MHA in D.C. to Argue Against Repeal and Replace

Following a meeting in Washington, D.C. with the American Hospital Association AHA and her association colleagues across the country , MHA President & CEO Lynn Nicholas, FACHE, along with MHA V.P. of Government Advocacy Mike Sroczynski engaged in a series of meetings with some members of the state’s congressional delegation, discussing, among other topics, the incoming Trump Administration’s efforts to repeal and replace the Affordable Care Act.

In a letter that Nicholas delivered to the delegation (see below), MHA states unequivocally, “On behalf of our member hospitals and health systems, the Massachusetts Health and Hospital Association opposes the repeal of the Affordable Care Act.”

Senate Republicans on Thursday passed (51-48) a budget blueprint that sets the stage for a special reconciliation bill – the process through which key parts of the ACA can be repealed without the threat of a filibuster.  President-elect Trump said this week he wants repeal-and-replace legislation passed “essentially simultaneously.” But with no firm replacement ideas currently in place, GOP senators said on Wednesday that they will probably need more time than the end-of-January deadline for action contained in the budget blueprint they passed.

MHA’s letter, citing the experience of the Bay State under its own Chapter 58 reform law, which served as a model for the ACA, outlined reasons why the ACA should not be gutted.

Nicholas wrote, “With 10 years now passed since then-Governor Mitt Romney signed our initial health reform initiative into law, we can proudly say that the commonwealth is better off than where we stood in 2005. We know we share this sentiment with other Massachusetts healthcare providers, insurers, the employer community, government leaders, and, most importantly, Massachusetts consumers and families. With time, support, and improvements to the ACA, we know the country will value and appreciate the full benefits of ensuring access to affordable health coverage to all citizens as well as creating an environment for our health system to better manage its resources and deliver high-quality care.”

MHA’s letter notes that ACA-specific initiatives in the form of federal tax credits and co-payment subsidies have allowed Massachusetts lower- and middle-income residents to shop for affordable health coverage. “And while there are many statistics that highlight the achievements made in expanding coverage, there has been a tremendous positive effect on individual lives as result of better access to care,” Nicholas wrote. “Researchers have found improvements in physical health, mental health, functional limitations, joint disorders, and body mass index for those in Massachusetts, especially for those with  low incomes, minorities, near-elderly adults, and women.”

Saying repeal of the ACA would “turn back the clock here in Massachusetts,” Nicholas wrote, “Attempting to revert back to our Massachusetts coverage programs that existed before the ACA would not be accomplished easily and would involve significant challenges related to the federal support needed for the current level of coverage as well as hospital uncompensated care for uninsured residents.”

The Massachusetts delegation has been staunch supporters of the benefits of the ACA, with Senator Elizabeth Warren saying this week on the Senate floor, “Repeal and run is for cowards.”

Baker Weighs in on Repeal and Replace

In a letter to U.S. House Majority Leader Kevin McCarthy (R-Calif.), Massachusetts Governor Charlie Baker wrote that while a bill the size of the ACA may contain flaws, the health reform legislation has been beneficial to the state and efforts to repeal and replace it must follow “a measured and objective analysis” and provide ample time for transition.

Referencing the enrollment website that plagued the roll-out of the ACA in Massachusetts, Baker wrote, “Although the state’s initial implementation of the Affordable Care Act was deeply flawed, today more than 220,000 individuals have healthcare coverage through our state exchange, 180,000 low to modest income residents receive federal and state subsidies, and an additional 300,000 adults are enrolled in Medicaid as a result of the expansion allowed through the Affordable Care Act.”

The governor also stressed the “economic engine” aspect of Massachusetts healthcare, noting that the sector contributed $19.77 billion to the state’s economy, “outpacing any other industry.” Also 10% of the state’s entire workforce is employed in healthcare related fields, Baker wrote.

The governor wrote that complying with the ACA mandates, which superseded the original Massachusetts reform law, has resulted in people shifting out of employer-sponsored coverage into public coverage. He says this shift has disrupted the commonwealth’s “coverage landscape and contributed to challenges in the growth of the Medicaid program.”  But he also noted the ACA’s benefits, including a ban on pre-existing condition exclusions, elimination of annual or lifetime limits and gender inequities, and authorization of important demonstration projects such as the one Massachusetts has undertaken for residents dually eligible for both Medicaid and Medicare.

Baker cautioned Congress to act carefully when addressing the ACA, noting that Medicaid is “a shared federal/state partnership.”

“Proposals that suggest states may be provided with more flexibility and control must not result in substantial and destabilizing cost shift to states,” he wrote. Baker urged “ample time for transitioning into new healthcare coverage and/or delivery models to ensure operational readiness.”

Joint Commission Issues Antimicrobial Standards

The Joint Commission has issued a new Medication Management standard relating to antimicrobial stewardship for hospitals, critical access hospitals, and nursing care centers. The new standard became effective January 1.

In May, the Centers for Disease Control and Prevention released a paper claiming that 20-50% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or inappropriate. The CDC noted that “the misuse of antibiotics has also contributed to the growing problem of antibiotic resistance, which has become one of the most serious and growing threats to public health.”

The new Joint Commission standard calls on hospitals to establish antimicrobial stewardship as an organizational priority, educate both staff and patients on the issue, and create an antimicrobial stewardship multidisciplinary team  to develop a stewardship program that contains a series of elements.

The complete Joint Commission standard is here .  MHA is working with DPH and other stakeholders to hold an antimicrobial stewardship program at MHA in May 2017.

Healthcare Cost Growth Benchmark Could Go Lower In 2018

For the past five years (2013 to 2017) the Massachusetts “potential gross state product” (PGSP) has also been used as the state’s  “healthcare growth benchmark,” which is the statewide target that the Health Policy Commission (HPC) sets for the rate of growth of total health care expenditures in Massachusetts.

The healthcare cost growth benchmark was created through the 2012 Chapter 224 reform law, which decreed that in calendar years 2018 to 2022 the healthcare benchmark would be the PGSP minus 0.5%.

On Thursday, as directed by statute, Secretary of Administration and Finance Kristen Lepore, Senate Ways and Means Chair Karen E. Spilka (D-Ashland), and House Ways and Means Chair Brian S. Dempsey (D-Haverhill) announced that they had set the PGSP for 2018 at 3.6%, which is the same number used for 2016 and 2017.  Deducting the mandated 0.5% leaves a 2018 Massachusetts  healthcare growth benchmark of 3.1%.

Under Chapter 224, however, the HPC can modify that benchmark and at Wednesday’s board meeting discussed the process to do that. HPC must hold a public hearing, and if it decides to modify, it must notify the legislature which can ultimately override the HPC modification. On Wednesday, HPC voted to notify the legislature that it may potentially hold a hearing (most likely on March 1) to hear testimony on potential modification of the healthcare cost growth benchmark for Calendar Year 2018. 

Quality Corner: Chasing Zero Harms at Spaulding Rehab Cape Cod

Recognizing the need to build a “just culture”, the leadership team at Spaulding Rehabilitation Hospital Cape Cod undertook a multidisciplinary, multi-pronged approach for improvement.

First, the hospital embedded a promise, in policy, to use incident and quality data for improvement purposes, not performance assessment. Then Spaulding Cape Cod ensured that staff were educated on this change, which provided the foundation for culture change. The hospital then joined the MHA Hospital Engagement Network and set zero harms, across the board, as its goal.

Through targeted, multidisciplinary committees that included front-level aides, staff education about the goals, frequent posting of outcome data, and celebration of successes, Spaulding Rehabilitation Hospital Cape Cod was able to create momentum and engagement, ultimately leading to an improved organizational culture.

The hospital’s efforts, according to 2015 data, the reduced harm “across the board” by 80.2% to 6.4/1,000 patient days, saving the healthcare system $1,883,181 and preventing incidents. Medication events were reduced 96.3% to 0.7/1,000 patient days. Overall patient satisfaction reached the top 1-3% of rehabilitation hospitals nationally, according to Press Ganey surveys.

For its efforts, Spaulding Rehabilitation Hospital Cape Cod was the winning entry in the “Enhancing Culture and Leadership” category of the first annual MHA Compass Awards held last November. Entries in each of the six Compass Award categories were voted on by non-Massachusetts judges from across the U.S., who assessed the entries “blind” – meaning there were no details to identify the hospital competing.

The deadline for the 2017 Compass Awards was this past week and MHA is preparing to send the 50-plus entries from 30 separate hospitals, health systems, and physician practices to judges shortly. Finalists will be notified in mid-February, and the award ceremony is scheduled for March 9 from 7:30 to 9:30 a.m. at the Burlington Marriott Hotel.

State Approves New Determination of Need Rules

The Massachusetts Public Health Council on Wednesday approved sweeping changes to the Determination of Need (DoN) process – the most wide-ranging revisions in 40-plus years to the program that reviews hospitals’ and other providers’ major capital expenditures, construction projects, and significant changes in service.

Notable provisions include:

•        All new ambulatory surgical centers must either be part of a hospital or an HPC-certified accountable care organization, or if operating in the primary service area of an independent community hospital, then it must be a joint venture with, or have a letter of support from, the hospital.

•        The new requirements notably allow for providers to seek a more limited review for certain projects that are deemed “conservation projects”, defined as projects that would sustain or restore a facility or service.

•        Providers will now be required to submit significantly detailed information to DPH, various state agencies (as determined by DPH) for additional reviews, and undergo a public stakeholder process that may include public hearings for proposed projects.  In addition, providers seeking a DoN will need to submit annual reporting to the state following the application approval.

The new rules go into effect on January 27. DoN applications submitted prior to the effective date are subject to the previous regulations. 

State Unveils Changes to MassHealth MCO Program

The state is proposing changes to the MassHealth Managed Care Organization (MCO).  About 850,000 MassHealth members today have their coverage through one of six MassHealth MCOs.  The Executive Office of Health and Human Services (EOHHS) has requested responses from MCOs that seek to serve in a revised program that will take effect in December 2017.

One of the changes introduces competitive bidding for MCOs seeking to participate in the program, where MCOs will now bid the administrative component of the per-member-per-month capitation rate that MassHealth pays the MCOs. EOHHS also intends to only contract with  no more than three MCOs  in each of the state’s five MassHealth regions, whereas today four to six MCOs operate in each region. Preference will go to bidders that operate statewide, that serve members in a larger number of regions, and that propose competitive rates related to the administrative component of the capitated payment.  And the state will require that a minimum proportion of enrollees receiving care through an MCO to have that care paid through an alternative payment methodology (that is, one that include risk sharing or bundle payments, for example.)

Responses to the MassHealth RFR are due March 15.

The Coder's Playbook for Risk Adjusted Coding

THURSDAY, MARCH 2; 9 A.M. - 3 P.M.
MHA CONFERENCE CENTER, BURLINGTON, MASS.

With payments shifting in healthcare to quality-based methodologies, it is critical for coders to understand coding for risk adjustment. Not only does this system better track patients and their full spectrum of medical issues, but it also enables optimal payment for the provider/hospital and helps recoup incentive dollars. This one-day course will feature an overview of risk adjustment and its effect through diagnosis coding.  The course will help attendees understand the various models of risk adjustment, and the financial impacts, diagnosis coding guidelines, and challenges associated with it. Register today and stay ahead of the risk adjustment curve. Visit here for more details .