Gov. Baker Addresses MHA Mid-Winter Leadership Forum

More than 400 healthcare leaders attended Friday’s MHA Mid-Winter Leadership Forum, "Healthcare at the Intersection of Cost and Innovation," which featured Massachusetts Governor Charlie Baker as closing speaker.

In an almost hour-long address, Gov. Baker touched on a wide range of state governance and healthcare issues.

Noting the administration's waiver negotiations with the federal government, Baker highlighted the difference in his time as secretary of administration and finance and now as governor, saying that, "Today there is more federal oversight that has changed and limited the state's discretionary decision making in the Medicaid program."

Then in speaking about his focus on the opioid crisis in the state, Baker applauded the work of MHA on the issue, saying "MHA was way ahead of other provider organizations around the country on the issue." Baker also stressed that much more needs to be done to address the epidemic.

The much-anticipated 49th annual MHA event also included a keynote address by Rich Siegrist, Director of Innovation and Entrepreneurship at the Harvard T.H. Chan School of Public Health, and two expert panels focused on different aspects of healthcare innovation. Attendees heard about the dynamic tension between costs and innovation in healthcare, digital and technological care advances, and some of the possibilities and cost management challenges posed by the latest emerging treatment options.

“The idea of ‘innovation’ isn’t unique to healthcare. But it has become an integral component of progress toward the “Quadruple Aim”: enhancing patient experience, improving population health, reducing costs, and improving the work life of healthcare providers,” said Lynn Nicholas, MHA’s President & CEO. "Massachusetts is the hub of life sciences and biotech innovation and the emphasis on meeting the cost trend goal for the Commonwealth ramps up the need for and pace of innovation, drawing caregivers and entrepreneurs into synergistic relationships. As a result, the economy will benefit, but most of all patients will be healthier and families will have peace of mind. We hope this year’s MHA event will inform and inspire even greater advances."

Governor's Budget Calls For $250 Million Hospital Tax

On Thursday, Governor Baker released his proposed FY 2017 state budget. The $39.6 billion dollar budget reflects the governor’s priority of “getting state spending under control.” The budget blueprint would hold overall state spending growth to 3.5 percent. Of particular interest to the hospital community was a proposed new annual $250 million tax upon acute care hospitals. The tax revenues would go into a new a trust fund named the “MassHealth Delivery System Reform Trust Fund.”

The proposed new tax would be in addition to the current hospital tax of $165 million bringing the total tax to $415 million. The provision is intended to leverage federal matching funds in order to support the investments in care organizations in the new MassHealth Accountable Care Organization (ACO) program. While the ACO investments are not expected to take place until FY2018, the hospital tax and payments begin on October 1, 2016. As a result, $93 million in federal revenue will be generated in state FY2017, of which MassHealth will use $73.5 million to partially address a FY2017 MassHealth budget gap.

The Baker Administration has indicated that it intends to make hospitals whole as a class with the funds generated by the tax, but not all hospitals will be made whole and many hospitals will be overall losers. Such a large tax raises significant questions and concerns especially given the experience with provider taxes in Massachusetts, as well as in other states. Some important questions being asked by hospitals include: what would be the consequences for those hospitals and their communities that would be net payers; what alternatives to taxing hospitals exist for raising new federal funding; why isn’t the proposed tax plan designed to benefit all hospitals; would the tax be temporary or permanent (there is no sunset provision in the budget language); what guarantee is there that the full $250 million in taxes will be returned annually to hospitals as opposed to being diverted for other state purposes in future years. Language in the proposed statue only states that hospitals may receive up to $250 million annually and such language is subject to future legislative changes.

Lynn Nicholas, President and CEO of the Massachusetts Hospital Association, stated that “these and other important questions and concerns will be the focus of the hospital community as we examine the governor’s proposal. Proposing a new tax of this size is no small matter. Many states, including Massachusetts, have a troubling track record with these types of taxes on healthcare providers. So it is fair to place the burden of justifying the new tax on the shoulders of those who propose it.”

The Baker Administration budget also makes changes to the Health Safety Net program that will reduce coverage for services provided by hospitals to uninsured and underinsured patients. The policy changes are estimated to be worth $60 million annually, much of which will result in a direct cost-shift to hospitals. The administration also proposes to eliminate the state’s annual $30 million contribution to the Health Safety Net program, putting further stress on that program which currently has a $76 million annualized funding shortfall. Hospitals are solely responsible for the program’s funding shortfalls.

The administrative budget to fund the Center for Health Information and Analysis (CHIA), approximately half of which is paid for by hospitals, is held to a modest growth rate of 0.9%. However, hospitals in FY2017 also become partially responsible for the administrative expenses of the Health Policy Commission (HPC), which is budgeted at $8.5 million. MHA is seeking reform of the assignment of these expenses to the hospital community.

Other notable assumptions in the Baker Administration’s budget include funding of hospital and health center Infrastructure and Capacity Building (ICB) grants at $20 million, the same level of funding provided in FY2016. The budget also assumes a 10% increase for Delivery System Reform Transformation Incentive payments as called for in the Waiver, holds most provider reimbursement rates flat, modifies rules for switching MassHealth MCOs, and creates a new trust fund to support the Sexual Assault Nurse Examiner (SANE) program. 

CDC Issues Guidance To Stop HEP-C Transmissions In Dialysis

The Centers for Disease Control and Prevention (CDC) on Wednesday issued a health advisory in response to an increased number of reports of newly acquired hepatitis C virus (HCV) infection among patients undergoing hemodialysis. Any case of new HCV infection in a patient undergoing dialysis should prompt immediate action, as infection control lapses in dialysis care could expose patients to HCV.

The CDC health advisory urges hemodialysis providers and facilities to:

1) Assess current infection control practices and environmental cleaning and disinfection practices within the facility to ensure adherence to infection control standards;

2) Address any gaps identified by the assessments;

3) Screen patients for HCV, following CDC guidelines, to detect infections, determine treatment potential, and halt secondary transmission; and

4) Promptly report all acute HCV infections to the state or local health department.

CDC has checklists and audit tools that providers can use to assess their practices, identify gaps, and improve infection control practices to protect patients. For additional information and resources, visit the CDC Dialysis Safety website for infection control guidelines, clinician education resources, patient information, and other resources. 

AG Healey Calls For Accessible Drug Prices

Attorney General Maura Healey on Wednesday addressed industry leaders at the Massachusetts Biotechnology Council's policy breakfast, calling for a balanced approach to drug pricing that would fairly compensate manufacturers while still make life-saving medications financially accessible to patients.

Pharmaceutical costs have also been cited as one of the main drivers of healthcare spending growth in Massachusetts. A recent cost trends report from the Health Policy Commission noted a 13 percent spike in per capita pharmacy spending in the state from 2013 to 2014.

MHA has called for “a rigorous conversation regarding prescription drug price increases as a driver of healthcare spending,” citing the HPC report’s additional finding that commercial hospital and physician spending grew just 1 percent per capita in 2014.

“The best way to advance the success hospitals and other providers have had reining in cost increases is to escalate the movement to alternative payment models,” MHA President & CEO Lynn Nicholas said. “Reducing total healthcare spending requires attention to all components of the overall cost trend, including prescription drugs.” 

Mass. Has First Case Of Zika Virus, CDC Issues Guidelines

State health officials Thursday confirmed one case of the Zika virus in Massachusetts and said additional cases are quite possible, though the virus cannot be spread from one infected person to others. The affected patient is male, so there is no concern in this instance about a pregnant patient with Zika or the birth of a baby with microcephaly -- a birth defect that results in smaller than normal head-size -- which has been associated with a Zika outbreak in Brazil.

The federal Centers for Disease Control and Prevention (CDC) has issued interim evaluation and treatment guidelines for infants born to mothers who traveled or lived in areas with Zika virus outbreaks during their pregnancy, as well as interim guidelines for healthcare providers caring for pregnant women who have traveled to the areas where Zika virus transmission is active. The Massachusetts Department of Public Health (DPH) is working closely with the CDC to coordinate testing for symptomatic pregnant women who have recently traveled to countries with identified Zika transmission. Currently all evaluations are being handled by the CDC.

Zika virus is a mosquito-borne virus in the same family as yellow fever, dengue and West Nile viruses, with symptoms including fever, rash and conjunctivitis. An estimated 80% of persons infected with Zika virus are asymptomatic and severe cases resulting in hospitalization or fatalities are rare.  

A Playbook For Managing Difficult Cases:

SOLUTIONS FOR COMPLEX PSYCHOSOCIAL DISCHARGES
WEDNESDAY, MARCH 16, 2016; 8:00 A.M. - 4:00 P.M.
MHA CONFERENCE CENTER BURLINGTON, MASS.

As hospitals shift from episodic care to managing populations, it’s clear that psychosocial issues play a large role in how treatment plays out. With complex cases, the challenges of successful treatment are magnified. This program will examine the increasingly impactful role that social work can play in managing complex cases and preventing admissions/re-admissions, especially with the more challenging cases. We’ll look at specific strategies to address both the medical and psychosocial needs of patients, and how to embed these practices better into the overall hospital/healthcare/ED environment. The program is targeted toward social workers, case managers, RNs, MDs, emergency department clinicians or leaders who are interested in innovative practice strategies to help better treat patients and reduce unnecessary hospital admissions.