House Budget, Advance Planning, and more...

MHA Weighs In On House Budget

With the Massachusetts House’s budget proposal for FY18 expected to be filed the week of April 10, MHA has been on Beacon Hill advocating for a number of priorities on behalf of the hospital community.

After Governor Charlie Baker filed his budget proposal in January, MHA weighed in with a pointed letter highlighting strong opposition to the governor’s plans to impose direct government regulation of provider payments in the commercial insurance market, including growth caps on commercial payments to providers, limitations on contracts covering Group Insurance Commission members, and a directive to eliminate facility fees.

In a letter to House Ways & Means Chairman Brian Dempsey (D-Haverhill) this month, MHA reiterated its opposition to those proposals but focused its attention on other budget priorities related to the Health Safety Net (HSN) and MassHealth program.  MHA advocated for strengthening the financing of the Health Safety Net, including the restoration of $30 million in state funding for the program. Despite a statutory directive requiring the state to invest $30 million in the HSN, the governor’s proposal did not include any state funding.  The safety net has been in a constant state of shortfall for many years, including FY2016 which ended with a $109 million shortfall. Hospitals alone bear the burden of all shortfalls, in addition to the assessment they pay to fund the program.

MHA also urged for the legislature to restore enhanced Medicaid payments to Disproportionate Share Hospitals (DSH) in recognition of the large numbers of low-income patients cared for by these facilities. Although such payments were included in the FY2017 budget, hospitals learned shortly after its passage that MassHealth would be eliminating the FY2017 DSH supplemental payments through changes in payment methodology.

Another priority MHA cited is to ensure post-acute hospitals receive additional Medicaid funding now that they will be paying a new annual assessment under the governor’s budget.

Recognizing the great uncertainty that remains about the future of federal Affordable Care Act funding in light of the sustained efforts to repeal key provisions of the law, and stressing the continuing pressure on Massachusetts given inadequate MassHealth payment levels, MHA’s letter to Dempsey noted, “The continuous path of cutting provider reimbursement to cover the costs of expanding MassHealth enrollment is not a viable long-term path and is weakening providers while endangering access to needed services. We hope that we can work together to secure a solid foundation for existing program funding and operational processes so that any payment and delivery reforms will be successful for patients, healthcare providers, and the commonwealth.”

Advance Healthcare Planning: What Are You Waiting For?

Throughout the month of April, MHA is re-doubling its effort to bring attention to the importance of advance healthcare planning – that is, the process you want your loved ones and caregivers to help you carry out if you become seriously ill.

If you have a plan in place, arrived at after conversations with those close to you, it will ensure that your family will not be burdened with making tough decisions on your behalf if you become seriously ill, and that your wishes will be carried out. Having a plan in place can also avoid disputes between family members who may have differing ideas about the care you should, or should not, receive. And avoiding those disputes, which often occur in care settings, assists the caregivers at your bedside as well, who will be able to provide the care you wish free of conflict.

Does your personal physician know how you want to be treated if you are seriously ill? Does anybody close to you know? Do you have your wishes outlined in writing?

National Healthcare Decision Week this year occurs from April 16 to 22. The decision week is an initiative of The Conversation Project, working collaboratively with the Institute for Healthcare Improvement. This month, MHA will educate its staff, its surrounding community, and its membership on the importance of advance healthcare planning. Information about such planning will be outlined in weekly Monday Report stories throughout April.

This week, after surveying its staff, MHA is providing all of its employees with a “Getting Started Tool Kit” from Honoring Choices Massachusetts. MHA is also reaching out to its neighbors in “The District” – the Burlington, Mass. executive park where our offices are located, to provide them with information about advance care planning and access to the Honoring Choices Getting Started Tool Kit. That toolkit allows any competent adult over the age of 18 to:

•        Choose a healthcare agent in a healthcare proxy;

•        Write down their choices for care in a personal directive;

•        And learn how to talk to their care providers to align their care to their choices.

So where to get started? First, choose a healthcare agent – someone who knows and can convey your care wishes – in a healthcare proxy, which is a legally binding document. Be aware that under Massachusetts law, a spouse or family member does not automatically have the legal authority to make decisions unless appointed in a healthcare proxy.  You do not need an attorney to appoint a healthcare agent; you can do it yourself by filling out the proxy form in the toolkit and having it witnessed and signed by two adults. In the proxy you can outline the extent of the authority you are giving your agent.

Once appointed, what is your agent supposed to do? How does that agent know what you want? This is where the personal directive comes in. A personal directive is not a legally binding document but it does lay out in detail specific information about your wishes and instructions about the kind of care you want. You can discuss your values, religious and cultural beliefs, and your choices in a personal directive.

The healthcare proxy and the personal directive “work hand-in-hand,” according to the Honoring Choices tool kit. “You appoint an agent in a health care proxy with the legal power to make healthcare decisions on your behalf, and give your agent essential information and instructions about the care you want in a personal directive.”

Finally, the toolkit provides a discussion guide to help you talk to your care providers about your wishes, concerns about your current or future care, and about how to get information about your healthcare agent and your personal choices entered into your medical record. It’s important to outline your information and to have it accessible in the event you can’t speak for yourself due to an emergency or illness.

There are a lot of moving parts to advance care planning and a lot of different overlapping terms. But much of the information available to the public is clearly written, with easy-to-follow steps.  While the decision to begin a conversation about serious illness and end-of-life care is almost always a difficult one to make, avoiding such a conversation now may make things more difficult for you, your loved ones, and your healthcare providers further along in your life.

For more information, visit PatientCareLink and click on “Healthcare Planning Throughout Your Life” under the For Patients & Families Tab, or “Serious Illness Care” under Improving Patient Care.

HPC Sets Benchmark at 3.1%

The state’s “healthcare growth benchmark” – the statewide target that the Health Policy Commission (HPC) sets for the rate of growth of total healthcare expenditures in Massachusetts – will be 3.1% for 2018, following a unanimous vote by the HPC board on March 29.

For the five years before 2018, the benchmark was 3.6% – the same as the Massachusetts “potential gross state product” (PGSP). Chapter 224 mandated that for the 2018-to-2022 period the benchmark would be PGSP minus 0.5%. In January, the state set the PGSP once again at 3.6%. So 3.6% minus 0.5% equals the 3.1% current benchmark. While HPC is empowered to alter the benchmark, the panel chose to maintain the pre-established threshold.

Prior to making its determination, HPC held a public hearing on the matter. At the hearing, MHA President & CEO Lynn Nicholas, FACHE, said that MHA endorses the new, lower benchmark of 3.1% – but with caveats. She said for the benchmark to function effectively, the state has focus on input costs such as pharmaceuticals and labor. Efforts to undermine the Affordable Care Act and uncertainty about delivery system reform in Massachusetts also must be recognized as factors affecting how the healthcare system operates, she said, adding that the continued growth in MassHealth enrollment affects healthcare costs as do socio-demographic factors and an aging population.

Nicholas said that lowering the benchmark is “aspirational and we should try to meet it, but the state must be cautious to avoid creating unintended consequences – especially regarding behavioral health.”

“Currently, providers cross subsidize underpaid behavioral health services by relying on revenue from higher paid services,” Nicholas noted. “Targeting cuts for higher margin services in an effort to reduce the cost growth benchmark has the potential to result in fewer resources to support underfunded services such as behavioral health and could potentially result in unintended consequences for those services.”

The state’s healthcare system as a whole has missed meeting the 3.6% benchmark for the past two years. However, the hospital segment of the system has consistently remained under the benchmark. According to the Center for Health Information and Analysis’ 2016 Annual Report on the Performance of the Massachusetts Health Care System, the rates of growth for commercially insured members on a per member per month basis for hospital inpatient (2.2%) hospital outpatient (2.9%) and physician services (1.9%) all fell well below the 3.6% benchmark.

Under Chapter 224, CHIA is required to identify and refer healthcare entities (payers and providers) that miss the benchmark to the HPC; the HPC reviews those entities and determines whether it will require submission of performance improvement plans detailing how the entities will lower costs.

Baker Expected To Serve On President's Opioid Panel

President Trump signed an executive order on Wednesday creating the President’s Commission on Combating Drug Addiction and the Opioid Crisis. New Jersey Governor Chris Christie will chair the commission, which is charged with reviewing the current federal response to the opioid crisis and make recommendations for improving that response. A report is due in 90 days.

Massachusetts Governor Charlie Baker was expected to be named to the commission. DPH has reported that nearly 2,000 Massachusetts residents died from opioid use in 2016 – a  number that has been increasing steadily in recent years.


Barbara Doyle, R.N., the CEO of MetroWest Medical Center since November 2013, has resigned, effective March 22. Denise Schepici, M.P.H., has been named interim chief administrative officer. 

2017 Lean In Healthcare Certificate Program


In this program, participants will learn the fundamentals of continuous improvement in a classroom setting. They will then work in teams to apply the principles and tools of continuous improvement in an actual healthcare process at Lawrence General Hospital. Each day participants will be introduced to appropriate best practices to address the challenges facing healthcare professionals. This learn-by-doing method will prepare students to return to their own workplaces with the confidence to implement continuous improvement methodologies.

This essential program was developed to provide healthcare professionals with the knowledge and experience needed to effect positive change within their own organizations. Participants will learn the critical steps they can take to assure dramatic, continuing improvements. The program will be held at Lawrence General Hospital in Lawrence, Mass. so that a combination of classroom and hands-on learning can take place.  Learn more and register by visiting here.

John LoDico, Editor