Clearing Up Deceptions, a Desperate MNA Move, and more...

Opioids: A Step Forward in D.C., a Potential Step Back in Mass.

The opioid crisis is of such great national importance that a usually fractious U.S. Congress came together last week to reach agreement on the bipartisan “SUPPORT for Patients and Communities Act.” Last Friday, the House voted 393 to 8 to pass the bill; the Senate is expected to vote sometime in the next two weeks before sending the package to the president. 

The 660-page bill makes numerous changes to the Medicaid and Medicare programs and the operations of many federal agencies to put in place new policies to deal with substance use disorder. The bill contains everything from ensuring that Medicare beneficiaries can receive treatment in a community setting, to requiring hospitals to develop protocols on how to discharge patients who have presented with an opioid overdose.

In Massachusetts, where the healthcare community and state government have begun to achieve success in combating opioid use disorder, optimism over the federal bill has been mixed with concern over an impending threat to the commonwealth’s entire behavioral health system.

Question 1 on the November ballot would impose government mandated ratios on all units of every hospital in the state – at all times. All hospitals includes acute psychiatric hospitals and acute care specialty hospitals, among others. One such facility, the renowned McLean Hospital in Belmont, issued a statement last week signed by its leadership team across seven divisions, detailing how Question 1 would cost it $10 million annually and “have a negative impact on patient care.”

“Ballot Question 1 seeks to impose rigid nurse-to-patient staffing ratios that we believe would be catastrophic to the already overburdened behavioral health system,” McLean wrote. “If Question 1 passes, McLean, as well all hospitals in Massachusetts, will be affected. Most concerning to us is the severe negative impact it will have on the state’s most vulnerable population—the people we serve every day.”

McLean’s detailed letter was met immediately by a “tweet’ from the Question 1 proponent’s chief spokesperson, who wrote, “you’re saying this bill will cost you $10M … but the bill DOESN’T APPLY TO YOU. How in God’s name is this going to cost you money to implement.” 

But Question 1 does apply specifically to “acute psychiatric hospitals” such as McLean. The nurses union behind Question 1 also has tried to argue incorrectly that the ratio mandate would not apply to rehabilitation hospitals – but it does. Other recent mistruths have involved the union claiming the ratio mandate would be lifted during declared “states of emergency” (it would only be lifted during declared “public health emergencies” of which they have been only four since 1970); and that ratios would be “flexible” (they’re not and must be applied “at all times”). 

“They’ve been trying to move this ratio law through for the past 20 years without success,” said Amanda Stefancyk Oberlies, PhD, R.N., the CEO of the Organization of Nurse Leaders. “Either they don’t understand the excessively restrictive ratios they are attempting to impose or they are being deceptive about the intent of the bill.  Either way is troubling.”

The Massachusetts Association of Behavioral Health Systems recently released a report, confirming McLean’s concerns by showing how Question 1 would result in the loss of 1,000 behavioral health beds in the state. The Massachusetts Association for Mental Health opposes Question 1, as does the Association for Behavioral Healthcare.

Read the entire Question 1 here.
Read McLean’s full statement here.
Read the Coalition to Protect Patient Safety’s response to the union’s deceptive arguments here.
Read the Mass. Association of Behavioral Health System’s report here.

Nursing Union Criticizes Oversight Group for Performing Oversight

The Health Policy Commission (HPC) announced last week that this Wednesday, Oct. 3, it will release its analysis of the healthcare costs associated with ballot Question 1. Monitoring healthcare spending in the state is the fundamental mission of the HPC. It is why the HPC performed a thorough analysis of the large Beth Israel Lahey proposed merger (see story below). Yet, even though the HPC is performing its oversight role, and before the cost report was even distributed, the nursing union behind Question 1 criticized the HPC’s as-yet-unreleased report as being unfair. A spokesman for the Coalition to Protect Patient Safety, which opposes Question 1, called the union’s pre-release attempt to criticize the report’s as-yet-unknown contents “desperate.”  The secretary of state’s “red book” voter guide released this week estimates that the cost of Question 1 to the nine state-owned hospitals alone will be between $67.8 million and $74.8 million annually.

HPC on BID-Lahey Merger: AG Review Needed

The Health Policy Commission last Thursday released its final report on the proposed large merger of hospitals and physician practices that would be known as Beth Israel Lahey Health (BILH), ruling that the new system needs further review from the Attorney General’s office. The HPC also called on the Department of Public Health to reconsider its previous Determination of Need approval it had granted BILH.

Attorney General Maura Healey’s office now has the authority to impose certain restrictions or conditions on the merger.

The HPC found that the merger would result in the new BILH having more bargaining leverage with insurers, thereby potentially increasing total healthcare spending by an estimated $128.4 million to $170.8 million annually for inpatient, outpatient, and adult primary care services.

“[W]hile the BILH parties have historically been low-priced to mid-priced and have not increased their prices relative to the market as they have grown through smaller transactions to date, the BILH transaction is likely to enable the parties to obtain significantly higher commercial prices across inpatient, outpatient, and physician services,” the HPC wrote in its final “Cost And Market Impact Review” report. “Achieving all of the parties’ goals for their proposed care delivery programs and for shifting patients to lower-cost settings would result in savings, but these savings would be less than the impact of projected price increases as a result of the parties’ enhanced bargaining leverage.”

The HPC specifically asked the AG to “assess whether there are enforceable steps that the parties may take to mitigate concerns about the potential for significant price increases, and maximize the likelihood that BILH will enhance access to high quality care, particularly for underserved populations.”

2019 RFA Goes into Effect on November 1

The 2019 acute care hospital Request for Application (RFA) – the main MassHealth (Medicaid) contract between the state and hospitals – was released last week and will take effect November 1. Last year’s RFA was extended one month as the state worked on 2019 changes related to outpatient reimbursement, readmissions, and the hospital pay-for-performance program.

Report Indicates Why Outpatient Care Costs May Be Rising

Recent attention on both the state and national level has focused on the trend of more and more patients receiving care in outpatient settings. Now a new national study from KNG Health Consulting LLC and commissioned by the American Hospital Association indicates that Medicare patients, including cancer patients, who receive care in a hospital outpatient department are more likely to be poorer and have more severe chronic conditions than Medicare patients treated in an independent physician office.

According to the study, relative to those seen in a physician’s office, Medicare patients seen in hospital outpatient departments are more likely to be: from lower-income areas; burdened with more severe chronic conditions; previously hospitalized; eligible for both Medicare and Medicaid; and previously cared for in an emergency department, thereby having higher Medicare spending prior to receiving ambulatory care.

The Massachusetts Center for Health Information & Analysis has identified a rising outpatient care cost trend in the commonwealth; the new AHA report may help explain part of that trend.

MGH to Lead Partnership Developing Disaster Response System

Massachusetts General Hospital (MGH) is just one of two hospitals nationwide to receive an important federal grant to develop a regional plan for delivering medical care during an emergency.

MGH’s grant from the U.S. Department of Health and Human Services’ Hospital Preparedness Program is to demonstrate how a Regional Disaster Health Response System could meet the needs of communities in need of immediate medical specialty care following a disaster.

With the $3 million grant, MGH will assemble a partnership group that will: build a statewide network of technical advisors from healthcare institutions to coordinate patient and resource movement during disasters and develop medical surge capacity; establish a 24/7/365 center that supports healthcare incident response; and develop general and specialty disaster medical response teams.

The partnership will also create expert advisory groups focusing on trauma, burn, radiological/nuclear hazards, mental health, HazMat – among many other areas that will need to be addressed during a mass-scale disaster.

What Massachusetts develops along with the other pilot project site at Nebraska Medicine in Omaha could be replicated across the nation. MGH and Nebraska Medicine were chosen from 19 national applicants for the grant.

Congress Nears Spending Agreement to Avoid Shutdown

On September 26, the U.S. House passed a House/Senate FY2019 spending agreement for several agencies, including the U.S. Department of Health and Human Services, which would receive $899.2 billion. The lopsided House vote of 361-61 included the Massachusetts House delegation voting with the majority.

CMS would receive the vast majority of the funding (approximately $797 billion), with the remaining dollars going to various HHS agencies and centers, such as the Health Resources & Services Administration (HRSA) and Substance Abuse and Mental Health Services Administration (SAMHSA). CMS funding mostly is allocated to mandatory programs, with $378.3 billion and $276.2 billion allocated to Medicare and Medicaid, respectively.

Other notable funding allocations include:
$1.1 billion for HRSA’s health workforce programs, which is nearly $639 million more than requested by the agency. There also is a $25 million grant for medical schools at public universities in states with the highest projected primary care shortage.
SAMHSA would receive $3.82 billion, an increase of $555.3 million over FY 2018. This funding is allocated mostly to efforts to combat the opioid epidemic.

Minority Health Policy Fellowship at Harvard Available

The Commonwealth Fund Fellowship in Minority Health Policy at Harvard University is accepting applications the 2019-2020 year. Established in 1996, the Fellowship in Minority Health Policy prepares physicians, particularly physicians from groups underrepresented in medicine, “to become leaders who improve the health of disadvantaged and vulnerable populations through transforming healthcare delivery systems and promoting innovation in policies, practices and programs that address health equity and the social determinants of health.” Up to six one-year, degree-granting fellowships will be awarded per year. Each Fellowship provides: $60,000 stipend, full tuition, health insurance, books, fellowship travel, and financial assistance for a practicum project. Application deadline is 5 p.m. on December 1, 2018. Please visit here for complete details.

John LoDico, Editor