As of March 1, 2018, approximately 1.2 million MassHealth managed-care members will have a new set of plan options in which to enroll. These options consist of 13 Accountable Care Partnership Plans; three Primary Care Accountable Care Organizations (ACOs); two Managed Care Organizations (MCOs); and MassHealth’s Primary Care Clinician (PCC) Plan.

MassHealth, ACOs, MCOs, the hospital and provider community, and patient advocates have been working diligently to ensure the people that are affected by the new ACO/MCO rollout can continue to receive the medically necessary services they need during the March transition – even if the services typically require prior authorizations from an MCO or the MassHealth program.  For example, MassHealth led an effort to identify high-risk patients and share existing information about them among the ACOs, MCOs, and MassHealth. Providers have reached out to patients to inform them of the changes and, importantly, MassHealth established a minimum “continuity of care” requirement.
    
The Executive Office of Health and Human Services held meetings last week to discuss with providers and others those continuity of care policies. To ensure that members transition to their new plans successfully and continue to have access to all the services they need, all members enrolling into a new plan on or after March 1, 2018, will have at a minimum 30-days continuity of care. The 30-day period begins on the first day the member is enrolled with the plan. During the continuity of care period, all existing prior authorizations for services and for provider referrals will be honored by the new plan. Members can continue to see all providers currently providing their care during this period, even if that provider is not in their new plan’s network.  ACOs and MCOs also may offer additional flexibility beyond the 30-day minimum.  Continuity of care requirements will also be effective for new applicants to the MassHealth program post March 1 and for those enrollees who switch plans during their 90-day plan selection period or for some other qualifying event.

For more information, please see this EOHHS continuity of care guidance document that was published last week.

Patient Safety Awareness Week, March 11-17, is right around the corner. This year’s activities will focus on two critical issues – safety culture and patient engagement. This is the first Patient Safety Awareness Week since the National Patient Safety Foundation, lead sponsor of the event for 15 years, merged with the Institute for Healthcare Improvement in 2017.

Throughout the week, IHI is encouraging those taking part in the event to share their activities on social media and on the event website, www.unitedforpatientsafety.org, where they can take a pledge for patient safety, get ideas for engaging staff and patients, download free resources, and order branded materials.

The safety culture focus of the week resonates well with the Massachusetts hospital community.  Currently, many hospitals are on the journey to become “high-reliability organizations”, which operate in complex, high-hazard domains for extended periods without serious accidents or catastrophic failures. To become an HRO, an organization does not merely follow certain best practice processes for improving safety, but also changes its culture, ensuring that everyone on staff is ever-mindful of the need to relentlessly prioritize safety.  Recently, Newton-Wellesley Hospital presented at a national conference on its journey towards becoming an HRO.

Since 2008, Massachusetts hospitals have used the Comprehensive Unit-based Safety Program (CUSP) to help build a strong safety culture to help lower infection rates. CUSP was created at Johns Hopkins in Baltimore, piloted in 2004 at some Michigan hospitals, and then funded nationally through the Agency for Healthcare Research and Quality.

CUSP toolkits to fight central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSI), detail not only best clinical practices, but also how to change the culture of organizations to ensure clinical team members work together and that executive members are engaged in the science of safety.

Massachusetts hospitals used the CUSP model as part of an MHA-created Statewide Performance Improvement Agenda (SPIA). Through SPIA, Massachusetts hospitals achieved a 40.3% reduction in incidences of CLABSI, CAUTI, and SSI.

Dr. Margot Hartmann, president & CEO of Nantucket Cottage Hospital since 2010, has announced her retirement plans in a letter posted on the hospital’s website. Hartmann said the search for her replacement will begin shortly, is expected to take several months, and once a new CEO is found, Hartmann will remain as president of the hospital through the summer of 2019. Hartmann has overseen the process of building a new hospital, which is expected to open by the end of 2018. She said of the transition plan, “This will be about an 18-month process to bring us safely into our exciting new building and through the completion of our historic capital campaign.”

Rep. Peter Kocot (D-Northampton), the House Chair of the Committee on Health Care Financing, died suddenly last week at age 61.  Kocot had served in the legislature since 2002. 

MHA’s President & CEO Steve Walsh, who also had held the chairmanship of Health Care Financing, said, “An aide long before an elected representative, our friend Peter was the epitome of a true public servant. His vocation was helping others and he didn’t care if that mission came with a title or not. He was often the smartest person in a room but had the confidence and humility not to have to prove it.  Where others would have capitalized on his booming voice and matching intellect, he instead chose to listen and learn, understanding that he was a conduit of a larger purpose.  Peter’s loss leaves a void, not only in stature, but in the heart and soul of the House of Representatives and in the people he gave his time to. My deepest condolences to his wife, his sons, and his loyal staff and extended State House family.”

In a very complex healthcare environment – beset with uncertainty from Washington, persistent MassHealth underpayments, ballooning pharmaceutical pricing, and the specter of an $880 million government-mandated nurse ratio ballot question on the horizon – hospital financial personnel work hard to keep their facilities afloat.

Did you know that there are currently 14 Massachusetts hospitals with negative operating margins?

The following three MHA Education Department programs are focused on hospital finances. Click on the links for more details and registration information.

Webinar: Finding Lost Revenue – Charge Capture Audits. Tuesday, March 13, 1 to 2:30 p.m. Attendees will learn the hot spots for lost revenue through charge capture audits. They will be able to identify their own internal areas of risk; both for compliance and revenue.

Webinar: Finding Lost Revenue – Why I Love the Two-Midnight Rule. Wednesday, April 11, 1 to 2:30 p.m. Attendees will learn the problems with inpatient versus observation classification and will be able to identify the most common problems with the lost inpatient–Two-Midnight Rule benchmark. High risk areas as identified by Medicare audits will be discussed, along with action plans to reduce risk.

MHA Conference: An Overview of Healthcare Financial Management. Wednesday, May 9, 8:30 a.m. to 3 p.m. This program will review the importance of budgeting and show participants how to read and better understand performance reports and dashboards.  It will introduce a proven method of determining the real underlying causes of budget deviations, explore an objective way to examine departmental performance that highlights both high-performing departments and those in need of some assistance, and examine three ways to look for improvement in routine work processes.