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A Renewed Commitment to Community Medicine
The 2007-08 Agenda
Massachusetts has embarked on a bold plan to improve
the quality of life of its citizens. Simultaneously,
we are addressing health reform, creating conditions
to expand our local economies, and creating new educational
opportunities. Community medicine can be an important
tool in supporting the above goals. By providing locally
based care we can be more focused on improving the health
status of our citizens at an affordable cost. By improving
access to health training programs we create new employment
opportunities. By expanding employment we contribute
to improving local economies and add greater value.
The following actions contribute to stabilizing the
primary and secondary care level of services and create
conditions for appropriate expansion to meet rising
new needs for care in our elderly population:
Regulatory and Reimbursement
We must have a level playing field in all aspects of
funding levels in all public programs and payment distribution
schemes. We need to have the Safety Net Trust Fund adequately
funded and the fee schedules with little variation from
one provider to another. The hospital assessment should
apply to all providers of similar services. For profit
niche providers, such as ambulatory surgical centers,
require greater control over licensure, inspection and
expansion subject to a Determination of Need (DoN).
Primary Care Physician reimbursement levels must be
raised.
Equity in Resource Allocation
We must put aside institutional self interest in favor
of greater cooperation and collaboration in order to
achieve ambitious goals. Greater transparency in Medicaid
funding schemes will contribute to greater accountability
for results and better outcomes for this population.
A stronger DoN process can help insure a better distribution
of resources state wide and mitigate a perception that
all funding decisions are Boston centric. A new health
planning function at DPH that focuses on identifying
the right care, at the right time, and at the right
place will lead to a better allocation of scarce resources.
Improve access to capital
We must not have two different levels of care in the
Commonwealth. Instead, community hospitals must have
access to the same types of information systems that
improve the quality of care as the well financed teaching
hospitals; Electronic Medical Records (EMR) and Computerized
Physician Order Entry (CPOE) are technologies that should
not be used as a basis of competition. We must also
have funding pools created to allow all of our hospitals
to access these technologies; in fact, many of our hospitals
currently have an impaired access to capital. Finally,
we must have financial flexibility to enter the capital
markets at the lowest cost of capital; authorizing HEFA
to issue moral obligation bonds will create a new low
cost route to capital.
Improved Workforce development
Strengthening the primary care physician supply is essential
to supporting expanded coverage. New incentives such
as tuition forgiveness programs at UMass Medical School
attached to commitments to practice in Massachusetts
community settings should be identified and implemented.
Strengthening the quality and supply of other key clinical
resources is a necessity as well. The absence of clinical
faculty at our community colleges and other educational
institutions is a current chokepoint seriously interrupting
the labor supply. Grants to health providers and educational
institutions to recruit and retain clinical faculty
are necessary to meet rising needs.
The following filed legislation meets some of the
needs identified above:
- H2063-addresses the need for improved licensing
of ambulatory surgical centers and requires new ASC's
to undergo a DoN process. This bill is with the Joint
Committee for Public Health.
- H2065-eliminates physician Letters of Exemption
(LOE) for certain technologies (e.g. MRI) that bypass
the DoN process. This bill is with the Joint Committee
for Public Health.
- S2368-Creates a community hospital capital reserve
fund that allows HEFA to issue moral obligation bonds.
Approved by the Joint Committee on Health Care Financing.
Currently at the Joint Committee on Bonding, Capital
Expenditures and State Assets for review.
- S692-creates a Commission to determine the capital
needs of community hospitals. Currently moving with
the Joint Committee on Rules.
- House Docket 4332-allocates the current $160 million
assessment on hospitals to support the health care
safety net trust fund to include niche providers and
clinical laboratories.
The following proposed budget line items, in addition
to meeting some of the needs identified above, recognize
the important role community hospitals play in providing
new and innovative systems to continue to ensure the
safe and effective delivery of community medicine; as
well as recognizing the important role community hospitals
play in partnering with local community and state colleges
in order to improve the local economy and the delivery
of community medicine by developing and employing a
highly skilled workforce.
Establish a $30 million technology investment program
for community hospitals for the acquisition and/or operating
costs of electronic medical records and computerized
physician order entry systems with a $500,000 individual
provider limit.
Establish a fund of $5 million for the purpose of expanding
community hospital primary care physician programs through
outright grants and/or UMass Medical School loan forgiveness
programs provided such recipients commit to practicing
in a community hospital setting for a certain number
of years.
Establish a fund of $5 million for the support of clinical
faculty at community and state colleges for the purpose
of expansion of the clinical workforce where access
to this fund is predicated upon community hospitals
providing a 25% contribution and a commitment to provide
internships as appropriate.
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