Establishment of Commission and Purpose

In order to improve the quality and safety of medical practice, there shall be established within the Executive Office of Health and Human Services, a special commission to investigate and make recommendations on the establishment of performance standards for physicians that will improve patient outcomes and the means of measuring professional performance. 

Membership of the Special Commission 

SECTION 2. In an effort to develop a system of measurable performance standards to help physicians to work at optimum levels, individually, a part of the health care team, and as a central figure in the health care system, the Special Commission established pursuant to Section 1, shall consider factors within and outside the health care system that affect physician performance.  The system shall include the most appropriate agents for evaluating physician performance, providing appropriate training for those agents, and identifying non-punitive remedial programs aimed at returning physicians to their highest standards of performance.  To that end, the commission consisting of fifteen members, one of whom shall be the Secretary of the Executive Office of Health and Human Services, or his designee, who shall act as chair, and one representative from each of the following organizations as designated by each organization; the Board of Registration in Medicine, the Department of Public Health, the Massachusetts Medical Society, the Massachusetts Hospital Association, the Massachusetts Nurses Association, the Massachusetts Organization of Nurse Executives, the Massachusetts Association of Health System Pharmacists, the Coalition for the Prevention of Medical Errors, Physician Health Services – a Massachusetts Medical Society Corporation, the Institute for  Health Care Improvement, the Joint Commission for the Accreditation of Health Care Organizations, the Betsy Lehman Center for Patient Safety and Medical Error Reduction, the Dean of the University of Massachusetts Medical School or his designee, and Health Care for All.  In addition to the foregoing, the Senate and House chairs of the committee on health care shall serve as members, ex-officio.  The Executive Office of Health and Human Services is authorized and directed to provide staff support for the work of the Special Commission.

Process for Developing Performance Standards

SECTION 2.  The commission shall develop a consistent and qualitative system for measuring the performance of physicians covering the full range of professional behavior, including, but not limited to: clinical competency, ethics and demeanor, and interpersonal relations with peers, other health professionals, and patients.  The system shall be designed to identify those who may be (1) impaired by substance abuse, mental illness, or physical illness; (2) who may demonstrate declining clinical competency in general medicine and the physician’s specialty or specialties including, but not limited to the degree to which physicians follow nationally recommended professional guidelines for treatment and prevention; or (3) who may demonstrate behavioral issues including, but not limited to, refusal to follow rules, abusive behavior toward patients, or abusive behavior toward other health professionals and health system staff.  For purposes of this section, abusive behavior is defined as failure to demonstrate respect for co-workers, subordinates, and patients, or lack of cultural competence.  Said system of measuring performance shall rely on such evidence as quality indicators, complications and mortality, complaints, and peer review.  The system shall be designed to provide early identification of physicians with one or more of the above reasons for impairment using evidence-based performance measures and to resolve the matter in a timely fashion with appropriate monitoring and remedial programs.  The commission shall also consider whether said system, or some alternative system, would be appropriate for use in evaluating applicants for medical school, evaluating medical students and residents, as well as evaluating practicing physicians at all levels.

Implementation Process

SECTION 3.  The system recommended by the commission shall be cost effective, designed not to significantly add to the administrative burden of the health care institution or the health care professional, and be evidence based to the extent possible.  The standards and method of evaluation shall recognize factors that affect performance that may be beyond the control of the individual physician including, but not limited to the role of physicians as part of care management teams and the stress factors of the health care system.  The commission will also make recommendations concerning methods for evaluation of compliance and the appropriate organizations or agents responsible for these evaluations.  Where appropriate, these efforts may implemented in collaboration with other states or national professional organizations. The commission shall also make recommendations regarding appropriate training and information for those in medical leadership roles to enable them to assume responsibility for identification of impaired physicians and for supervising recovery. The Commission shall report its findings, together with any recommendations for legislation or regulations to the joint committee on health care not later than twelve months following the initial appointment of its members. 

Authorizing Electronic Signatures for Prescriptions

SECTION 4.  Section 12H of Chapter 112 of the general laws as most recently appearing in the 2002 Official Edition, is hereby amended by adding the following sentences at the end thereof.  A physician who enters a prescription by a computerized prescription order entry system shall enter an electronic signature directly below the prescription.  The Board of Registration in Medicine, in consultation with the Board of Registration of Pharmacy shall promulgate appropriate regulations to ensure that this system maintains confidentiality and security of the information so transmitted. 

Expanding Treatment Opportunities for Disabled Physicians

SECTION 5. Section 5F of Chapter 112 of the general laws as most recently appearing in the 2002 Official Edition, is hereby amended by inserting after the words, “drug or alcohol program satisfactory to the board,” the following: - or who is in compliance with the requirements of a mental, behavioral, or physical health treatment or rehabilitation program satisfactory to the board.”

Effective Date 

SECTION 6.  This act shall take effect upon its passage