Bill Would Set Primary Care Expenditure Targets for Massachusetts

A bill in the Massachusetts Legislature would establish an aggregate primary care spending target for the Commonwealth, as well as a prospective payment model for primary care physicians.

The invoice, S.750, introduced by Senator Cindy F. Friedman, calls for the target to increase from 8 percent of total Commonwealth health care spending for calendar year 2026 to 10 percent in 2027 and 12 percent in 2028.

For calendar years 2029 and later, if the Massachusetts Health Policy Commission determines it is warranted, the commission may recommend modifications to such goals, provided that the goals do not fall below 12 percent of total health care spending in the Commonwealth or increase above 15 per cent.

A February essay in the Commonwealth Lighthouse by Wayne Altman, MD, described several ways in which the current primary care system in Massachusetts is “broken.”

“Every day, in primary care offices across the Commonwealth, new patients seeking basic healthcare services are turned away or asked to endure exorbitant wait times. For Massachusetts families, this is a full-blown crisis,” she wrote. “There are not enough primary care doctors in the state and those left in the profession are aging: One-third of the workforce is already over 60. Others are burning out, reducing their hours or leaving the field altogether.”

Altman, a family medicine physician in Arlington, Massachusetts, and also a professor of family medicine at Tufts University, added that “the consequences of reduced access to affordable and timely primary care services are predictable, but also deeply troubling: money runs out.” “They are spending on unnecessary hospital and emergency care to treat conditions that are aggravated by primary care that is out of reach. Emergency rooms are overrun and replacing primary care.”

Altman noted that Delaware, Rhode Island and Oregon have taken similar steps and pointed to Friedman’s bill as a possible solution.

The legislation also calls for the creation of a 19-member primary care board, charged with developing and recommending a primary care prospective payment model, to be implemented by the commission, that would allow a primary care provider in the Commonwealth to elect receive a single monthly payment for all primary care services provided.

The bill provides that the prospective payment model will include a base monthly payment per patient, based on various historical payment factors, with the baseline adjusted based on factors such as quality of care and clinical and social risk of the panel of patients.

The bill said the model should include a list of primary care “transformers,” created by the board, which, if adopted by a primary care provider, would increase the base monthly payment per patient.

Transformatives would be evidence-based primary care services that improve quality or access, improve the patient experience, or promote health equity in primary care. These could include:
• Employ community health workers or health advisors as part of the primary care team;
• Invest in the social determinants of health;
• Collaborate with primary care clinical pharmacists;
• Integrate behavioral health care with primary care;
• Provide treatment for substance use disorders, including medication-assisted treatment, telehealth services, including telehealth consultations with specialists, medical interpretation services, home care, patient counseling groups, and group visits;
• Use physician optimization programs to reduce documentation burden, including, but not limited to, medical scribes and ambient voice technology;
• Invest in care management, including employing social workers to help manage care for patients with complicated health needs;
• Establish systems to facilitate planning for end-of-life care and palliative care;
• Develop systems to assess the health of the patient population to help determine which preventive medicine interventions require patient care;
• Offer walk-in or same-day care appointments or extended hours of availability; and
• Any other primary care service that the board considers relevant.

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