Doctor offers reform ideas to lawmakers

State policy makers should consider setting rates for medical services to counteract the dominance of certain hospitals, a prominent doctor told state policymakers at a hearing organized by the Patrick administration and Attorney General Martha Coakley’s office.

Some hospitals have been cited in recent reports as using their leverage to drive up the amount they get paid, according to Dr. Stephen Schoenbaum, the former medical director and president of Harvard Pilgrim Health Care and the current executive vice president of the Commonwealth Fund.

Schoenbaum suggested that creating teams of primary care physicians who provide services like dermatology, ophthalmology, mental health, obstetrics and gynecology would help drive down costs and encourage more coordinated, effective care.

Encouraging such integration, he said, would dovetail with efforts to establish a system of “global payments” to cover individual patients’ care over the course of a year, he said.

Under such a system, he said, groups of doctors and specialists, called “accountable care organizations,” would be incentivized to coordinate care and improve patient outcomes, as opposed to the current system, which critics say encourages unnecessary testing and discourages doctors from working together.

Schoenbaum also suggested that the state consider establishing a medical system that provides after-hours services for patients. Pointing to a similar model in the Netherlands, he said such a system would prevent unnecessary emergency room visits and save costs.