The Cost of Regulation, Nicholas Departs, and more...

The Multi-Billion Costs of Excessive Regulation

No one argues that healthcare – a major component of the economy – should have strict guardrails influencing its direction and operation. But do the ever-increasing number of mandated reports and regulations result in providers having to hire more administrative staff to handle paper as opposed to clinical staff that improve patient care?

New data now exists on the federal level that provides proof that the regulatory state may be affecting care. A report from the American Hospital Association (AHA) released on Wednesday shows that hospitals, health systems, and post-acute care providers spend nearly $39 billion a year on administrative activities related to regulatory compliance. The average-sized hospital spends $7.6 million annually to comply with federal regulations, equal to $1,200 every time a patient is admitted, and dedicates 59 full-time equivalents to the task, more than one-quarter of whom are health professionals who would otherwise be caring for patients, the study found.

"There is growing frustration for those on the front lines providing care in a system that often forces them to spend more time pushing paper rather than treating patients," said AHA President and CEO Rick Pollack.

Those are federal numbers. In Massachusetts, hospitals and health systems report regularly to the Health Policy Commission and Center for Health Information & Analysis (both agencies’ budgets are funded primarily by hospitals), as well as the Attorney General’s Office, Division of Insurance, MassHealth, DPH, each insurance plan – among many other entities.

While debate in Massachusetts and in Washington focus on healthcare costs and healthcare access, a more general question merits attention: In the incessant effort to regulate all aspects of the healthcare community, is government creating a regulatory quagmire that is driving up costs?

Nicholas Leaves After Successful 10 Years at MHA

On her last day of work, October 31, after an impressive 10-year stint as MHA’s President & CEO, Lynn Nicholas, FACHE, will deliver a talk to the 21st Annual Delaware Health Care Forum.  Her speech – “Under the Benchmark: Hospital Perspective on Payment Reform in the Bay State” – is a variation of one that Nicholas has delivered over the years across the country to groups interested in the commonwealth’s forward-thinking reform efforts.

And on Wednesday, Steve Walsh, MHA’s new leader, assumes control of the 81-year-old association. He steps immediately into the healthcare reform thicket as the state engages in debate over a new 101-page reform bill from the State Senate.  Walsh, a former state representative, was House Chairman of the Joint Committee on Health Care Financing and led the effort on a previous comprehensive reform bill – Chapter 224. More recently, Walsh has led the Massachusetts Council of Community Hospitals since 2014.

On Friday, MHA staff gathered for an in-house tribute to Nicholas where good humor – a characteristic of Nicholas’s reign at MHA – was mixed with more than a few moist eyes as employees bid her farewell.

Lynn arrived in Massachusetts in 2007 right after the state passed its historic healthcare reform law – Chapter 58.  She was hired to ensure that MHA had a “seat at the table” in future and necessary healthcare debates to control costs. Serving on numerous key committees, Nicholas advocated ably for hospitals as new mechanisms were created to transition the state away from fee-for-service payments  and to tested, but still evolving, global payment systems.  She became an in-demand national voice for healthcare change as the innovations born in Massachusetts rippled out across the nation.

Nicholas always insisted that MHA – a well-respected organization from its inception in 1936 – not remain stuck in the past. Seeing the importance of growing physician practices to the health of hospitals, she created MHA’s Physician/Hospital Integration Collaborative. Aware that hospitals, while the key component to systems of care, were nonetheless merely a part of the greater healthcare environment, she stressed a health-centric – not hospital-centric – focus for MHA. Behavioral health, wellness, preventive care, post-acute care, home care, and more were woven into MHA’s annual goals. Finally, in 2016, Nicholas changed the name of the association to the Massachusetts Health & Hospital Association.

Recalling how tobacco use affected her own family’s health, Nicholas led the effort to ban tobacco use on hospital campuses, and won state and national recognition for her efforts. She was at the helm of MHA’s Substance Use Disorder Prevention and Treatment Task Force that created protocols subsequently adopted by all hospitals to regulate how opioids are dispensed. In short she was an agent for positive change.
Nicholas had the supreme confidence to stick her neck out on unpopular issues and not relent, but she showed a level of humility too often lacking in leaders. That is, if she didn’t grasp a complex issue, she’d admit it – but then she’d out-study, out-prep, and out-practice anyone until she mastered a subject.  She’d also share praise and thanks with the staffers who helped her to represent MHA and its membership on the public stage.

Lynn Nicholas was also a mentor to up-and-coming staff at MHA, but especially to young women; she promoted women in the workplace, networked with other powerful women in the state, and did not abide with any sexist BS.

The women and men of MHA, the leaders of hospitals and physician practices, the hundreds of thousands of workers in Massachusetts healthcare, and, most importantly, the patients and communities that have been served well by a Massachusetts healthcare system that has steadily improved during Lynn Nicholas’s tenure at MHA, offer her a heartfelt thank you and warm best wishes for the future with her loving husband, Nick.

Addressing Physician Burnout

Bring together sector leaders for a state-of-the-state discussion of Massachusetts healthcare and one recurring theme that arises, in addition to cost and quality issues, is physician burnout.

Doctors are facing increasing patient loads as populations are finally getting access to better insurance coverage. And MDs are also facing the pressures from implementing new electronic health record systems, and from increased administrative reporting; some Massachusetts health systems are responsible for monitoring and improving over 600 quality metrics. Layer on top of all that the great emotional burden caregivers face in helping patients deal with oftentimes debilitating and life-threatening illness and it becomes clear why many extraordinarily intelligent and committed physicians are eager to leave a profession they worked so hard to enter.

In addition to negatively affecting physician satisfaction and well-being, burnout negatively affects patient satisfaction, patient engagement, teamwork and team morale, quality and patient safety, and healthcare costs. Burnout is a driving force resulting in a physician suicide rate twice that of the public at large.

To address the physician burnout problem, MHA and the Massachusetts Medical Society have created the MMS-MHA Physician Burnout Task Force composed of physicians and physician group leaders within both hospital and physician practice environments. The task force work is expected to begin in January 2018 and conclude its work by year end. It will be co-chaired by Alain A. Chaoui, M.D., president-elect of MMS, and Steven M. Defossez, M.D., MHA's V.P. of clinical integration.

MHA and MMS will each appoint seven members to the task force.

A Request for an Additional Report

The State Child Fatality Review Team (SCFRT) recently released guidance asking all 51A mandated reporters to also report instances of pediatric deaths where there is no immediate apparent cause.

In Massachusetts, there are local teams that examine the circumstances of child fatalities under their jurisdiction to determine if the death was preventable and to formulate recommendations outlining education, policy, and prevention action steps to take in order to prevent similar deaths in the future. These recommendations are used to inform the SCFRT as it formulates statewide best practices.
Through recommendations made by the local teams and a child fatality review working group, the SCFRT recently released a letter to mandated reporters recommending that all pediatric deaths without an immediately apparent cause is sufficient evidence to believe that neglect or abuse may have occurred.

Clinicians are already required to report all deaths of a child under the age of 18 to the Office of the Chief Medical Examiner. But now the SCFRT is asking mandated reporters to submit additional reports through the 51A process so that local teams may obtain information and develop recommendations to reduce similar deaths in the future.
While this is not a mandated requirement, and while many clinicians already are fulfilling the request, MHA this week recommended to its membership that it adhere to the new guidance as a way of improving the health system.

National Resource for Opioid Fight Cites MHA’s Efforts

On Monday, the American Hospital Association released Stem the Tide: Addressing the Opioid Epidemic, a toolkit that provides guidance, information and case examples to help hospitals and health systems tackle the problem ravaging the U.S.

The efforts of MHA’s Substance Use Disorder Prevention and Treatment Task Force (SUDPTTF) are cited throughout the AHA document. For example, AHA links to the Massachusetts Emergency Department Opioid Management Policy, Patient Information Sheet, which MHA created to assist emergency department clinicians in educating patients who come to the ED; and provides another link to MHA’s Guidelines for Prescription Opioid Management within Hospitals. Those documents and MHA’s other efforts, that the AHA cites, are here.

Did Pres. Trump Go Far Enough in Opioid Fight?

On Thursday, President Donald Trump declared the national opioid crisis a public health emergency, which allows the federal government to relax some regulations and allows states to expand the use of telemedicine treatment. The declaration lasts 90 days but can be renewed. The last time a national public health emergency of this scope was declared was during the H1N1 influenza virus in 2009.

A public health emergency does not rise to the level of the more severe “national state of emergency” which would have triggered the release of Disaster Relief Funds for states to use.

Many Democratic Massachusetts officials immediately criticized the extent of the president’s efforts. Massachusetts Attorney General Maura Healey said, “Fire and police departments are struggling to afford overdose reversal drugs. Schools and health centers need to expand prevention education to all students. Families need expanded access to substance use treatment. These are actions we can take right now. And this announcement does little to support any of them.”  While U.S. Senator Edward Markey said, “President Trump offered the country a Band-Aid when we need a tourniquet.” He was especially critical of the president’s plan to fight the opioid crisis by reallocating funding from HIV/AIDs programs. Markey said that is “robbing Peter to pay Paul, especially as HIV and AIDS rates spike due to increased heroin and fentanyl use.”

Is The Price Right? The Emergence of Pricing Transparency

Friday, November 3; 8:30 a.m. – 12:15 p.m.

MHA Conference Center, Burlington, Mass.


Pricing transparency has been Massachusetts law since Ch. 224 passed in 2012, requiring healthcare providers to give consumers the costs of admissions, office visits, or procedures within two business days of a request. The law also requires that insurance companies provide their members with price information in real time, including the member’s out-of-pocket costs and an online cost estimator tool. Consumer awareness of this law has been low, but is expected to increase sharply in coming months as the state’s Center for Health Information Analysis launches a cost transparency website and patients with high deductibles seek more affordable options for care. Is your organization ready to respond? Join us at this conference where we’ll take a look at the latest trends in healthcare pricing transparency and consumer engagement, and help answer questions like: What is working well?  What are the challenges” And how can organizations be sure they are putting their best foot forward in providing accurate and meaningful information to consumers?  Learn more information, including registration details, here.

John LoDico, Editor