Business Groups Rap Ratios, House Budget, and more...

Employer Groups Join Opposition to Nurse Staffing Ballot Question

The Greater Boston Chamber of Commerce, Associated Industries of Massachusetts (AIM), the Massachusetts Taxpayers Foundation, and the Massachusetts Business Roundtable have all joined the Coalition to Protect Patient Safety to oppose a nurses union’s ballot question, which would impose government-mandated, rigid nurse staffing ratios on every Massachusetts hospital.

“This proposal would be bad for business and terrible for patients,” said AIM President Richard Lord. “The one-size-fits-all mandate will force hospitals to decrease service considerably to comply with the costs associated with this bill. These costs will be felt across the entire healthcare system, important programs will be cut, wait times will increase, and some hospitals will close entirely.”

"Health care costs are already a burden for many families and employers across Massachusetts,” said Eileen McAnneny, president of the Massachusetts Taxpayers Foundation. “The additional costs incurred from this bill will be passed on to patients, with no proof that it will improve quality of care. Massachusetts should use its healthcare dollars to focus on more pressing priorities, like mental health care and addiction treatment rather than this self-serving ballot initiative.”

If it passes, the ballot question will cost Massachusetts more than $800 million each year, and patients will pay the price in the form of higher insurance costs and taxes at a time when many Massachusetts families are already struggling to pay for healthcare. Hospitals will be forced to cut vital health programs, such as opioid treatment, mental health services, cancer screenings, early childhood intervention, domestic violence programs and pre- or post- natal care.

“We have some of the best hospitals in the nation, with consistently high-quality outcomes in every category. If passed, this ballot question would endanger this hard-earned reputation with absolutely no evidence that that one-size-fits-all nurse staffing ratios will improve patient care,” said Jim Rooney, president of the Greater Boston Chamber of Commerce. “The added costs that our hospitals would have to take on would be passed off to our residents and small business owners, which goes against our goal of ensuring that quality care is accessible to all and affordable for the state, businesses, and individuals.”

“While healthcare in Massachusetts – near universal access to it and the high quality of it – remains a key competitive advantage and major economic engine, the rising costs of healthcare continue to be a concern for businesses,” said JD Chesloff, executive director of the Massachusetts Business Roundtable. “We need to adopt a balanced approach that ensures Massachusetts remains a global leader in healthcare, while carefully managing costs for consumers and businesses. Complex issues such as staffing decisions at hospitals should be made by health care professionals, not at the statewide ballot box.”

The ballot question, proposed by a Massachusetts nurses’ union, which represents less than a quarter of nurses in the commonwealth, would require that hospitals across the state, no matter their size or specific needs of their patients, adhere to the same rigid nurse staffing ratios within all hospital units, at all times. The petition does not make allowances for rural or small community hospitals, holding them to the same staffing ratios as major Boston teaching hospitals, resulting in increased costs across the healthcare system.

Even among nurses, the proposed ballot question is raising red flags and facing mounting opposition. The business groups join the American Nurses Association Massachusetts and the Organization of Nurse Leaders, among others, in opposition.

“Registered Nurses in Massachusetts should adapt staffing plans based on the dynamic needs of their patients —not by sheer numbers,” said Lynne Hancock, a registered nurse at Boston Children’s Hospital. “Each nurse is unique in their experience and skill set, and each patient has unique healthcare needs. To ensure the most optimal patient outcomes in the safest care environment, staffing decisions should be made in real time by clinical experts – the nurses delivering the day-to-day care.”

To comply with the mandated ratios, hospitals would be forced to transfer patients to other hospitals further outside their community or allow the emergency room to fill until patients can be admitted within the legal ratios. Emergency room wait times will dramatically increase, as hospitals would be prevented from admitting patients if the number of nurses on duty does not comply with the rigid government mandate.

House Budget Provides Support for DSH and Safety Net

The Massachusetts House Ways & Means Committee, chaired by Rep. Jeffrey Sánchez (D-Mission Hill), released its proposed FY19 state budget last Wednesday, and a preliminary review of it shows that the budget writers were responsive to some key hospital priorities.

For instance, the committee’s proposed budget requires a $15 million transfer from the Commonwealth Care Trust Fund to the Health Safety Net program – a long-standing MHA priority.  Previous budgets were passed with language indicating that “up to” $15 million may be transferred. That permissive phrasing resulted in no transfer occurring in the past three fiscal years.

The Ways & Means budget also includes a provision to adjust both inpatient and outpatient reimbursement rates for disproportionate share hospitals (DSH). Under the Baker administration’s budget proposal,  DSH hospitals may have received a supplemental payment that totals $13 million. The House approach includes the payment adjustment within actual reimbursement rates – which protects the needed enhancements from the vagaries of state revenue fluctuations and potential mid-year budget cuts. The higher level of certainty that the payments will actually be made, allows the safety net hospitals to factor the payments into patient care delivery and hospital operations.

Ways & Means rejected a proposal in the governor’s proposed budget that would have required about 140,000 people enrolled in MassHealth to get their insurance through the Connector. MHA had supported the governor’s plan with the proviso that certain statutory protections be created to ensure that those being shifted to the Connector would be able to afford their coverage.

Five outside sections in the House Ways & Means budget create an Office of Health Equity within the Executive Office of Health & Human Services to assist in reducing and eliminating disparities in healthcare access and outcomes related to racial, ethnic, and disability status.

The House Ways & Means budget supporting documents indicate that substance use disorder funding has been increased by $37 million over FY2018.

MassHealth ACO Program Continues to Evolve

MassHealth continues to tweak its sweeping Accountable Care Organization (ACO) program that went live in March.  Specifically, last week MassHealth extended its “continuity of care” deadlines from one month to 90 days (or May 31). And the ACO program is now allowing patients greater flexibility to enroll in an ACO that does not technically serve their geographic area.

Originally, members had 30 days from March 1 for the continuity of their care, meaning they could stay with their existing provider for 30 days to meet scheduled appointments or continue treatments.  Now, under the new rules, MassHealth members who have not yet transitioned to their plan’s in-network providers may continue to see their existing providers until May 31. (This is for medical care; behavioral healthcare always had the May 31 extended deadline.)  Many health plans had this continuity of care period on their own but now this protection is universal.

By partially removing the service area limitations, MassHealth is addressing a significant problem that MHA, many providers, and consumers raised.  The general rule had been that a MassHealth member could not choose an Accountable Care Partnership Plan that did not operate in his or her service area. But beginning April 9, enrollees wanting a primary care physician that is in an Accountable Care Partnership Plan that does not technically serve the area in which the enrollee resides will be permitted to request an exception.  MassHealth says the criteria for granting an exception will be if the patient has an established relationship with the primary care physician or a specific cultural, language, accessibility, or medical need.  Homelessness is also an acceptable exception criteria. MassHealth will notify the member in writing within 30 days of an exception request and the decision is appealable.

New (and Limited) Transparency Site Nears Completion

The new transparency website from the Center for Health Information and Analysis (CHIA) is nearing completion and last week CHIA sent out a notice to interested parties to take one last look at it before it goes live in the coming weeks.

The site – the creation of which was mandated by the Chapter 224 reform law – allows consumers to enter in a procedure (say, MRI of the arm) and then see what various providers in a geographic area charge for that procedure.  But CHIA itself warns there are limitations: the prices listed are from 2015, and what is shown may bear no relation to what a consumer will actually pay since that is dependent on the patient’s co-pays and deductibles.  Responding to the more than 200 suggestions stakeholders made, CHIA has added prominent flags on the site encouraging consumers to check with their insurers for a more accurate cost quote.

Overdose Reversal Strategy Grants Available

The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting applications for Improving Access to Overdose Treatment grants totaling up to $200,000 per year for up to five years.

SAMHSA will award the funds to Federally Qualified Health Centers, Opioid Treatment Programs, or practitioners who have a waiver to prescribe buprenorphine to expand access to FDA-approved drugs or devices for emergency treatment of known or suspected opioid overdose. The recipients will partner with other prescribers at the community level to develop best practices for prescribing and co-prescribing FDA-approved overdose reversal drugs. After developing best practices, the recipient will train other prescribers in the community as well as individuals who support persons at high risk for overdose.

SAMHSA expects to fund up to five grantees. Click here for the funding opportunity announcement for this grant. Click here for information on how to apply.

Thoughts on Federal Opioid-Fighting Legislation

The U.S. House Ways & Means Committee, on which Massachusetts Representative Richard Neal (D) is the ranking minority member, last week issued this white paper that summarizes the more than 100 comments the committee received on what legislation is needed to address the opioid crisis within the Medicare program.

While the committee received a wide variety of suggestions, it said the bulk of the comments could be sorted into one of the seven buckets: 1) treatment, reimbursement, and increasing access to medication-assisted treatment (MAT);  2) increasing utilization and access to non-opioid treatments of pain; 3) Part D lock-in (that is, limit Medicare beneficiaries with a history of drug abuse to seeing one prescriber and one pharmacy); 4) limiting prescriptions (initial supply, second fills, prior authorization, etc.); 5) better data tracking; 6) provider education; and 7) patient education.

Slightly more than half the respondents expressed support for or directly called on the committee to enact legislation to expand the use of MAT.

Transitions – John Fernandez on Boston Board of Health

Boston Mayor Marty Walsh last week named Massachusetts Eye and Ear President John Fernandez to the Boston Board of Health, along with Dr. Jennifer Childs-Roshak, the president and CEO of Planned Parenthood League of Massachusetts.  Fernandez is a past member of the MHA Board of Trustees.  Walsh also named Dr. Jennifer Lo as the Boston Public Health Commission's new Medical Director.

Annual Design, Operations and Construction Conference

Friday, May 11; 8:30 a.m. to 3 p.m.
MHA Conference Center, Burlington, Mass.

MHA's Annual Design, Operations & Construction program provides the latest information on critical topics such as:  security and emergency management, energy and sustainability, and preparing for the Joint Commission. This program always provides great education, information and networking.

The conference is FREE for MHFPS, NEHES or other facility professionals working for a member hospital or health system. The event is supported by the vital consultant and vendor community in the Healthcare A/E/C/RE industry. Through generous sponsorship and registrations, this event is available to all facility professionals at all levels.  We encourage you to attend!

Click here for complete program details.

John LoDico, Editor