GOP Succeeds In First Step To Scuttle ACA

The U.S. House of Representatives by a vote of 217 to 213, with no Democrats voting yes and 20 Republicans voting no, passed the American Health Care Act (AHCA) which repeals the bulk of the Affordable Care Act.

The AHCA was opposed by the state’s Democratic congressional delegation as well as by Republican Governor Charlie Baker, who noted that the AHCA would result “in a massive loss of critical funds for the commonwealth.”

Unlike the last attempt to pass the GOP-healthcare bill, House leadership this time around did not give the Congressional Budget Office time to “score” the bill. The CBOs scoring assessment of the first AHCA found it would result in 24 million people losing coverage.

MHA President & CEO Lynn Nicholas, FACHE, denounced the House vote, saying, “It is inexcusable that the House would vote on a bill that could have such dramatic consequences for the healthcare system and the nation’s solvency without its members having adequate time to understand what is in the bill or what it would cost.”

MHA’s full statement follows:

“The Massachusetts Health & Hospital Association and our members are distressed by the latest efforts by President Trump and Republican congressional leaders to repeal the Affordable Care Act (ACA), and deeply appreciate our Massachusetts Congressional delegation’s uniform rejection of this ill-conceived bill. Today’s passage of an amended version of the American Health Care Act (AHCA) threatens to severely damage the progress our state and country have made in healthcare access, affordability and delivery. Most troubling, it will put health coverage in jeopardy for many Americans, particularly for older and sicker patients.

The bill’s replacement of today’s equal state and federal partnership in the commonwealth’s Medicaid program with a restrictive per capita financing scheme will result in significant funding implications for health coverage for thousands of Massachusetts low-income individuals and the providers that care for them.  MassHealth, as it is known in Massachusetts, covers nearly 1.9 million members and has been key to our collective effort to reduce the number of uninsured.  Diminution of funding to MassHealth as a result of the AHCA bill would directly imperil the program and its future goals. 

It is inexcusable that the House would vote on a bill that could have such dramatic consequences for the healthcare system and the nation’s solvency without its members having adequate time to understand what is in the bill or what it would cost.

For those purchasing insurance in our insurance exchange, the bill’s tax credit approach will offer far less to those with the most financial need, and lead to increased levels of uninsured and under-insured.  Given the major implications on both Medicaid and subsidized insurance coverage, the AHCA threatens to turn back the clock on all of the work that has been accomplished since our state’s 2006 health reform law and seriously disrupt efforts to improve the ways healthcare is delivered.

The amended AHCA bill also permits states to obtain waivers from essential health benefits and rules governing how insurance is priced. Such an option would likely leave many around the country with inadequate coverage and make coverage for those with pre-existing conditions unaffordable.  How can such a solution be good for anyone?

MHA and our member hospitals, health systems and other providers have made great strides in healthcare payment and delivery reform, thanks in large part to Massachusetts’ groundbreaking health reform law of 2006 and the Affordable Care Act. We believe our state serves as an example of how the ACA’s approach to expanding access to affordable health coverage can be successful nationally if given the time and support it deserves, and the hospital community is strongly opposed to its repeal.”

In Support Of Affordable Connectorcare Offerings

On Tuesday before the Joint Committee on Health Care Financing, MHA testified in support of one of its priority pieces of legislation – HB592 / SB630, “An Act Restoring Affordable Health Connector Coverage.”

The proposed bill ensures the continuation of affordable ConnectorCare products and, in particular, protects members from drastic premium and cost-sharing increases. Without these protections, the state risks people dropping coverage, going without necessary care, falling into debt, and unraveling the coverage gains that the state has made under both the Massachusetts health reform law and the Affordable Care Act.

“This legislation affirms the state’s 2006 health reform commitment to provide affordable health insurance offerings for low-income enrollees in the Connector that are aligned with the commonwealth’s historically subsidized insurance offerings,” MHA’s Director of State Government Advocacy Adam Delmolino testified before the committee as a member of the Affordable Care Today!! Coalition with Vicky Pulos, staff attorney from the Mass. Law Reform Institute.

Federal Spending Bill Helps Opiod Fight, NIH

The U.S. House passed a $1.1 trillion omnibus spending bill on Wednesday and the Senate followed with a yes vote on Thursday, sending the bill that funds the U.S. government through September to President Donald Trump’s desk.

The bill contains two items championed by Massachusetts Senator Elizabeth Warren (D) that benefit the state’s healthcare sector.  The spending bill includes $100 million in new funding to address the opioid epidemic and includes $34.1 billion in total for the National Institutes of Health (NIH) – a $2 billion increase over the previous year’s funding.

Massachusetts in 2016 received about $2.5 billion from the NIH, the second highest total in the U.S. (behind California). The top NIH-funded research institutions in the state, according to NIH are: Massachusetts General Hospital; Brigham and Women's Hospital; Harvard University Medical School; University of Massachusetts Medical School-Worcester; and Children's Hospital Corporation.

Quality Corner: The MHA Compass Awards Compendium

This Compass Awards 2017 Compendium of Entries contains summaries of 54 Massachusetts healthcare initiatives that have shown measureable improvements to the populations being served. Thirty hospitals, physician practices and other care entities responded to MHA’s call to participate in the association’s second Accountable Care Compass Awards, nominating their programs in one of six categories: Enhancing Culture and Leadership; Improvements Across the Care Continuum; Improving Organizational Efficiencies; Physician Practice Innovations; Providing Care to Special Populations; and Reducing Hospital-Acquired Conditions and Readmissions.

Six highly respected, independent judges from outside of Massachusetts reviewed the submissions, which were anonymous – meaning that there were no details included that would allow the judges to match the initiative to a provider. The judges picked three finalists from each category, and one winner from the finalists. MHA held an awards breakfast on March 9, which was attended by nearly 200 representatives from the healthcare community.

“Each day providers are called on to provide exceptional care with ever-decreasing resources as well as continuing pressures to meet new reporting guidelines and cost-reducing benchmarks,” said MHA President & CEO Lynn Nicholas, FACHE. “In the face of such ever-mounting pressures, hospitals and physician practices have responded with creativity to craft specific, targeted initiatives with proven, positive results that are also replicable by other providers.”

MHA created the compendium not only to inform the public and policymakers of the work MHA members are performing, but to help those members learn from each other. It has always been MHA’s goal that its Accountable Care Compass Awards, now in their second year, leads to a dialogue among caregivers and the sharing of information.

Health Affairs Study Again Raps Readmission Penalty

Reconfirming what other studies have shown, a new study in the May 2017 issue of Health Affairs presents further evidence that CMS’s penalties against hospitals that have higher-than-expected 30-day Medicare readmission rates generally penalize hospitals that are urban or major teaching facilities that treat larger shares of Medicare or socioeconomically disadvantaged patients.

The study found that hospitals that received high baseline penalties in the first year of CMS’s program “continued to receive significantly higher penalties in subsequent years.”  The readmission penalty program causes, in effect, a vicious cycle.

According to the report, “Reducing readmissions involves multifaceted interventions that involve time and resources to implement. The cumulative effects of [the] penalties and other pay-for-performance programs could constrain hospitals’ ability to invest in costly interventions to reduce readmissions, particularly for hospitals with limited resources, such as those serving low-income populations.”

“Most Hospitals Received Annual Penalties for Excess Readmissions, but Some Fared Better than Others” appears in Health Affairs, 36, No. 5 (2017): 893-901.

MHA Hosts Forum On Antimicrobial Stewardship

Given the increasing threat of antibiotic resistance, the judicious use of antibiotics in all healthcare settings has never been more important. On Wednesday, MHA in collaboration with DPH, Healthcentric Advisors/New England QIN-QIO, Massachusetts Senior Care Association, and the Massachusetts Coalition for the Prevention of Medical Errors presented a one-day antimicrobial stewardship program that more than 140 people from across the U.S. attended.

Healthcare professionals from Bethany Health Care Center in Framingham, Massachusetts General Hospital, and Tufts Medical Center presented. Two national subject matter experts from the HRET Hospital Improvement Innovation Network (HIIN) and STRIVE (States Targeting Reduction in Infections via Engagement) program also presented.

“These programs are remarkably efficient at bringing professionals together to learn the step-by-step details of implementing replicable initiatives that have shown measureable progress in reducing harm from the injudicious use of antibiotics,” said Lorraine Schoen, R.N., MHA’s senior director of clinical affairs.

Mass. Medical Endorses Controversial Injection Facilities

The Massachusetts Medical Society’s (MMS) House of Delegates voted last Saturday to endorse within the state a pilot “supervised injection facility” (SIF) – that is, an environment where people can inject illicit drugs under the supervision of a trained staff.  MMS called for such a facility to be under the direction and oversight of a state-led task force convened by a state authority, such as DPH.

An MMS task force assessed data from existing SIFs in Canada and Australia before reaching its conclusion to endorse a Massachusetts pilot. The runaway level of opioid deaths in Massachusetts and across the U.S. also influenced the vote by the state’s largest physician’s group.  According to DPH, there were 1,979 opioid-related deaths in Massachusetts in 2016.

As for the ethical questions regarding physicians overseeing the injection of street drugs, MMS wrote: “SIFs are in keeping with the MMS Code of Ethics whereby physicians are obligated to provide compassionate and respectful medical care to all people while respecting individual human dignity and rights.”

MHA has been actively engaged in dealing with the opioid crisis and will be discussing MMS’ creative proposal with its hospital and clinical members, as it is clear that it will take innovative approaches to defeat the devastating effects of opioids in communities.

Healthcare Planning: Take The First Step Webinar

As part of its ongoing work in serious illness care, MHA is hosting a webinar – on Wednesday, May 17 from 11 a.m. to 12:30 p.m. – for hospitals and health systems on how to provide resources to help employees plan ahead in the event of serious illness. The webinar is entitled “Healthcare Planning: Take the First Step” and consists of a panel of health system leaders who will share how they have worked within their organizations to help provide information and resources for their employees. Join MHA for this informative and complimentary webinar by clicking here.

Nominate A New Healthcare Quality Measure

The Statewide Quality Advisory Committee (SQAC) is seeking the public’s input on what measures should be added to or deleted from the state’s Standard Quality Measure Set (SQMS). The measure set is updated annually and serves as the basis for provider reporting – the results of which are then compared against national standards.  In previous years, MHA, through the Mass Collaborative, worked with health plans to identify a common set of quality measures for use in insurance plan tiering. MHA has consistently argued that there should be standardization of measures among payers and transparency in how the measures are used.

Anyone who would like to nominate a measure or measure area for SQAC’s consideration can complete this Quality Measure Nomination Survey before June 15, 2017. E-mail SQAC@state.ma.us with any questions.

MHA's 81-st Annual Meeting

CAUGHT IN CHAOS: IS META LEADERSHIP THE ANSWER?
WEDNESDAY, JUNE 7 - FRIDAY, JUNE 9
CHATHAM BARS INN, CHATHAM, MASS.

As change and uncertainty continue to dominate the healthcare arena, leaders are stressed more than ever. The challenges of running hospitals and healthcare organizations oftentimes overpower the ability to look at the bigger picture of shaping the transformational healthcare sector as a whole. At this year’s MHA Annual Meeting, we will provide a break from everyday intensity to look at how Meta Leadership can help leaders think bigger and bolder despite the challenging distractions that arise each day. We hope you’ll join us and bring members of your team to learn, network, and allow yourselves time to consider the big picture.

Visit here for full details, including registration information.