure that the state makes it voluntary for providers to participate during the initial stages of the global payment rollout.
To learn more about this dispute:
- read this piece from The Boston Globe
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