On Tuesday The Senate Ways & Means Committee released its state budget proposal for the coming fiscal year (2018), calling for total spending of $40.8 billion and including a number of provisions of great interest to the healthcare community.

By Thursday night, a series of proposed amendments to the budget were filed, including three MHA priority amendments aimed at: overturning current MassHealth policies that limit reimbursement paid from commercial MassHealth Managed Care Organizations (MMCOs) to acute care hospitals; devoting more funding to disproportionate share hospitals; and requiring the state to study an emerging – and troubling – insurance industry practice of imposing restrictive policies on how certain pharmaceuticals are dispensed to patients. Debate on the budget and amendments is scheduled to begin Tuesday, May 23.

The MMCO amendment  (sponsored by Sen. Michael Moore (D-Millbury)) would reverse recent problematic MassHealth policies that improperly limit reimbursement paid from MassHealth Managed Care Organizations to acute care hospitals. MassHealth recently has issued policies to limit negotiations between MassHealth MCOs and acute care hospitals, which puts hospitals at a significant disadvantage in the negotiation process.  The amendment is budget neutral to the state as it does not affect the payments MassHealth pays MCOs. This amendment simply reestablishes the long-standing free-market practice of allowing healthcare providers to fairly negotiate with MassHealth MCOs.

The disproportionate share hospital (DSH) amendment  (Sen. Jim Welch (D-West Springfield)) builds upon the Senate budget proposal that includes $13 million for DSH. The amendment would direct total additional payments for DSH to be $24 million, which equals the amount that was assumed in the FY2017 state budget. The amendment also directs $6 million of that funding to be used for behavioral health services provided in the DSHs, in particular for services provided to children and adolescents. 

The amendment relating to so-called  forced “brown-bagging” and “white-bagging” of cancer drugs  (Sen. John Keenan (D-Quincy)) calls on the Health Policy Commission to study the practice and issue a report. Hospitals, healthcare professionals, and patient advocates decry new insurance practices that require cancer and chronic disease patients to now obtain certain injected or infused medications through a specialty pharmacy. In many cases, these medications are no longer covered by insurance companies unless the patient self-administers the medication, uses a visiting nurse, or brings the drug to their healthcare facility or physician’s office to be administered by a clinician – a practice known as “brown-bagging.” Some insurers also require “white-bagging” – where medications are required to be dispensed by a specialty pharmacy and delivered to a hospital, infusion center, or physician for administration to a specific patient. The imposition of such restrictions in certain cases raises both significant quality and safety concerns and troubling legal conflicts related to the state’s prohibition on the re-dispensing of pharmaceuticals.


On Tuesday, May 16, Dr. Lynda Young, president of Tobacco Free Mass and former president of the Massachusetts Medical Society, testified with Chris Lathan, M.D., a medical oncologist from Dana Farber Cancer Institute in support of legislation that would raise the legal age for purchasing tobacco from 18 to 21 and would prohibit the sale of “e-cigarettes” to anyone under age 21. MHA, which is a member of Tobacco Free Mass, submitted written testimony in favor of SB1218/HB2864, “An Act to Protect Youth from the Health Risks of Tobacco and Nicotine Addiction.” The bill is sponsored by Joint Public Health Committee Chairman Jason Lewis (D-Winchester) and Rep. Paul McMurtry (D-Dedham); Lewis’ co-chair from the House, Rep. Kate Hogan (D-Stow), is also supportive of the legislation.

Of the state’s 351 cities and towns, 151 have prohibited the sale of tobacco products to anyone under age 21. A Institute of Medicine report released in 2015 found raising the tobacco age to 21 will result in a 12% decrease in tobacco addiction and prevent 250,000 deaths.

As for e-cigarettes, Dr. Young noted that the e-liquids that are mixed with tobacco products “come in hundreds of candy and fruit-flavors that appeal to kids, including cotton candy, bubble gum, grape, and Kool-Aid. Disclosure of e-cigarette ingredients is not required by any governmental agency, but a scientific review of research conducted over the last several years found toxins and carcinogens, including formaldehyde, cadmium, lead, and nickel in secondhand vapor.”

Some argue that e-cigarettes are actually a deterrent to outright “smoking” and that they could be considered a cessation device.

“The reality is that the FDA attempted to regulate these products as cessation devices nearly 10 years ago and the e-cigarette industry sued to be regulated as a tobacco product instead,” Young said. “While the science continues to develop around e-cigarettes and cessation, two goals should remain paramount: that decisions about cessation should be made between the individual smoker and his or her doctor; and that states and local governments must do everything they can to make sure that the marketing, sale and use of these devices do not increase youth nicotine addiction or threaten the long-term gains we’ve made reducing overall tobacco use in Massachusetts.”

Another part of the bill – banning the sale of tobacco products at healthcare institutions and pharmacies – is also endorsed strongly by MHA, which wrote in its testimony, “We believe that it's counterproductive to the collective mission of hospitals and healthcare providers – including pharmacies – if tobacco products are sold where healthcare treatment is offered.” More than 75% of MHA member hospitals have established completely tobacco-free campuses and several hospitals have joined MHA in establishing employment practices in which tobacco users are not hired.


In these two letters to the Board of Registration in Medicine (BORIM), MHA expressed concerns shared by a wide segment of the provider community that BORIM’s proposed substantial changes to its regulations would increase healthcare costs and administrative burdens while decreasing the time providers can spend on patient care.

As an example, the proposed recent changes to BORIM’s “Licensing and Practice of Medicine” requirements impose several new informed consent and patient notification requirements that MHA said in its letter will delay patient care and appear to be in direct conflict with the governor’s 2015 Executive Order seeking to reduce inconsistent and redundant requirements. In addition, much of the reporting BORIM included in its proposed regulation is already covered by existing reports to BORIM, DPH, and other state and federal agencies.

MHA said in its letter that the proposed changes to the regulations will also increase credentialing and licensure criteria that will delay the processing of licensure applications.  Physicians currently wait several months for their licensure application to be approved in order to provide services in the commonwealth; BORIM’s proposed regulations would add further delays, MHA said.

In its letter, MHA indicated that providers are concerned that BORIM did not seek to expand use of innovative technology, such as telemedicine, that many regulators, providers, and advocates agree would enhance access to critical services, such as those relating to behavioral health and substance use disorders. As drafted, the regulations indicate the use of telemedicine would only be allowed within a hospital or nursing home, in limited circumstances. Anuj Goel, MHA’s VP of Legal and Regulatory Affairs, who drafted MHA’s letter, said BORIM missed an opportunity to work with the provider community to improve services and facilities in a manner consistent with state and federal healthcare reform and system innovation goals.


Massachusetts Attorney General Maura Healey joined 15 other AGs from across the U.S. in filing a motion aimed at preserving the so-called “cost-sharing reductions” contained in the Affordable Care Act. Cost-sharing reductions are payments from the federal government to health insurers that allow people with low enough incomes to receive subsidies to help reduce out-of-pocket expenses, such as co-pays and deductibles. In Massachusetts, about 150,000 individuals receive subsidies through the cost-sharing reductions at issue.

The lawsuit, in which the AGs wish to become party to, is a holdover from the Obama administration. The U.S. House sued the Obama administration over the legality of the cost-sharing payments. The GOP-led House won that case but the court gave the administration the opportunity to appeal. With the change of administrations it’s now up to President Trump to pursue the appeal and preserve the ACA subsidies. In their motion, the AG’s say they don’t believe the president – a staunch opponent of the ACA – will act in the best interests of the people receiving the subsidies; they wrote, "The states and their residents cannot continue to rely on the Executive Branch to represent them in this appeal."


If the per capita caps endorsed by the GOP-backed American Health Care Act (AHCA) are used to distribute Medicaid funds then Medicaid payments for children’s healthcare between 2020 and 2026 will be reduced by at least $43 billion, according to a new study from the healthcare consulting group Avalere Health.

Massachusetts would lost $714 million over the 10-year period in funding for non-disabled children’s healthcare.

“Over time, per capita caps could significantly reduce the amount of funding that goes towards Medicaid coverage for children,” said Dan Mendelson, president at Avalere Health. “While local control and more efficient operation of Medicaid programs are laudable goals, coverage and access for low income children are ultimately dictated by federal funding, and reductions of this magnitude could disrupt access.”

An MHA analysis of the methodology Avalere used to reach its conclusions finds that the study is credible.


MHA’s President & CEO Lynn Nicholas, FACHE will participate on a panel at  Boston Children’s Hospital  on Wednesday, May 31 to discuss how recent federal healthcare policies will affect children and families.  The timely “Grand Rounds Session” also features Rob Restuccia, executive director of Community Catalyst, and Myechia Minter-Jordan, M.D., president and CEO of The Dimock Center. Sandra Fenwick, president and CEO of Boston Children's Hospital will moderate. Special emphasis will be given to the potential effects of Medicaid cuts on children and healthcare institutions. Networking begins at 9:30 a.m. with the panel to run from 10 to 11 a.m.  To register, click here, or watch the livestream of the meeting here.


The Massachusetts healthcare environment has been moving steadily over recent years from a collection of individual hospitals to a collection of large hospital systems with members bound together through either mergers or creative affiliations.

On Monday,  Anna Jaques Hospital  of Newburyport announced that it had signed a letter of intent to explore a merger with  Beth Israel Deaconess Medical Center, Lahey Health,  and  New England Baptist Hospital (NEBH) . And days later, on Thursday,  Mount Auburn Hospital  of Cambridge announced the same thing – an exploration of a merger with the BIDMC-Lahey-NEBH entity.

NEBH had announced its merger intentions in April and BIDMC and Lahey announced the merger of their existing systems in January 2017. All of the entities are either in negotiations or have announced that negotiations will begin. But none of the entities to date have filed the necessary papers with the Health Policy Commission, which reviews all mergers and affiliations.


DPH issued a notice on Monday about the presence of Carfentanil in New Hampshire, Maine, and Rhode Island, and urged Massachusetts caregivers to be both on the lookout for cases involving it and to use caution.

Carfentanil is 10,000 times more potent than morphine and is used as an anesthetic for large animals, such as elephants. Two milligrams of it (about the size of Lincoln’s beard on a penny) can be lethal. People who OD on it can be treated with Naloxone but generally need repeated doses of it.  Because it is so lethal in such small quantities, caregivers who encounter Carfentanil while treating patients should exercise extreme caution. This notice from the DEA gives more information about the dangerous drug.


In April and May, MHA, the Center for Health Information and Analysis (CHIA), Massachusetts Coalition for the Prevention of Medical Errors, and New England QIN QIO offered a webinar series on leveraging data reports to drive quality improvement. Now the materials from the two webinars – which were well-received and well-attended – are available online. The materials include the slide sets, recording of the webinars, and a one-page document explaining the methodology of the CHIA and QIN-QIO readmission data reports. To view the materials from the April 28 webinar on the CHIA all-payer hospital reports, visit here.  To view the materials from the May 4 webinar on the QIN-QIO Medicare, fee-for-service hospital reports, visit here. The methodology one-pager is available on both event pages.

John LoDico, Editor