A state commission comprised of prominent healthcare stakeholders has proposed a new plan for Massachusetts state officials that would let them reject hospitals’ pricing for services if it exceeded the market norm, according to a Boston Herald report.
Under the proposal, providers would be required to defend their prices before a panel of state healthcare finance officials if those prices were more than the “norm” and if a payor declined to pay them.
The recommendation was approved 9-1 by the commission, which includes Gov. Deval Patrick’s budget chief Jay Gonzalez, Sen. Richard Moore (D-Uxbridge), Rep. Steven Walsh (D-Lynn) and representatives of the state Division of Health Care Finance and Policy, the Massachusetts Hospital Association, the Massachusetts Medical Society, the Group Insurance Commission, Blue Cross Blue Shield of Massachusetts and the Massachusetts Association of Health Plans.
Lynn Nicholas, president of the Massachusetts Hospital Association, voted against the plan. Ms. Nichols later released a statement saying it would be premature to let the state regulate provider prices without further review of the factors that cause price variation.
Hospitals have expressed concern over government rate setting and that the commission is de-emphasizing cost drivers. Payors, however, have shown support for the state intervention and say studies have shown how healthcare providers skew the marketplace.
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