In addition to small practices, MMS indicated that payment reform exceptions would need to be put in place for safety net providers. "A high percentage of their patient population is Medicaid and Medicare," Coombs said. "As such, they have very narrow margins whereby every time there is a Medicare cut, they're whole practice is threatened."
MMS expressed additional concerns about the ACO model, saying in a statement that it remains an untested method of healthcare financing and can pose unintended consequences that can impair the physician-patient relationship.
The society also cautioned against ACOs becoming so large they would control the state's healthcare system and have to power to include or exclude stakeholders at will. "Without heterogeneity in accountable care organizations, it won't foster the diversity that's necessary to deal with the different patient circumstances in Massachusetts," Coombs said.
State legislators that are pushing a global payment system are most interested in curbing healthcare costs, according to Coombs, who sees the society's role as helping policymakers see the whole picture. "Our objective as providers is to look at quality, access and cost," she said. "If you do not address quality and access, you will actually see costs rise as individuals skip visits to a primary care doctor and wind up in the emergency room."