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.