Q&A: Mandatory participation

Q: Should physician licensure be tied to mandatory participation in a certain health plan to control costs?

A. “If this type of compulsory participation in an unprofitable health care plan became law and significantly impacted doctors’ incomes, there would be more pressure than ever from physicians’ groups to further cap medical malpractice damage awards or otherwise limit the already restricted rights of victims of medical malpractice. Health care providers might use the resulting decrease in their income and a possible exodus of doctors from the state to
advance the false premise that medical malpractice claims are at the heart of the health care cost crisis. If this were to occur, it would be difficult for the legislature to resist calls for so-called tort reform.”
— Roger Brunelle, medical
malpractice plaintiffs’ attorney, Sbrogna & Brunelle, Worcester

“Small businesses are struggling with the rising cost of health care. The Affordable Health Plan would
provide immediate relief to small businesses, decreasing premiums by as much as 22 percent, by requiring health care providers and health plans to limit their costs.  While the bill requires providers to participate as a condition of licensure, it also requires health plans to offer this product.  The Affordable Health Plan would sunset after three years, a limited period of time, but enough to hopefully help small businesses weather the economic storm.  Helping small employers get a handle on health care costs so that they can grow jobs requires health plans and providers to share in the responsibility for controlling those costs and lending a hand to small businesses.”
— Eric Linzer, senior vice president of public affairs & operations, Massachusetts
Association of Health Plans, Boston

“Oversight of physician licensure by the Board of Registration in Medicine is an important step in
assuring the public that the physicians they see are qualified and competent. Linking licensure to mandated participation in a particular form of health insurance would represent a breach of the authority and spirit of the Board. Success in the Board’s mission to have ‘qualified physicians … provide a high standard of care’ is accomplished by vetting the education and training of applicants for licensure, and by ongoing evaluation of continued competency by the Board. It is not accomplished by required participation in specific insurance plans. Creating such a linkage is an affront to the professionalism of all physicians.”
— Dr. Dennis Dimitri, president,
Massachusetts Academy of Family Physicians

“Doctors already participate in
efforts to control health costs as they accept reimbursements for services from public and private insurers significantly below the amounts charged for the care provided. Many doctors are forced to join independent physician associations to gain some bargaining power in negotiating reimbursement rates that allow for the operation of their practices. No professional should have onerous financial obligations placed on him as part of the licensure procedure. Every professional needs some measure of independence in his practice, whatever practice that may be. To require a doctor to have his license tied to participation in a health care plan will be a burden to him that will do none of us any good.”
— William Dailey, defense
attorney and senior partner, Sloane & Walsh, Boston