National Rankings, Ratios, and more...

New National Rankings Undercut Ratio Proponent Arguments

The Commonwealth Fund’s most recent Scorecard on State Health System Performance places Massachusetts at number 2 in the nation – up from fifth place in 2017.

The rankings – based on 40-plus measures of healthcare access, outcomes, disparities, and more – rank Hawaii at number one and Mississippi at the bottom.

As has been true in the past, the Bay State leads the nation in 30-day mortality prevention; that is, patients here have a better chance of staying alive in the 30 days after leaving a hospital for care. (According to the Medicare Hospital Compare program, deaths after a 30-day period may have less to do with the care the hospital provided and more to do with other complicating illnesses, patients’ own behavior, or other care services patients received after they leave the hospital.)

The very high-quality Massachusetts healthcare system always has been considered an important component of the state’s desirability and economic health. Recently, as part of its effort to pass a mandated nurse staffing ratio ballot question in November, one nursing union has attempted to denigrate Massachusetts healthcare. Specifically, the union has said the only state with mandated ratios – California – performs better than Massachusetts.

While the “Golden State” has many positive attributes and many fine hospitals, it lags the Bay State, according to the Commonwealth Fund rankings.

Massachusetts is ranked #2 overall, up from #5. California remains at #14.
Massachusetts is #1 in lowest 30-day mortality; California dropped to #8 from last year’s #7.
For the only infection measure included on the scorecard – central line-associated blood stream infection, or CLABSI – Massachusetts ranks #6 while California ranks at #27.
Massachusetts significantly outranks California on key nursing-related scores such as lower rates of “Hospital patients discharged without instructions for home recovery” (#7 vs. #43) and “Hospital patients who did not receive patient-centered care.”
When it comes to disparities, Massachusetts outperforms California overall – #2 versus #22.

Importantly, the nursing union has made claims relating to healthcare spending between Massachusetts and California, falsely insinuating that costs in California are lower and are due to nurse staffing ratios in hospitals. However, the Commonwealth Fund reports that in California individuals have both higher out-of-pocket spending and higher employee health insurance contributions than Massachusetts.

More Healthcare Groups Review and Reject Ratio Bill

Two more nurse-centric groups last week came out against the ballot question that would impose rigid nurse staffing ratios on all hospitals at all times.

Home Care Alliance of Massachusetts, a non-profit association of home care agencies working with 5,000 nurses across the commonwealth, and VNA Care, which employs 800 visiting nurses throughout the state, joined the Coalition to Protect Patient Safety in opposition to the proposed nurse staffing ballot question.

“This ballot measure would negatively impact the important work that we do at Home Care Alliance. Thousands of adults and children who are frail, disabled or at the end of their lives depend on home health care nurses to provide them with care when they are unable to travel to get that care,” said Pat Kelleher, executive director of Home Care Alliance of Massachusetts. “If hospitals across Massachusetts need to hire more than 5,000 new nurses, I fear it will pull nurses away from the home health community. There is a tremendous risk that we will simply be unable to sustain a nursing workforce to provide care to those who desperately need us.”

“Providing home healthcare requires nurses to constantly rely on the skills we learned in nursing school, and our experience spending time with patients,” said Holly Chaffee, R.N., CEO of VNA Care. “There is a strong movement toward shifting acute care patients home, but this measure will contribute to the shortage of seasoned nurses in and make it harder to offer those patients appropriate care. VNA Care and other nursing agencies will struggle to fulfill our missions if this measure passes.”

The Home Care Alliance and VNA Care join American Nurses Association Massachusetts, the Organization of Nurse Leaders, the Massachusetts Associations of Colleges of Nursing, the New England Chapter of the Infusion Nurses Society, and other healthcare leaders in opposing the rigid ratio question.

UMass Memorial’s National Recognition for Community Care

UMass Memorial Medical Center was one of three finalists for the prestigious 2017 Foster G. McGaw Prize for Excellence in Community Service sponsored by the Baxter Allegiance Foundation, the American Hospital Association, and AHA’s Health Research & Educational Trust.

Yale New Haven Hospital won the award this year. Massachusetts General Hospital in 2015 was the last Massachusetts recipient of the McGaw Prize, which recognizes a healthcare organization that provides innovative programs that significantly improve the health and well-being of its community.

UMass was recognized for its dedicated prevention programs, including preventive mental health services, a community-wide intervention targeting asthmatic public schools, a mobile health care unit, as well as recreation and job programs to promote positive youth development for inner-city children.

HPC Hears Concerns Over Insurers’ Pharmacy Mandates

MHA last Wednesday informed the Health Policy Commission about the patient safety and cost considerations related to insurance companies’ “white bagging” and “brown bagging” drug policies.

Insurers have increasingly altered their benefit structures by moving certain injectable and infusion drugs out of the medical benefit and into the pharmacy benefit, requiring that these drugs be obtained from a specialty pharmacy and delivered to patients to bring to their providers (brown bagging) or delivered directly to physicians or hospital outpatient departments to be administered to specific patients (white bagging).  In some plans, in order to be covered, the patient must receive the medication from a home infusion company rather than in a provider’s office or clinic.

“MHA is concerned about the growing subset of injectable and infusion medications that generally require special handling, storage, temperature control, and/or compounding prior to administration and may also have significant side effects requiring the presence of a physician when the drug is administered,” MHA’s Senior Director of Managed Care Karen Granoff commented. “When insurers mandate that these medications must be provided by specialty pharmacies and, in some cases, administered in the patient’s home, the result is the creation of significant clinical, operational, patient safety, access, and financial challenges.”

Granoff urged the HPC to develop a clinically appropriate approach “that does not compromise patient safety, create administrative complexity for patients and providers, add operational challenges to hospitals, make it more expensive for patients to obtain these medications, and put hospital pharmacists in the difficult position of potentially re-dispensing any medication which has been previously dispensed by another pharmacist.”

Ongoing concern about the insurers’ bagging policies led the legislature to include an MHA-backed provision in the FY2018 budget requiring HPC to analyze health insurance payer practices and submit a report and recommendations to the legislature by July 1, 2018.

At the public hearing, Granoff submitted these comments and was joined by UMass Memorial Medical Center’s Division Chief of Pediatric Gastroenterology Jenifer Lightdale, M.D., and Neil Gilchrist, manager of pharmacy operations. Others offering comments at the hearing included Dr. Sharon Stotsky, Rheumatology and Internal Medicine Associates, in Wilmington and president of the MA, ME, NH Rheumatology Society; Sylvia Bartel, V.P. of pharmacy for Dana-Farber Cancer Institute; David Twitchell, chief pharmacy officer for Boston Medical Center Health System; and representatives of Blue Cross Blue Shield of Massachusetts.

Hallmark Health is Now MelroseWakefield Healthcare

The former Hallmark Health system has rebranded itself to MelroseWakefield Healthcare to better define its service area of north suburban Boston.

MelroseWakefield Healthcare consists of Lawrence Memorial Hospital of Medford and MelroseWakefield Hospital in Melrose, as well as urgent care locations, visiting nurse and hospice care, plus 90 community physicians who are part of Tufts Medical Center Community Care (formerly Hallmark Health Medical Associates).

MelroseWakefield Healthcare is part of Wellforce, which also includes Tufts Medical Center, Circle Health (including Lowell General Hospital), Floating Hospital for Children, plus Lowell General Physician Hospital Organization and New England Quality Care Alliance.

House Bill Sets Strict Limits on Tobacco

The Massachusetts House last week passed a bill by a vote of 146-4 that would raise the legal age for purchasing tobacco products from 18 to 21, prohibit e-cigarettes from the workplace, and prohibit pharmacies from selling tobacco products.

MHA strongly supported the bill, which now moves to the State Senate that passed similar legislation last session.  The legislation was championed in the House by House Public Health Committee Chair Kate Hogan (D-Stow), House Ways & Means Chair Rep. Jeffrey Sánchez (D-Mission Hill), Rep. Paul McMurtry (D-Dedham), and Rep. Sean Garballey (D-Arlington). It had been spearheaded by Tobacco Free Massachusetts, of which MHA is a member.

Almost 90% of MHA hospital members have established completely tobacco-free campuses, and several hospitals have joined MHA in establishing employment practices that screen for tobacco use.  Visit MHA’s Tobacco-Free Hospitals webpage.

Tobacco and nicotine use is the leading cause of preventable illness and premature death in Massachusetts.

MHA Solutions: Take a Look

If you haven’t yet, take a look at MHA Solutions Insurance & Benefits, MHA’s wholly owned subsidiary specializing in insurance and risk management not only for healthcare but for all types of businesses as well as individuals.  MHA Solutions’ resources and industry-wide clout places it well above other insurance agencies. Decades of expertise and in-depth knowledge of the healthcare sector solidifies MHA Solutions’ position in the marketplace. For business, personal, or employee benefit needs, please visit MHA Solutions here.

Caring for Elderly Patients: Best Practices & Innovations

Friday, June 22, 8:30 a.m. – 2:30 p.m.
MHA Conference Center, Burlington, Mass.

In 1900 the average lifespan was 47 years. Americans can now expect to live well over 80. By 2050, the number of people 65 years or older is expected to significantly outnumber children younger than five years of age. At the same time, birth rates are decreasing across the globe, leading us to an increasingly grayer world, one where there is a higher proportion of older citizens living longer lives. This will affect many areas of society, from politics to business. But there is one area that will be affected more than any other – healthcare. Hospitals and other providers of care will need to adopt innovative approaches to this societal shift. Caregivers will need to be retrained for new technologies, including the growing prevalence of post-care monitoring. This conference will attempt to explore the changes we can expect due to our increasing longevity and look at resources and new care delivery models for providers. We’ll also provide a legal update on recent legislation affecting elder care in Massachusetts hospitals.  Click here for registration information.

John LoDico, Editor