Plans to control doctors' pay big in Massachusetts, not so much in Washington

Aug 5 2009

Massachusetts officials are proud of their low rate of uninsured people, but the state also hosts the highest health care costs in the country, a problem that jeopardizes their achievement in expanding coverage, NPR's Morning Edition reports.

A commission charged with overseeing the insurance plan for 310,000 government workers recently voted – unanimously – that doing away with the current, fee-for-service model for paying doctors was the first step to controlling those costs. "Massachusetts policymakers want to replace fee-for-service with 'global payment' — paying groups of health providers a flat yearly fee for each patient they cover," NPR reports (Knox, 8/5). 

Responding to a viewer's question about whether similar plans to set physician rates are being considered in Washington, CNN health correspondent Sanjay Gupta said, "Nothing's been set in stone but… we are hearing for example, there may be caps on out of pocket expenses and full coverage for things like preventive care. There is no plan in any of bills so far to set prices across the board across the country" (8/4).

Doctors, meanwhile, are growing antsy about their fees under the current system. "Insured patients typically expect to make a small co-payment when they see a doctor, and later get billed for anything else they owe. But physicians no longer want to wait for their money," the Wall Street Journal reports. Some doctors are asking patients for co-pays as well as other out-of-pocket portions, such as their deductible or co-insurance, before leaving after an office visit or receiving a procedure. Practices report collecting only 50 percent of their charges if they bill patients after they leave the office, and only 10 to 20 percent from uninsured people.

However the new policies sometimes put patients in difficult positions: "Mary Lou Hatch, 43, of Surprise, Arizona, delayed the start of chemotherapy for her breast cancer earlier this summer because the oncologist demanded $450 from her in advance" (Matthews, 8/4).