01.23.2017

Changes Coming to Healthcare System, and more...

Baker Floats Price Caps, Employer Assessment

Responding to the massive increase in MassHealth enrollment as more employers drop coverage and workers migrate into public health programs, Governor Charlie Baker last week signaled he will include a $2,000-per-worker fee on those employers with more than 10 full-time-equivalent (FTE) employees who don’t offer health insurance to their workers.  Baker also signaled he would impose price caps on providers.

The State House News Service first reported the proposals on Tuesday, citing an internal Baker Administration document. The proposals most likely would be part of the administration’s FY18 budget plan expected to be filed next week and could also address low-income workers who opt on their own to enroll in Medicaid over employer-offered commercial insurance.

Employer assessments were part of the shared responsibility philosophy behind the state’s 2006 Chapter 58 reform law. The fee then was pegged at $295 per FTE for employers with 11 or more employees. Passage of the ACA with its own employer mandate, which has not yet been put into effect, motivated the state to drop its employer assessment. Baker’s current attempt to bring it back is intended to address the administration’s view that healthcare coverage for a growing number of employed individuals is moving to publicly subsidized healthcare. The assessment would also generate $300 million annually, according to the State House News report. 

The documented drop in those covered by commercial insurance has had an effect not only on the MassHealth budget, but also on healthcare providers.  Given that MassHealth reimburses healthcare providers significantly less than commercial insurers, the concurrent decrease in commercial coverage and the increase of those covered by Medicaid has resulted in a financial hit on providers. The governor’s plan does not seem to acknowledge this effect and compounds the issue by proposing capping the rates providers can charge. The Division of Insurance would be empowered to set the cap levels, according to the news service’s reporting on the issue.

MHA President & CEO Lynn Nicholas, FACHE, said she understands the governor’s need to address the MassHealth budget and to ensure employers maintain their fair share of responsibility in the commonwealth’s coverage efforts. She also said it is noteworthy that the federal government currently pays 86% of the cost of the ACA Medicaid expansions in the state and that funding, along with other dedicated state health reform funding, needs to be better understood in how it supports low-income health coverage. 

Nicholas added that the state’s own studies show that providers are not the cause of healthcare cost increases.

“Massachusetts did not meet its own healthcare cost growth benchmark because of increasing pharmaceutical costs and massive increases in MassHealth enrollment,” she said. “Provider costs have consistently come in far below the benchmark. In fact, since 2006 MassHealth enrollment has increased steadily, while per-member, per-month costs have remained relatively stable. Hospitals continue to do their part to drive down costs and provide high-quality care even as they shoulder significant losses because of insufficient reimbursement from the state. They shouldn’t be penalized for their effort. Hospitals are not responsible for the increase in MassHealth enrollment, but hospitals are losing money due to the shift from the commercial market to Medicaid.”

Changes Coming to Healthcare System

Donald J. Trump was sworn in as the 45th President of the United States on Friday, a transition of power that promises to once again transform the nation’s healthcare system in a fashion as dramatic as the changes his predecessor, President Barack Obama, brought about eight years ago.

However, the form of Trump’s health reform will take is unknown. While repealing Obama’s signature Affordable Care Act was a main plank of Trump’s campaign, the new president has not revealed what will replace it or when.  Will he work with a Republican-controlled Congress to gut and replace the ACA concurrently? Will repeal be accompanied by a date certain for a future replacement? Will that future target be extended as was the case in repeated attempts to fix the Medicare Sustainable Growth Rate or “doc fix”? No one knows. President Trump on Friday did not mention healthcare in his inaugural address.

Last weekend in an interview with the Washington Post, President-elect Trump said of his new plan, “We’re going to have insurance for everybody. There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”  He didn’t provide specific details.

Neither has Tom Price, the new president’s designee to head the U.S. Department of Health and Human Services, who on Wednesday had a confirmation hearing before the Senate’s Health, Education, Labor and Pensions Committee on which Massachusetts Senator Elizabeth Warren (D) serves.  Price said the new administration “would allow for every single person to gain access to the coverage that they want and have nobody fall through the cracks.” Under intense questioning, Price did not delve into details.

On Tuesday, the non-partisan Congressional Budget Office released a report saying that repealing the ACA without a replacement would result in 18 million people losing coverage in the first year, and 32 million by 2026. Premiums in the non-group market would also spike by 20 to 25% in the first year after repeal, the CBO wrote.  Republicans slammed the report saying its conclusions are based merely on full repeal without any consideration of a replacement strategy.

Democrats countered by saying how can one even begin the process of dismantling the ACA before even creating a replacement?  Massachusetts Rep. Richard Neal, the ranking Democrat on the Ways & Means Committee, said on the House floor last week during debate on a measure that began the process of dismantling the ACA, “We want to hear what the plan is, we want to understand what the alternative is, we want to know precisely what is going to be included — or just as importantly, what will be excluded — from the benefits that this Affordable Care Act has given to the American people.”

“Until the details are revealed, the only thing safe to say is: change is coming,” said MHA President & CEO Lynn Nicholas, FACHE. “But all indicators show that change will pose a threat to the collective healthcare reform successes that have been achieved in Massachusetts dating back to 2006. MHA is opposed to the repeal of the ACA and has committed to work with state and federal policymakers to ensure that affordable health coverage is sustained so that our efforts can continue to focus on the promising payment and delivery reforms that are underway.”

Quality Corner: How Tax Prep Advice Can Improve Care

The medical care you receive at a Massachusetts hospital may save your life. That’s a well-known fact.  But the non-medical care that hospitals provide every day in their communities can have a beneficial effect on your health as well. An innovative program embedded in the pediatric primary care clinic at Boston Medical Center provides one such example of how hospitals are using atypical methods to improve health.

The Earned Income Tax Credit (EITC) each year provides more than $66 billion in tax benefits to low-income working families. According to the non-partisan research and policy institute, the Center on Budget and Policy Priorities, the EITC has been linked to improved infant birth weight, lower premature birth rates, less maternal stress, higher employment rates of single mothers, improved kindergarten through grade 12 school performance, higher graduation rates, and increased future earnings.

The problem is that a lot of eligible families don’t know about the credit or have trouble filling out the forms.  And the fees charged by commercial tax preparation businesses dilute the EITC refunds families can receive.

In a recent article in JAMA Pediatrics, researchers from the Combined Residency Program at Boston Children’s Hospital and Boston Medical Center, and from Boston University School of Medicine write about the StreetCred program embedded in the primary care clinic at Boston Medical Center.

According to the article, here is how it works:

“StreetCred volunteers and staff called families with upcoming pediatrician appointments to (1) remind families of their appointment, (2) offer free tax preparation during their appointment, and (3) tell families what tax-related documents to bring to their appointment. When a family arrived to the clinic, StreetCred volunteers collected the family’s documents and began the tax return while the family waited on and saw their pediatrician. Most tax returns were completed in approximately 20 minutes. After seeing the physician, the family returned to review, sign, and submit their tax return alongside StreetCred staff. During the 2016 tax season, StreetCred’s pilot program provided free tax preparation to 186 families and, ultimately, returned more than $400,000 to low-income working families, including several Boston Medical Center employees. Set-up and implementation costs totaled less than $20,000, mostly in staff salary expenses; thus, for every $1 we spent, we returned $20 to poor families. Pilot year revenues came from grants, corporate donations, and grassroots fundraising.”

Write researchers Michael K. Hole, M.D., Lucy E. Marcil, M.D., and Robert J. Vinci, M.D., “The trust and regular contact between families and their children’s medical professionals present a special opportunity to screen for and address the social determinants of health.”

Joint Committee, Marijuana Bills Expected This Session

The Massachusetts legislature will establish a joint committee to address the implementation and issues surrounding the legalization of recreational marijuana in the commonwealth. It is anticipated that a number of bills will be filed to address concerns resulting from passage of last November’s Ballot Question 4. 

After passage of the law, the legislature quickly passed (and Governor Baker signed) a law delaying the opening of marijuana shops from January 1, 2018 to July 2018. It is likely that several potential fixes will receive consideration during this legislative session, including: raising the tax rate on marijuana (from the 3.25% contained in the ballot question); reducing the amount of pot plants people can grow in the homes (from the ballot-approved 12 plants); increasing the age of possession and consumption; and regulating how marijuana edibles are labeled and distributed.

MHA, in a recent letter, urged legislative leaders to legislative leaders to take corrective action, highlighting recommendations that included:

•        Prohibiting youth access to marijuana, including specific restrictions on marketing and advertising, child-proof packaging, and location restrictions for facilities that factors in their proximity to locations that youths frequent. MHA also encouraged public health warnings on product labels.

•        Instituting state quality and safety standards for marijuana and delaying the introduction of edible marijuana products until the development of methods for accurately measuring THC potency for edibles and other marijuana products. MHA also recommended strict limitations be placed on the development, marketing, and sale of edibles.

•        Ensuring that law enforcement has statutory tools for determining driver impairment due to marijuana use.

The recently approved delay to the law's implementation included a recommendation that MHA and other concerned groups suggested: a directive that DPH enter into an agreement with a research entity to conduct a baseline study of marijuana use in the commonwealth, including patterns of use, methods of consumption and general perceptions of marijuana, incidents of marijuana impaired driving and hospitalization, and the economic impact on state and local governments related to legalization, including how legal marijuana affects the production and distribution of marijuana in the illicit market.

Does Your physician Ask About Your Healthcare Goals?

Massachusetts Health Quality Partners (MHQP) on Wednesday released its 2016 patient experience survey results, which found doctor-patient communication at an all-time high in the commonwealth, although many patients also report their physicians have not discussed their overall health goals and possible barriers to achieving them.

The MHQP patient experience assessment surveys nearly 65,000 patients at more than 500 primary care practices across the commonwealth, collecting data about the care these patients or children in their care actually receive at their physicians’ offices. The report measures how well the offices achieve nationally recognized standards for primary care. MHQP’s Patient Experience Survey was first conducted in 2005.

On the cumulative measure of how well physicians communicate with their patients, the 2016 statewide mean score for all adult practices was 93.6 out of a potential 100 points and 96.7 for pediatric practices – both all-time highs for the MHQP survey. However, for the measure of whether primary care providers talked with patients about their goals for health or if there were things that made it hard for patients to take care of their health, the statewide mean score for all adult practices was 55.3 out of a potential 100 points and 46 for pediatric practices.

The complete report is available here.

BHI Training To Primary Care Practices

The Health Policy Commission is offering technical assistance at no cost to primary care practices on behavioral health integration (BHI) starting in March 2017. HPC’s PCMH PRIME program recognizes practices that have achieved NCQA PCMH status and meet 7 out of 13 behavioral health integration standards.  Practices that commit to being on the “pathway to PCMH PRIME” are eligible to participate in the March program. For more information on the program and pathway, please visit here.

The technical assistance program will provide individualized support and is provided by a team of clinical experts from Health Management Associates. It features the following, over a six-month time period:

•        Practice coaching support for all practices;

•        Two day-long learning collaborative sessions, focused on learning the foundations of the Collaborative Care Model, which is key to successful and sustainable behavioral health integration;

•        Optional webinars on specific behavioral health integration skills and topics, recorded for viewing at your convenience; and

•        Optional regional knowledge-sharing meetings, to enable peer-to-peer learning and best practice sharing. 

If you want to sign up, you must do so by February 9 by visiting here.

Patient Flow Strategies For Emergency Department Throughput

FRIDAY, MARCH 3; 8 A.M. - 3:30 P.M.
MHA CONFERENCE CENTER; BURLINGTON, MASS.

Improving patient flow in the emergency department (ED) is a top priority for hospitals. The challenges are numerous and daunting and it can be hard to find solutions to produce lasting change. This conference will take a deeper look at some of the common ED throughput challenges faced by hospitals today. More information is here.

John LoDico, Editor