Debate Begins on Senate bill, Plus a CHIP Vote, and more...

Debate Begins Wednesday on Sweeping Senate Bill

Debate on the State Senate’s sweeping healthcare bill -- An Act Furthering Health Empowerment and Affordability by Leveraging Transformative Health Care (S.219) – begins on Wednesday, Nov. 8 and 9.

The Senate has set 5 p.m. on Monday as the deadline for amendments. Senate President Stan Rosenberg was quoted in the State House News Service as saying on Thursday, “This area is so big that there's room for a lot of other ideas and we hope others will put other ideas on the table.”

MHA has taken a fine-toothed comb through the 100-page bill and has found much to support, including steps to advance patient access to care – such as telemedicine - and a number of pieces that would enhance care coordination. But MHA has also found many items of concern.

For example the Senate bill proposes a reimbursement floor for all hospitals – which is something MHA has endorsed. The thinking is that commercial payment variation between the lowest-paid hospitals and other hospitals is tied to a historical base, and due to a lack of bargaining power, many of the lowest-paid hospitals have been unable to negotiate higher levels of payment. MHA’s Board of Trustees has publicly opined that, under appropriate Division of Insurance oversight, commercial payment rates to the lowest paid hospitals should be increased and that there should be a reasonable floor on these payments with the goal to reduce unwarranted disparity in payments.

But hand in hand with the Senate’s establishment of a payment floor  is another proposal that sets a commercial hospital spending growth target that is tied to national marketbasket increases. This new hospital target is separate, distinct, and lower than the growth rate target the state sets each year under the innovative Chapter 224 reform bill. “Adding another layer of complexity by setting commercial hospital spending growth limits –in isolation from all other market participants – at a lower level than the statewide benchmark and tying the cap to the Medicare inpatient marketbasket will subject hospitals to a greater degree of downward cost pressure than the rest of the healthcare system at a time of great uncertainty about the stability of the Medicare and Medicaid programs,” MHA recently wrote to the Senate.

And if the new hospital spending growth targets are not met? The Senate bill proposes assessing fines against “the top 3 hospitals” by virtue of their size alone.

Other areas of concern cited in MHA’s comments focused on sweeping prohibitions on fees for outpatient services that reach far beyond related reductions imposed by Medicare, and a punitive approach to readmission reductions focused solely on hospitals.

MHA pledged to work with the Senate on collaboratively advancing the shared goals of enhancing access to high-quality patient care and minimizing costs.

Hospitals Top Women-Led Business List

Recognizing the hospital sector’s importance to the state’s economy, a recent list of the top women-led businesses in the state awards the top three spots to Massachusetts hospitals CEOs.

The Commonwealth Institute – which for the past 20 years has devoted itself to advancing businesswomen in leadership positions – along with The Boston Globe last week released its annual list. Topping the list is Brigham Health President Elizabeth Nabel, M.D., followed at #2 by Boston Medical Center Health System President & CEO Kate Walsh, and then Boston Children’s Hospital President & CEO Sandra Fenwick. Mount Auburn Hospital President & CEO Jeanette Clough is listed at #12; Emerson Hospital President & CEO Christine Schuster at #14; Hebrew Rehabilitation Center’s President Mary Moscato at #15; New England Baptist Hospital President & CEO Trish Hannon at #16; and Partners Community Physicians Organization President Lynn Malloy Stofer at #21.

The Commonwealth Institute and Globe said that in creating the list, they looked at revenue or operating budget and other variables, including number of full-time employees in the state, workplace and management diversity, and innovative projects. They then ranked the organizations using their own formula.

Recognizing Heroes Against Violence and Continuing the Fight

Harrington HealthCare System held a special ceremony Monday night recognizing Elise Wilson, the emergency services nurse who on June 14 was stabbed numerous times by a patient at the hospital. Harrington also celebrated the actions of the numerous hospital employees as well as emergency responders who tended to Wilson and saved her life.

Edward Moore, Harrington president and CEO, was quoted in the Worcester Telegram as saying at the event, “Elise, you are our hero because you refuse to be a victim.”  The veteran nurse is still recovering but says she wants to return to work.

In the weeks following the June assault on his staff, Harrington worked tirelessly to install a new layer of plant security over what it already had in place. Harrington’s three-point plan focuses on enhanced plant security, emergency preparedness, and staff education/awareness.

Over and above national Joint Commission and state hospital licensure standards, Massachusetts hospitals consistently work with their employees and communities to focus on policies that best address risks of violence within their unique facilities. They also work collaboratively on best practices and education programs under the MHA banner. The workplace safety page on MHA’s PatientCareLink website offers a snapshot of some of these efforts.

House Passes CHIP Bill, But Its Future is Unclear

The U.S. House on Friday passed legislation to extend the Children’s Health Insurance Program (CHIP) for five years.  The bill also contains a two-year delay of the Affordable Care Act disproportionate share hospital (DSH) cuts, and essential funding for Federally Qualified Health Centers (FQHCs or community health centers).  While there has always been bipartisan support for CHIP, the House vote was along party lines, with Democrats – including the Massachusetts delegation – opposing the bill, mainly because its cuts the ACA’s Prevention and Public Health Fund. It is unclear whether the Senate will get to the bill before December.

CMS Hears Outcry, Vows to Revisit Regulatory Burden

CMS Administrator Seema Verma announced on Monday an initiative to reduce the quality reporting burden on healthcare providers. Noting that across the CMS hospital quality reporting programs, inpatient hospitals report up to 61 quality measures, Verma said the new CMS program – Meaningful Measures – “will involve only assessing those core issues that are the most vital to providing high-quality care and improving patient outcomes.”

“We’re revising current quality measures across all programs to ensure that measure sets are streamlined, outcomes-based, and meaningful to doctors and patients,” Verma continued. “This includes a review of the Hospital Star Rating program.”  Hospital groups, including MHA and AHA, along with 225 members of the U.S. House and 60 Senators, all have urged CMS to ditch the star rating system until the methodology can be improved.

Citing an October AHA report that found non-clinical regulatory requirements cost providers nearly $39 billion a year and divert clinicians from patient care, Verma said, "That's a lot of provider time, money and resources focused on paperwork instead of patients."

HPC Casts Cold Eye, Preliminarily, on Partners-MEEI Merger

The Health Policy Commission’s (HPC’s) preliminary Cost and Market Impact Review (CMIR), on the merger between Partners HealthCare and the Massachusetts Eye and Ear Infirmary, and its Massachusetts Eye and Ear Associates physician organization was released last Wednesday, with the HPC finding that Partner’s acquisition of MEEI “may warrant further review and referral to the Massachusetts Attorney General's Office.”

The HPC assumed that if Partners acquires MEEI it will raise the prices that the hospital and its physician organization charge, and therefore raise overall healthcare costs. Partners has argued that the merger will lead to operational efficiencies.

The HPC said that since DPH is assessing the merger under its Determination of Need guidelines, the HPC may submit its finding to DPH. It also said it will issue a final report after it receives written comments.

Partners spokesperson Rich Copp said, “We will review the details contained within the HPC’s preliminary report and work with them to address any concerns they have.  This partnership will greatly strengthen the clinical and scientific relationships between our organizations and will help make Mass. Eye and Ear services and research accessible to a broader population of patients, further improving the quality of life for thousands of individuals and families in Massachusetts.”

Walsh Begins at MHA

MHA’s new President and CEO Steve Walsh began his tenure this past Wednesday, November 1.  Steve spent his first days connecting with the MHA Board of Trustees and meeting with staff before jumping back into action on the legislative and regulatory matters affecting the hospital and healthcare community.

Transition – UMass Memorial’s Muldoon

Patrick Muldoon, the president of UMass Memorial Medical Center since 2013 (and the CEO of Health Alliance Hospitals before that) has announced his retirement effective January 31, 2018. Muldoon served as MHA Board of Trustees Chair during the 2013-2014 term, and has always been considered a thoughtful and important voice within the Massachusetts healthcare community. UMass Memorial’s Executive VP and COO Jeffrey Smith, M.D. will serve as interim president while the hospital conducts a nationwide search for Muldoon’s replacement.

Increasing Your Margins in a Challenging Environment

Friday, December 8; 9 a.m. to 2:30 p.m.
MHA Conference Center, Burlington, Mass.

With the uncertainties in the healthcare financing system, hospitals continue to find ways to innovate and contain costs while improving performance – especially here in Massachusetts, which has such a strong regulatory mandate for cost reduction. Join us at this timely program where we’ll look at the most viable and effective ways hospitals can stay successful in a challenging environment. We’ll hear from national expert, Michael Nugent, on key innovations he is seeing at health systems around the country. We’ll also feature a close look at how Texas Health Resources is leveraging its workforce to gain significant operational efficiencies. We’ll highlight Massachusetts hospitals and healthcare organizations, and take a look at their strategies to provide the best care and reduce overall costs. Click here to learn more about this MHA educational offering.

John LoDico, Editor