05.16.2016

HPC seminar on criteria to integrate behavioral health and primary care, and more...

HPC seminar on criteria to integrate behavioral health and primary care

On May 23 and 24, the state’s Health Policy Commission (HPC) will hold an introductory seminar regarding the Patient-Centered Medical Home (PCMH) PRIME Certification and National Committee for Quality Assurance (NCQA) PCMH Recognition programs on May 23 and 24.

The HPC developed the PCMH PRIME certification program in collaboration with NCQA to endorse practices that pass NCQA’s rigorous guidelines for patient-centered care while also maintaining additional behavioral healthcare services for a population.

NCQA PCMH Recognition requires practices to meet rigorous, evidence-based standards. Now, in Massachusetts, practices that go through the recognition process can earn PCMH PRIME certification if they meet at least 7 out of 13 behavioral health criteria.

During this 1.5-day training seminar, NCQA faculty members will present a thorough review of the NCQA PCMH 2014 standards and PCMH PRIME requirements. They will review the criteria, documentation requirements, and application process. The training will give participants the opportunity to practice scoring elements as well as examining documentation that supports an NCQA PCMH application and PCMH PRIME Certification. 

The seminar is open to healthcare professionals, administrators, decision makers, or consultants in Massachusetts who are interested in getting the inside perspective from NCQA about NCQA PCMH 2014 Recognition and PCMH PRIME Certification.

The PCMH PRIME certification is voluntary. The Commonwealth’s Health Policy Commission does offer technical assistance to practices that undergo certification. 

Hospitals urged to review policies based on updated surgery guidance

Hospitals should review their policies and procedures to ensure consistency with recently updated Statements on Principles from the American College of Surgeons (ACS) regarding the responsibilities of primary surgeons during surgery. That’s the recommendation of the American Hospital Association (AHA) and Association of American Medical Colleges (AAMC), which issued an advisory last week following the release of the ACS principles document. The ACS guidance comes in the wake of several news reports that raised questions about primary surgeons initiating a second surgery before the first surgery was fully completed.

In its principles document, ACS states:

The primary attending surgeon is personally responsible for the patient’s welfare throughout the operation. In general, the patient’s primary attending surgeon should be in the operating suite or be immediately available for the entire surgical procedure. There are instances consistent with good patient care that are valid exceptions. However, when the primary attending surgeon is not present or immediately available, another attending surgeon should be assigned as being immediately available.

The AHA and AAMC emphasize that no increased risks to patients have been linked to overlapping or concurrent surgeries, and potential risks may be controlled and/or mitigated by existing policies, procedures and practices. Nevertheless, the professional associations recommend that hospitals review their policies and procedures to ensure that they are consistent with the updated ACS Statements on Principles.

For additional information, contact Nancy Foster, AHA vice president of quality and patient safety, at nfoster@aha.org, or Ivy Baer, AAMC senior director and regulatory counsel, at ibaer@aamc.org

National nurses week

MHA and its member hospitals, health systems and other affiliates joined their colleagues across the country in lauding the vital contributions of nurses during this year’s National Nurses Week, May 6 to 12.

“We deeply appreciate the important work nurses throughout the commonwealth perform every day on behalf of their patients,” said Pat Noga, PhD, RN, MHA’s Vice President of Clinical Affairs. “Making sure our nurses are as prepared and supported as possible to succeed in their careers is one of our key and ongoing goals.”

Among other efforts, MHA is working through the Massachusetts Action Coalition and in partnership with the Organization of Nurse Leaders of MA/RI/NH/CT and the state Department of Higher Education to increase the number of nurses with a nursing bachelor’s degree or higher, and to streamline the educational pipeline for quicker achievement of degrees. The Coalition is also working to provide mentorship to diverse nursing candidates, better prepare graduate nurses for transition into the workforce and engage healthcare employers to support their nursing workforce and advance employees’ career objectives.

Urging reconsideration of health safety net eligibility changes

MHA sent a letter to EOHHS Secretary Marylou Sudders on May 6, requesting reconsideration of scheduled eligibility changes to the state’s Health Safety Net program, and, in particular, the new presumptive determination policy.

MHA explained that the Health Safety Net presumptive determination policy will result in uninsured individuals who would otherwise be eligible for MassHealth to instead be enrolled temporarily in the Health Safety Net. The policy also doesn’t address retroactive situations, such as when a low-income patient seeks financial assistance after they receive care, either because they were unable to complete an application at the time of care or later determine they cannot afford their out-of-pocket expenses.

“While we appreciate that EOHHS may have intended to develop this policy in response to the many concerns raised about the reduction of retroactive coverage, it does not materially address those concerns and in turn produces a host of new concerns related to program integrity and hospital operations,” wrote MHA Executive Vice President Tim Gens. “In the interest of sustaining a viable safety net for low-income patients, we respectfully request the eligibility regulations be revised to remove this policy and that Health Safety Net coverage be restored to prior levels.”

The eligibility changes are currently scheduled to take effect June 1, 2016.

Weighing in on waiver, Medicaid ACO proposal

On May 6, MHA submitted a letter to EOHHS Assistant Secretary Daniel Tsai highlighting comments and recommendations related to the development of the MassHealth Accountable Care Organization (ACO) program and 1115 Medicaid Waiver amendment proposal. MHA addressed issues surrounding the ACO program and risk options; delivery system reform incentive payments and the requirement for formal relationships between ACOs and certified community partners. MHA also discussed the need to clarify how ACOs would interact with both MassHealth Managed Care Organizations and the MassHealth Primary Care Clinician (PCC) program.

“MHA and its members support the development of alternative payment arrangements in the MassHealth program and we want an ACO program to be successfully implemented,” MHA Executive Vice President Tim Gens wrote. However, MHA also raised concerns about the risk options, given the underpayment and complexity of the MassHealth program. “MassHealth currently pays below the cost of care for many providers, especially hospital, physician, and behavioral health services,” wrote Gens. “Factoring in downside risk on services that are underpaid certainly increases the risk for their being further underpaid…[and]we hope that MassHealth is considering other options related to risk for those providers that would like to participate in these models.”

The MassHealth ACO program is expected to begin in October 2017 with the application process for ACOs starting this year. A Medicaid waiver amendment proposal is expected this month. 

Ensuring protection of transgender rights

The Massachusetts Senate decisively approved legislation Thursday that would protect the rights of transgender residents. The legislation, which was approved by a vote of 33-4, adds “gender identity” to the state’s civil rights law for public accommodations, and builds upon previous laws that provide legal protections for transgender people in the areas of credit / lending, housing, employment and public education. By adding explicit protections in the law, the legislation will help all residents of the commonwealth feel empowered to lead healthy lives and improve the overall health of the state. MHA is a member of the Freedom Massachusetts coalition, which is leading support of the legislation. It is anticipated that the House will consider a similar proposal in the near future.

Serious illness coalition holds inaugural summit

The Massachusetts Coalition for Serious Illness Care held its inaugural summit at the JFK Library in Boston Thursday, sharing the results of a landmark survey on Massachusetts residents’ experiences and preferences concerning end-of-life (EOL) care. Among the Coalition’s findings were deep divides between what patients know and want concerning EOL care, and their actions. For example, the survey found 85 percent of Massachusetts residents believe that physicians and their patients should talk about end-of-life care – but only 15 percent have actually had such conversations. However, the survey also found that when respondents do name a health care agent, 85 percent talked to their agent about their wishes if faced with serious illness.

Featured speakers included Governor Charlie Baker and Atul Gawande, MD, author of the best-selling book “Being Mortal.” The Coalition’s goal is “for everyone in Massachusetts to be cared for in accordance with their own goals and preferences, at every stage of health care and illness.” The Massachusetts Hospital Association has joined the coalition.

Speak At Your Best! 
Influencing Audiences In The Healthcare Environment

THURSDAY, JULY 14; 9 A.M. - 4 P.M.
MHA CONFERENCE CENTER, BURLINGTON, MASS.

To be a successful leader today in healthcare, you must be able to persuade and influence at all levels. This day-long program, taught by nationally recognized speech expert Gary Genard, is designed to help healthcare managers and executives become more successful communicators. Whether speaking at meetings, in public forums, or motivating co-workers, you will benefit from actor and author Dr. Genard’s unique system of dynamic oral communication training.

John LoDico, Editor