Proposed Caps for Massachusetts Doctor Payments Could Lead to Shortages

Published June 23, 2009

A new piece of legislation in Massachusetts could fundamentally change the conditions of licensure for doctors in the state, requiring them to accept reduced pay and commit to seeing certain patients.

Senate Bill 2170, introduced by state Sen. Richard T. Moore (D-Uxbridge), has the support of the Massachusetts Association of Health Plans, a non-profit representing 11 health care plans in the state. It would compel doctors to accept specific patients, predominately from the small business community, with an insurance plan that will pay them at rates of Medicare plus 10 percent before they could become a licensed doctor in the state.

‘Over Our Dead Body’

Mario E. Motta, M.D., president of the Massachusetts Medical Society (MMS), strongly opposes the proposal.

“It will pass over our dead body,” Dr. Motta said.

“The insurers in the state artificially lumped high-risk pool patients with small businesses to try and spread the cost, but small business groups have lots of insurance claims, and because of that, Gov. Deval Patrick and a number of other people are up in arms, and appropriately so, because insurance has become unaffordable for small business. Large companies and other risk pools are much more stable, but small business pools have high fluctuation in rates because of this decision to pool high-risk patients with small business,” Motta explained.

Massachusetts’ Commonwealth Care plan has reduced the uninsured population in the state from 6 percent to 4 percent, but rising health care costs and doctor shortages continue to plague the Bay State. According to an annual study conducted by MMS in June 2009, a total of seven physician specialties are operating under “severe labor market conditions,” including Ob-gyns.

“The percentage of primary care practices closed to new patients is the highest it’s ever been as recorded by the Medical Society,” the report found.

MAHP Supports Capping Profits

Eric Linzer, senior vice president at the Massachusetts Association of Health Plans, argues Senate Bill 2170 is a good piece of legislation which will reduce costs for Massachusetts. He claims another piece of legislation introduced by Rep. Harriett Stanley (D-West Newbury), House Bill 4452, will sunset the 2170 measure, making it expire at the end of 2012.  

“This idea was to build on the idea of shared sacrifice between health care providers and health care insurers in the state, and 2170 sets a statutory reimbursement rate for one product in the insurance plans at 10 percent above the Medicare rate. It also requires that insurers in Massachusetts cannot make more than a 2 percent profit, and it reduces small business’ health care premiums by 22 percent,” Linzer said.

Fewer Doctors, Higher Costs

Motta believes doctors will feel the pinch if Senate 2170 passes. Because they will be expected to see patients at dramatically reduced rates, new doctors will be hesitant to come to Massachusetts, and with fewer doctors will come higher costs and longer wait times, he argues.

“Who in their right mind as a student or a resident would want to set up shop in Massachusetts?” Motta asks. “Already, there are 38,000 licenses in the state, but only 22,000 of those actually have addresses in Massachusetts, [and] out of those a large number are retirees and a number work in research and work maybe one day a month at Massachusetts General. So the real number of doctors in the state is already low— it’s practically in the teens.”

Motta believes 2170 is an attempt to cover over mistakes inherent in the Commonwealth Care system.

“This is a manmade problem, the result of the universal health care law that was forced by the legislature, a policy designed to get everybody insured. 2170 tries to solve this by making it a part of a condition of licensure, without thinking of the consequences of a system that desperately needs more doctors,” Motta said. “This bill is just the beginning of more harebrained schemes by a few people in legislature who have taken over the practice of medicine in Massachusetts.”

Thomas Cheplick ([email protected]) writes from Cambridge, Massachusetts.

Internet Sources:

Massachusetts Legislature: Senate Bill 2170:

Massachusetts Medical Society 2009 Workforce Survey: