The Health Policy Commission (HPC) last Wednesday announced its SHIFT-Care grant awardees – hospitals and health centers that reach out into their communities to craft innovative programs to reduce avoidable use and to address social issues such as opioid use disorder.

The recipients will receive up to $750,000 each but will be responsible for contributing at least 25% of the total cost of the initiative.

There are three funding tracts: addressing health-related social needs (such as housing stability and fulfilling transportation needs, among others); addressing behavioral health needs (such as reducing opioid use and increasing follow-up care); and enhancing opioid use disorder treatment (by, for example, improving alcohol and other drug abuse dependence treatment).

This powerpoint from the HPC summarizes the recipients, the programs they are undertaking, the amount received (including the facility’s contribution), and the community partners working with the hospitals.

Congratulations to the following MHA members and associated entities for their creative and meaningful work to help the communities they serve: Boston Medical Center; Massachusetts General Hospital; North Shore Medical Center; Holyoke Medical Center; UMass Memorial Medical Center; Hebrew SeniorLife; Beth Israel Deaconess Hospital – Plymouth; Beth Israel Deaconess Medical Center; Baystate Health Care Alliance; Addison Gilbert/Beverly Hospital; Harrington Hospital; Mercy Medical Center; Holyoke Medical Center; Lowell General Hospital; and individual members of the Community Care Cooperative (C3).

The Massachusetts Legislature approved a $41.88 billion FY2019 state budget last Wednesday and sent it to Governor Baker, who has 10 days to decide whether to veto and/or make amendment recommendations.

From a hospital/healthcare point of view, the proposal holds reimbursement rates for most providers flat in FY19, but MHA and the hospital community worked successfully on a series of items that were incorporated into the budget that emerged from the conference committee last week.

For example, the budget states that the Executive Office of Health and Human Services (EOHHS) “shall” expend an additional $13 million in the aggregate for disproportionate share hospitals. This was MHA priority language in the conference budget as the Senate version had included “may expend” language.  Also, the budget includes MHA priority language directing a transfer of up to $15 million to the Health Safety Net.
 
The hospital community was able to beat back language that was included in the Senate version of the budget that would have given the Health Policy Commission more regulatory authority to investigate and prevent service closures – even when retaining such services would adversely affect a provider’s finances or operations. Also, the final conference budget did not adopt language that would have required the Department of Public Health to initiate a task force to review the service closure process.

As more and more people learn about the ballot question to impose government-mandated RN-to-patient ratios on all Massachusetts hospitals, opposition to Question 1 on the November ballot grows.

Last week The Western Massachusetts Nursing Collaborative joined the Coalition to Protect Patient Safety in opposition to the nurse staffing ballot question.

“As nurses, we rely on our professional judgement to make decisions every day that are in the best interest of our patients,” said Diane Brunelle, co-chair of the Western MA Nursing Collaborative. “When we collaborate with one another, make our own decisions about our patients and focus on being effective caregivers, we ensure the delivery of quality healthcare in a caring, structured, and responsible manner. This misguided proposal does not improve the quality of healthcare or place patients first.”

Western MA Nursing Collaborative members include nurses from American International College; Bay Path University; Elms College; University of Massachusetts, Amherst; Westfield State University; Baystate Health; Caring Health Center; Cooley Dickinson Health; Genesis Health/Heritage Hall; Holyoke Medical Center; Porchlight VNA/Home Care – Chicopee; Shriners Hospitals for Children – Springfield; Mercy Medical Center; and the Western Massachusetts Black Nurses Association.

Also last week, the Marlborough Regional Chamber of Commerce joined the Coalition. The Chamber’s members include UMass Memorial-Marlborough Hospital, along with numerous eldercare centers, rehabilitation facilities, and doctor’s offices.

“Our local hospitals are a huge part of our community, and have much different needs than larger, city hospitals,” said Susanne Leeber, president and CEO of the Marlborough Chamber of Commerce. “This one-size-fits-all ballot question will have an enormous impact on our hospitals and our local economy, and ultimately harm patient safety and quality of care.”

Currently Massachusetts law mandates ratios only for ICU units, but those restrictions have adversely affected patient care.

“Since the ICU ratios were mandated, Marlborough Hospital has suffered considerably. It is not unusual for us to transfer patients out when we can’t meet the ratio, and currently, we can only staff eight patient beds when we are a ten-bed unit,” said John Kelly, a registered nurse and Chief Nursing Officer and Chief Operating Officer at UMass Memorial-Marlborough Hospital. “This is not good for our patients or our community. To date, there is no evidence that the staffing ratios have improved quality or outcomes.” 

Read more recent developments on Question 1 here.

The Boston Globe had a strong article last week by reporter Liz Kowalczyk highlighting the ongoing problem of emergency department “boarding” for Massachusetts children needing behavioral health treatment.

The article resonated with MHA members that have expressed concern that the nurse staffing ratio ballot questions scheduled for the November ballot would worsen the intractable boarding issue.

“With many families already facing significant hurdles to access mental healthcare for their children, the rigid, government-mandated nurse staffing ratios required under Question 1 will only further constrict the Massachusetts behavioral healthcare system,” said Coalition to Protect Patient Safety spokesperson, Dan Cence. “Increased wait times in the ER and mental healthcare facilities, and decreased access to qualified nurses and mental healthcare professionals will leave our most vulnerable residents even further away from the care they need.”

If behavioral health facilities are unable to recruit the additional RNs required to meet the ratio mandate, behavioral health facilities will be forced to eliminate inpatient behavioral health beds and outpatient services, negatively affecting access to behavioral health throughout the commonwealth.

ED boarding occurs when a patient must wait in an ED until an appropriate inpatient psychiatric or substance use disorder bed is available. The amplified impact of the behavioral health crisis on children is especially evident in the context of ED boarding. Teenagers make up 21% of all behavioral health visits that board. For patients that board for two or more days, children and teenagers make up 59% of all cases.

According to the state Department of Mental Health, the biggest barrier to pediatric behavioral health admissions was a lack of available beds, but existing difficulties in recruiting RNs and other professionals with psychiatric experience also cause significant access obstacles for children and adolescents with behavioral health needs.

Question 1 on the Massachusetts ballot this November would impose strict, rigid, one-size-fits-all nurse staffing ratios at all times on every unit of every hospital in the state. Community hospitals and academic medical centers would need to have the same RN staffing, regardless of the very different patient populations they may care for, or individual nurses’ experience or skills. These ratios would be required at all times – nights, scheduled and unscheduled nursing breaks, patient transfers, and any other time that nurses may need to step away from patients, even for just a few minutes. The law would also impose heavy fines of up to $25,000 per violation, per day, for any infractions.

The Massachusetts House and Senate reached agreement on minor difference between their bills that will raise the legal age for tobacco use to 21, and have sent the bill to Governor Baker.

The bill, which is an MHA legislative priority, will increase the age of sale for tobacco-related products, including e-cigarettes, from 18 to 21 years, add e-cigarettes to the smoke-free workplace law, and prohibit the sale of tobacco products at healthcare facilities.

In its support of the bill MHA noted in communications to legislators that tobacco and nicotine use is the leading cause of preventable illness and premature death in Massachusetts. Tobacco consumption results in hundreds of millions of dollars in lost productivity due to illness and premature death, and increases healthcare costs to the state by $4 billion annually. Youth are particularly susceptible to nicotine addiction, MHA noted; according to the US Surgeon General, almost 95% of tobacco users become addicted to nicotine before age 21.

In a 37-0 vote last Thursday, the Massachusetts Senate passed “An Act for Prevention and Access to Appropriate Care and Treatment of Addiction,” which is a revised version of legislation that passed the House on July 11 and was originally filed by Governor Baker as the CARE Act. The proposal was championed in the Senate by Sen. Cindy Friedman (D-Arlington), who chairs the Senate’s Joint Committee on Mental Health, Substance Use & Recovery, in addition to Sen. John Keenan (D-Quincy), who chairs the Senate Special Committee on Addiction Prevention, Treatment & Recovery Options.

Notable provisions in the bill include:

• requiring acute care hospitals that provide emergency services in an emergency department (ED) and satellite emergency facilities to be able to administer opioid agonist treatment for those who have suffered an overdose and are seeking addiction treatment, and to directly connect patients to ongoing treatment;
• allowing partial fill prescriptions for certain narcotic drugs and enabling patients to go back to the pharmacy later to seek the full prescription, if necessary, without additional out-of-pocket costs;
• issuance of a statewide standing order for dispensing opioid agonist treatment such as Narcan;
• permitting licensed certified social workers and other licensed healthcare providers to administer substance use disorder evaluations (SUDEs) in hospital EDs;
• an initiative that allows for the integration of the MassPAT into hospital electronic medical record systems; and
• language that streamlines reporting on the frequency and location of SUDEs.

The Senate adopted a redrafted version of an amendment MHA supported and that was filed by Sen. Keenan to ensure that there is proper coding and payer coverage for the new opioid agonist treatment provisions.

The legislature must now reconcile the discrepancies between the House and Senate bills and send a compromise proposal to Governor Baker prior to the July 31 end of legislative formal sessions.

The Health Policy Commission has weighed in on another hospital/health system merger, reaching the opposite conclusion from the merger’s proponents, who say the hospital deal will result in better coordinated care and lower healthcare costs.

The HPC last Wednesday released its Preliminary Cost and Market Impact Review (CMIR) on the proposed merger of Lahey Health System, Beth Israel Deaconess Medical Center and its affiliated hospitals, New England Baptist Hospital, Mount Auburn Hospital, Seacoast Regional Health Systems (including Anna Jaques Hospital), and the Beth Israel Deaconess Care Organization physician practice. The new system would be known as Beth Israel Lahey Health (BILH) and would be the second largest system in the state financially after Partners HealthCare.

The HPC preliminary report estimates that BILH’s enhanced bargaining leverage would increase commercial prices, raising total healthcare spending by an estimated $138.3-to-$191.3 million annually. While the HPC acknowledged that “plans to shift care to BILH from other providers and to lower-cost settings within the BILH system would generally be cost-reducing,” they did not believe the savings would offset projected price increases.

The Lahey-BID systems have 30 days to respond to the report and the HPC says it plans to issue a final report in September. The HPC can’t stop the merger but it can refer the case to the Attorney General’s office, which can impose conditions on the agreement or halt it entirely.