The Bay State has one of the lowest rates of growth in annual health spending, according to a report from the state’s HPC. The data released on Wednesday relies upon the federal CMS’ State Personal HealthCare Expenditure data set.

The data shows that between 2009 and 2014 the average annual healthcare spending growth in Massachusetts was 2.32%, which is below the national average of 3.14% growth and represents a lower rate of growth than all but three states (Arizona, North Carolina, and Hawaii).  And during that five-year stretch, both hospital and physician spending in Massachusetts grew at a lower rate than the national average.

While excess spending in Massachusetts relative to the U.S. average decreased for hospitals, physicians, and nursing care facilities, spending in home health and for drugs increased relative to the national average.

The report also noted the average Massachusetts resident pays $10,559 a year on healthcare, which is significantly higher than the U.S. average ($8,045). Some have argued that Bay Staters have one of the highest income levels in the U.S. and that they pay more for everything from healthcare, to electricity, to real estate. In fact, a 2016 Commonwealth Fund analysis shows that families in the District of Columbia and Massachusetts had the lowest health insurance costs as a share of income, at 6.8% and 7.3%, respectively.

In general, as various entities have attempted to parse data to make sweeping conclusions about large economic systems, MHA has urged caution. In fact, the authors of recent Health Affairs article [published online, June 14, 2017] that the HPC used in compiling its report, note: “Variation in per capita personal health care spending by state tends to be associated with several factors. States that have relatively higher levels of personal income per capita, greater percentages of the population enrolled in Medicare or Medicaid, and more health care capacity tend to have relatively higher levels of health spending per capita. On the other hand, states that have relatively higher rates of uninsurance tend to have relatively lower levels of health spending per capita.”

And in a you-get-what-you-pay-for argument, it is important to note that Massachusetts – in various surveys, including this one – is consistently rated one of the healthiest states in the U.S.

The State House News Service obtained a copy of a letter from Administration & Finance Secretary Kristen Lepore to the House and Senate Ways & Means Committees announcing the administration’s intention to collect nearly $140 million from state trust funds to balance the FY17 budget. Notably the proposal seeks to obtain $23.5 million from the state’s Distressed Hospital Fund which is used to fund the Health Policy Commission CHART grant program. Lepore was required to submit the letter to the Legislature 45 days prior to the transfer of the funding from the account.

The state’s Health Policy Commission (HPC) on Wednesday introduced “DataPoints” – described as online briefs that will spotlight data findings relevant to HPC’s mission of driving down healthcare costs.

The data was released at a joint meeting of two HPC committees – Community Health Care Investment and Consumer Involvement (CHICI) and Cost Trends and Market Performance (CTMP).

Avoidable Emergency Department Use
The HPC says “avoidable” ED use includes two types of visit categories: visits that could have been treated by a primary care provider (for example, an ear infection) and visits that did not require any immediate medical care (sore throat with no fever).

The HPC found that such visits occur equally across the state and that about 31% of them occur between 8 p.m. and 8 a.m. The 69% of visits that occur during daytime hours led the HPC to opine that access problems exist, adding that some solutions may involve the increased use of telemedicine and granting nurse practitioners full practice authority.

Oral Health ED Visits
HPC found that ED visits for oral health complaints continue in Massachusetts even though hospital EDs are not really equipped to handle such visits and result in higher costs than having care provided in a dentist’s office.

Elderly patients (65 to 74) showed the greatest increase in ED visits (15%) along with children ages 5 to 10 (also 15%).  The 25% of Massachusetts residents residing in the lowest-income areas of the state accounted for 45.3% of oral health ED visits in 2015, HPC found.  In 2014, just 35% of dentists in Massachusetts treated a MassHealth patient.

Contraceptives
The Affordable Care Act (ACA) mandated that insurers cover certain preventive services with no patient cost-share, and the regulations subsequently drawn up to enforce the ACA included the full range of contraceptive devices under preventive services.

The HPC found that decreases in out-of-pocket spending for all prescription claims were greater for women than men in Massachusetts.  The reason for the decrease in women’s spending “was almost entirely due to a significant decrease in cost sharing for contraception.”  While prescription contraception claims remained relatively constant from 2011 to 2014, the claims with any patient cost sharing decreased from 98% to 6.5%; average out-of-pocket spending per contraception claim dropped from $16 in 2011 to $1.73 in 2014.

While prescription contraception claims remained static, IUD claims between 2011 and 2014 rose 34%, from 13,800 to 18,500. Patient cost sharing for IUDs also plummeted during this period.

HPC’s detailed DataPoints are here.

The state’s sweeping Chapter 224 healthcare reform law contained a provision calling on the State Auditor to release a comprehensive report on the effectiveness of the law. Last week Auditor Suzanne Bump issued the report that focuses on the gains and remaining challenges of the law on containing costs, improving care (including behavioral healthcare), and maintaining a strong healthcare workforce.

The full report and executive summary are here.

While much of what the Auditor covered in the report relating to costs and care has been a regular part of the Massachusetts healthcare stakeholder dialogue in recent years, one section of it – workforce – usually gets less attention. In the Auditor’s report, the Commonwealth Corporation and the Center for Labor Markets and Policy at Drexel University provided insight into how Chapter 224 affected the commonwealth’s healthcare workforce.

The report notes: “Healthcare providers are redesigning delivery systems to allow workers to work at the top of their licenses and to increase efficiencies and quality. The healthcare industry employs greater shares of women, African Americans and Latinos than all other non-health industries combined, so any changes affecting the healthcare workforce will impact these groups. Demand is rapidly growing for home health aides and personal care assistants, yet wages for these direct care jobs have held stagnant since 2004. ... Employers seeking to fill these positions are increasingly competing with employers in retail, food service, and other industries. Third-party reimbursement rates have constrained the ability of home health agencies to raise wages in order to respond to this labor supply challenge.”

The report predicts “a sharp rise” in the demand for healthcare services among “frail older adults,” adding that “the healthcare system and state government finances will face major challenges in meeting what is likely to be a massive increase in service requirements while limiting the impact on taxpayers.”

As the market changes, the researchers note that healthcare workforce requirements are also changing. “In these heavily regulated labor markets, one of the most important developments is the increasing propensity for workers to work at the top of their licenses, meaning they practice to the full extent of their education and training,” the report notes. It added, “Emotional, cognitive, and drug-induced disorders have risen sharply in Massachusetts, yet little is known about the labor markets for behavioral health care. Indeed, the authors are unaware of even a simple measure of this labor market’s size in the Commonwealth. Therefore, a baseline study of behavioral health care workers would be useful.”

The Health Policy Commission announced on Friday that it would conduct a comprehensive Cost and Market Impact Review (CMIR) on the proposed merger of Partners HealthCare and Massachusetts Eye & Ear (MEE). The two facilities signed a letter of intent in January to explore the merger proposal in which Mass Eye & Ear would keep its name and hospital license, and maintain its own board of directors, executive leadership team, medical and research staff, and community outreach and fundraising activities. After reviewing the completed notices of intent that Partners and MEE submitted to HPC, the HPC staff said it had “identified the potential for the transaction to result in meaningful impacts on health care costs and the competitive market.”  Therefore HPC staff will recommend to the full HPC Board at its next meeting on July 26 that the staff be empowered to conduct a CMIR.

MHA’s Vice President of Clinical Affairs Pat Noga, R.N., PhD is one of 173 distinguished nurse leaders from across the U.S. selected by the American Academy of Nursing as a 2017 Academy fellow.

The fellows are nurse leaders in education, management, practice, policy, and research. Fellow selection criteria include evidence of significant contributions to nursing and healthcare, and sponsorship by two current Academy fellows. Applicants are reviewed by a panel composed of elected and appointed fellows, and selection is based, in part, on the extent the nominee's nursing career has influenced health policies and the health and wellbeing of all.

Joining Noga from Massachusetts are: Teri Aronowitz, UMass Boston; Marianne Ditomassi, Mass. General Hospital; Maureen Fagan, Brigham and Women's Hospital; Jane Flanagan, Boston College; Elizabeth P. Howard, Northeastern University; Susan M. Lee, Brigham and Women's Hospital; Cecilia McVey, VA Boston Healthcare System;  Janice Palaganas, Center for Medical Simulation; and  Inez Tuck, MGH Institute of Health Professions.

11th Annual Administrative Professionals Conference

Friday, September 22, 2017; 9 a.m. - 2:15 p.m.
MHA Conference Center, Burlington, Mass.

Join us in September for an interesting two-part conference to assist administrative professionals achieve all they can in the workplace.  The morning workshop will feature Cassandra Lee, founder and president of the human improvement company, SSANEE Training & Consulting Group, in Chicago. Known as the “D.I.V.A. of Dialog,” Lee uses the guidance of “Divine Inspiration Vocally Applied” to live out her passion for teaching through speaking while educating and empowering audiences to personal growth and career success. She helps administrative professionals and professional women remove the landmines blocking their workplace satisfaction and career success. In the afternoon, Kofi Jones, principal and owner at KJ Health Matters, will share with us her perspective on the state of the state in healthcare and how she sees innovation playing a key role in its near future. Jones is a former communications chief in the housing and economic development secretariat under Governor Deval Patrick. Learn more about this empowering conference here.