New MassHealth ACO Program, RN Education, and more...

Outreach Begins for New MassHealth ACO Program

The MassHealth Accountable Care Organization (ACO) program – more than a year in the making, approved by a complex federal waiver, and the focus of massive hospital, provider, and managed care restructuring – is set to go live March 1, 2018. In mid-November, MassHealth began its outreach campaign to approximately 300,000 individuals informing them of their ACO and Managed Care Organization (MCO) options. Throughout December, MassHealth will notify about 815,000 more who are expected to be part of the MassHealth ACO program.  If MassHealth members do not make an active decision, MassHealth plans to “specially assign” individuals based on their primary care physician’s (PCP) affiliation with an ACO.  PCPs not participating in an ACO will also still be available in the MassHealth MCO and existing Primary Care Clinician (PCC) programs.

Health systems participating in the MassHealth ACO program have been making large investments in new health information technology, re-deploying resources, and drawing up new contracts with their provider partners within the ACO as well as with MassHealth MCOs.  In ACOs, the patient’s PCP practice is usually the central entity responsible for managing and coordinating care on behalf of the patient. One of the most significant changes compared to the past is that PCPs participating in ACOs will be exclusive to that single ACO.
November also saw MassHealth reaching out to providers to educate them so that they, in turn, can educate the MassHealth members who will undoubtedly have questions about their enrollment and provider options under the new program.

This new MassHealth website helps enrollees learn about their new options. And this provider bulletin provides a general overview of the ACO program and managed care choices including how it will affect members, access to care, enrollment rules, and ACO contact information.

Judge Rejects Nurse Union’s Anti-Vaccination Effort

The Massachusetts Nurses Association’s attempt to violate Brigham and Women’ Hospital’s mandatory flu vaccination policy was rejected by a Suffolk Superior Court judge last week.

Judge Robert N. Tochka’s rejected the union’s request for an immediate injunction; however, the union’s lawsuit against the hospital to avoid the flu shots continues. Tochka wrote: “MNA’s speculative claim of potential harm to an unspecified number of unidentified nurses is not adequate to outweigh the risk of harm to the hospital, its employees, and its patients if there is an outbreak of the flu.”

Some hospitals in Massachusetts require caregivers to receive flu vaccines each year, and all hospitals in the commonwealth offer free flu vaccine to their employees. Recent state reporting shows across-the-board increases in healthcare workers receiving flu vaccinations.

MHA supports the establishment of state policies that would require all members of the healthcare workforce to be vaccinated.

“As healthcare providers, our members are responsible for promoting public health and should be role models,” said MHA V.P. of Clinical Affairs Pat Noga, R.N. “As centers for care, hospitals will continue to be proactive in ensuring the safest conditions possible for patients and healthcare professionals alike. Patient safety shouldn’t be optional and that means that vaccination compliance shouldn’t be optional either.”

Mass. Colleges Unveil New Nursing Education Program

A new nurse education initiative announced on Friday compliments long-standing MHA efforts to improve both the supply and education of registered nurses in Massachusetts.

Westfield State University and Greenfield Community College last week unveiled their RN-to-BSN Completion Program, which offers associate's degree graduates and others a one to two-year path to a bachelor of science degree in nursing from Westfield State.

That new program is well aligned with the efforts of the Massachusetts Action Coalition (MAAC) to achieve the Institute of Medicine’s (IOM) landmark recommendations included in the report entitled “The Future of Nursing: Leading Change, Advancing Health.” The IOM report calls for transforming nursing practice through nurses practicing to the full extent of their education and training, and for transforming nursing education.

An MHA-endorsed bill – HB1186 sponsored by Rep. Kay Khan (D-Newton) – would establish a commission to design academic pathways and necessary supports to advance 95% of all registered nurses in Massachusetts to the baccalaureate degree–level by 2030.

Research shows that strongest correlation between nurses and patient care outcomes is the education and experience level of the nurse, as opposed to more divisive and scientifically unsound initiatives such as setting a statewide mandated nurse-to-patient ratio for all hospitals regardless of the education of the nurses at the hospitals, the acuity level of patients being served, and the other resources that each individual hospital may deploy.

A component of the new degree-granting program allows students to move from Greenfield’s practical nursing program, through its associates degree nursing program, then to Westfield’s BSN program, and then on to potential employment at Cooley Dickinson Health Care. Anthony Scibelli, VP Operations and Chief Administrative Officer at Cooley Dickinson, said, “This program provides an opportunity for Cooley Dickinson to employ locally trained nurses who fill vitally important roles both in our hospital and at our outpatient provider practices. There is truly a need for more nurses, and we are excited to offer employment opportunities to the program’s graduates.”

CMS Scraps Key Mandatory Bundled Payment Programs

Last Thursday CMS cancelled two mandatory bundled payment models – relating to hip fracture and cardiac care – that were scheduled to begin on January 1. CMS also changed the parameters of the Comprehensive Care for Joint Replacement (CJR) Model, reducing the mandatory geographic areas participating in CJR from 67 areas to 34.

The bundled payment models were created during the Obama Administration as a way of shifting from fee-for-service reimbursement to reimbursements based on expected costs for different types of care. The Trump Administration’s first Health & Human Services Secretary, Tom Price, while in Congress had been an opponent of such mandatory models as had many provider groups who argued that the evidence for their cost-cutting was scant.

In its notice last Thursday, CMS said, “CMS expects to increase opportunities for providers to participate in voluntary initiatives rather than large mandatory bundled payment models.”

Puerto Rico Still Suffering; MGH Deploys to Help

As of the end of last week, about 34% of Puerto Rico residents lacked electrical power and in some parts of the island at least 10% of the residents didn’t have running water. Hospitals continued to receive assistance from humanitarian workers deploying from U.S. states and other countries. Because many healthcare workers, public safety and environmental health personnel continue to travel from Massachusetts to Puerto Rico and the U.S. Virgin Islands to help with their hurricane recovery efforts, the Boston Public Health Commission and Massachusetts DPH issued a health and safety advisory last week.

The advisory cautions volunteers to, among other things, avoid drinking or using ice made from tap or well water, and eating food served at room temperature or raw/uncooked meat/fish. Because Puerto Rico and the U.S. Virgin Islands are at risk for outbreaks of Zika, dengue, and chikungunya, pregnant relief workers are discouraged from deploying. All workers must have current vaccinations and they were cautioned that the stressful conditions could affect their mental health.

On November 25 a medical team from Massachusetts General Hospital deployed to Puerto Rico for an estimated 16 days. The 26-person team includes 15 nurses, four nurse practitioners, five doctors, one physician assistant, and one logistics/security staff person. The deployment was coordinated by MGH, DPH, and the Massachusetts Emergency Management Agency (MEMA). The request for assistance from Puerto Rico came through the Emergency Management Assistance Compact (EMAC), which is the national emergency management mutual aid system that facilitates state-to-state disaster assistance.

New Disaster Prep Rules are Now in Effect

Providers participating in the Medicaid or Medicare program (and that’s just about everyone) are facing new “Conditions of Participation” – the basic rules providers must follow – relating to emergency preparedness. CMS’s new rules establish national emergency preparedness requirements to ensure adequate planning for both natural and man-made disasters, and coordination with federal, state, tribal, regional, and local emergency preparedness systems.  The rules were changed last year but as of November 15, 2017, all affected entities had to be in compliance.

Earlier in November, MHA sent to its membership registration materials for two DPH-sponsored courses on how to comply with the new conditions. The Providers can pick either the Tuesday, Dec. 5 course in Dedham or the Thursday, Dec. 7 course in Marlborough. Complete registration details are here.

Increasing Your Margins in a Challenging Environment

Friday, December 8; 9 a.m.-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 this 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 register.

John LoDico, Editor