[The following editorial is crossposted at HealthcareWealthcare.com]

I’ve written much on my health policy blog … of the microscope under which the state of Massachusetts is operating its own brand of healthcare delivery in the wake of universal healthcare coverage. The ambitious undertaking by the state’s lawmakers to introduce the concept of universal coverage to its citizens over two years ago attempts to answer the question — can healthcare delivery costs be reined in while mandating care for everyone? The answer is, to the surprise of no one, a resounding “no”. As a matter of fact, the cost of covering an additional 430,000 people has thrown the state’s healthcare economy into a tailspin.

The numbers tell the sobering story: Massachusetts spent over half a billion dollars more over the last three years than before the initiation of its universal care coverage. This 40 percent increase in state spending has even forced the state’s legislature to look at its immigration policy in reconsidering how it spends its healthcare dollars on its legal immigrants — something the Commonwealth should not have to resort to unless faced with massive budget deficits. But desperate times call for desperate measures.

Earlier this year, the state’s lawmakers went into crisis mode to try to come up with a solution that would attempt to head off the hemorrhaging of its finances. What is shaping to be Massachusetts’ shameful secret — privately loathing its rather public experiment in healthcare reform — is not winning any kudos from the constituency it is supposed to be supporting, at least on an emotional level — its physician workforce. You see, before the state can study what impact new schemes in healthcare spending have its delivery, it must do what any government agency has to do to “evaluate” a new spending initiative: set up demonstration projects.

In the case of Massachusetts, the guinea pigs are primarily physicians. And the state’s grand plan? A so-called global payment system for doctors centered around the patient. In an effort effectively to abolish the state’s wasteful fee-for-service reimbursement system under healthcare reform, Massachusetts lawmakers are proposing practices receive payments based upon yearly “fees” per patient, whose amounts would be based upon factors adjusted by an individual patient’s healthcare needs. This, lawmakers say, would establish more patient-centered care, forcing a patient’s primary care provider to coordinate care with specialists and ancillaries more seamlessly, saving money in the process. An independent payment commission which has included physicians, hospital executives, and insurers was created to advise the state of these new payment policies. Of course, there would be infrastructure support during this transition to a global payment system in which providers would receive training in technical assistance and information technology.

Physicians have been the out-of-the-box skeptics, crying a return to capitation — a system which resulted in many practice and health plan fiscal losses back in the 1990s. Health system executives quickly followed suit. They continue to refuse to “buy in”, while groups have already begun to pilot the project. Proponents of this new payment initiative quickly say that this process is adjusted for risk, as opposed to capitation. But, it will take a lot more than a mechanism for risk-adjustment to get majority physician support in Massachusetts. That faction will most likely be fighting this new reimbursement system all the while the eyes of the nation (read: Washington) look upon Massachusetts anew in the search for health policy’s holy grail — healthcare reform that will save money and provide meaningful and demonstrated quality.

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