The Massachusetts healthcare community stepped up to the plate this past week, quickly responding to a call for help from a hospital outside of Houston, Texas that had been affected by flooding from the devastating Hurricane Harvey.

On Wednesday, 27 Massachusetts nurses and one cardiac catheterization laboratory technician boarded a chartered plane at Hanscom Field in Bedford, Massachusetts to fly to Ellington Airport in Houston. Once there they were deployed at Bay Area Regional Medical Center (BARMC) – the Webster, Texas hospital that on August 29 had contacted MHA President & CEO Lynn Nicholas seeking help.
 
(Photo at left: Pre-flight pep talk. On the bus before the flight, MHA President & CEO Lynn Nicholas (standing, right) addresses the volunteers, joined by MHA Sr. Director of Clinical Affairs Lorraine Schoen, R.N. (left) and ONL CEO Amanda Oberlies, R.N. (center).)

The Texas disaster response protocol allowed individual care facilities to seek help on their own, which is why BARMC CEO Stephen Jones, Jr., called his former colleague Nicholas as well as one in New Jersey. Within hours after MHA put out a call to its membership, more than 100 caregivers from across Massachusetts signed up to help. New Jersey deployed its nurses first and over the Labor Day weekend MHA staff and BARMC, along with Organization of Nurse Leaders of MA, RI, NH & CT, plus MassPort, coordinated the details of what types of caregivers were needed, when they would deploy, and how they would travel to and from Texas. BARMC provided the 30-seat propeller plane that left on Wednesday morning and will return on September 12.

“I’m incredibly proud of our generous and dedicated nurses and techs for stepping up to help when and where it’s needed most,” Nicholas said. “Not only will they provide clinical care, but many plan to volunteer with clean-up in the area. This effort is one of the most heart-warming things I’ve been engaged with during my entire career.”

Among the volunteer nurses traveling to Texas were two sisters RNs and a couple that recently became engaged.

 The caregivers came from the following MHA member hospitals: Boston Medical Center; Brigham and Women’s Hospital; Fairview Hospital; Lawrence General Hospital; Lowell General Hospital; Mercy Medical Center; Newton-Wellesley Hospital;  Southcoast Health Hospitals; Tufts Medical Center; UMass Memorial Medical Center; and Winchester Hospital.

As the effort in Houston was underway, Hurricane Irma slammed into Puerto Rico, other Caribbean islands, and was on a direct path to Florida. At their peak, Irma’s winds were clocked at 185 m.p.h.

Saying that healthcare providers have “a moral obligation to help patients remain alive and healthy until they can choose recovery,” MHA on Wednesday testified in support of a Massachusetts senate bill that would allow DPH to implement safe injection facilities (SIFs) subject to local approval.

SIFs are spaces for people who use illicit drugs to consume those drugs (brought into the SIF) under the supervision of a healthcare professional or other trained staff. The reasoning is that if users take drugs in monitored spaces, as opposed to unsupervised on the street, there’s less of a chance they’ll overdose and a greater chance that they’ll be directed to treatment.

On average, 5 to 6 people die of opioid overdoses daily in Massachusetts. The state and healthcare community have adopted many strategies to address that shocking trend. For example, an MHA-convened expert panel developed new opioid prescribing guidelines for all hospitals and the state has upgraded its prescription monitoring system. But as the problem persists and more powerful opioids like fentanyl are becoming widely available, providers and policymakers are looking to such seemingly counterintuitive strategies such as SIFs or “safer drug consumption programs”  as the Senate Bill 1081 refers to them.

On Wednesday, MHA’s V.P. of Clinical Integration Steve Defossez, M.D., testified with MHA’s V.P. of Government Advocacy Mike Sroczynski before the Joint Committee on Mental Health, Substance Use & Recovery.  The bill’s lead sponsor is Sen. William Brownsberger (D-Belmont).
They noted that substance use disorder (SUD) is a chronic physical disease of the brain amenable to successful therapy just like other chronic diseases such as diabetes or hypertension. One component of SUD, however, is impaired decision-making. Therefore, not all patients with opioid SUD are ready to choose recovery, treatment and abstinence when it is offered to them. However, such patients may be amenable to pursuing treatment when exposed to cost-effective treatments that reduce harm; initial data shows that supervised injection facilities, as envisioned by SB1081, hold great promise on this front.

“The end result of an opioid substance use disorder may be recovery, incarceration or death,” Defossez said. “Alternative strategies such as SIFs help move SUD patients toward recovery. MHA believes healthcare providers have a moral obligation to help patients remain alive and healthy until they can choose recovery.  SIFs can help accomplish this goal by reducing or eliminating the risk of overdose death and helping reduce transmission of viral diseases such as HIV and hepatitis.”

Sroczynski noted that in one study, a safe injection facility documented a 30% increase in the rate of patients choosing recovery rather than persistent drug use.  “The reason for this increase is that every time a patient uses a SIF, it’s a touchpoint for a compassionate healthcare worker to make a personal connection with a client and increase that client’s awareness of their treatment options,” he said.

The Massachusetts Health & Hospital Association (MHA) website – www.mhalink.org – has been re-designed to make it sleeker, more visually appealing, and more user friendly.
  
A major upgrade is the addition of an “A-to-Z” search list where users can search thousands of pages from ACOs to Workplace Safety. (We don’t have any X, Y, or Z topics yet!). 

Over one year in the making, the website was designed graphically by Fassino Design of Waltham, Mass. (C) Systems Global provided the backend support.  MHA’s Communications and IT departments drove the internal MHA-wide effort to improve the site.

This week, the Massachusetts House Congressional delegation sent a letter to U.S. Health and Human Services Secretary Tom Price urging that the Trump Administration not move forward on proposed cuts to Medicaid Disproportionate Share Hospital (DSH) funding.   Hospitals and other advocates across the country, including MHA, recently weighed in on a proposed CMS rule that would implement required cuts to state Medicaid DSH funding called for in the Affordable Care Act (ACA).  The proposed CMS methodology to implement the $2 billion cuts nationally in FY2018 would result in a 31% reduction in Medicaid DSH funding to Massachusetts, the largest reduction in the country. The cuts grow eventually to $8 billion by 2024.

The Massachusetts House letter to Price stated, “Your Administration has advocated for greater state flexibility to allow the type of innovation which Massachusetts initiated in 2006 under the Bush Administration and continues to this day. ... However, the proposed DSH cuts would disrupt and possibly destabilize this reform effort while also penalizing our success in reducing the number of uninsured.”

Governor Charlie Baker also wrote a letter to Secretary Price, stating, “The impact of the DSH cuts will have a destabilizing effect on the public and safety net hospitals if the rule is implemented without revision.  Furthermore, the DSH reductions would have the effect of endangering Massachusetts’ longstanding almost universal healthcare coverage and new health reform efforts.” A third letter from the Bay State’s two U.S. Senators is reportedly in the works as of Monday Report’s press time.

The Medicaid DSH funding cuts to states are scheduled to take effect October 1, 2017. MHA has advocated that the proposed rule be delayed and raised concerns with the proposed methodology that heavily weights the funding cuts based on Massachusetts’ successful efforts to cover the uninsured.

Governor Charlie Baker testified before the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) on Thursday, arguing in favor of continuing the cost-sharing reductions that are included in the Affordable Care Act and that help insurance companies provide lower-income people with more affordable plans purchased in exchanges.  HELP Committee Chairman Senator Lamar Alexander (R-Tenn.) called for a bipartisan plan focused on addressing issues affecting access and affordability of insurance offerings in the individual market.

The Trump Administration has consistently sent monthly mixed messages about whether it will extend the cost-sharing reductions. “Month to month resuscitation of cost sharing reductions is not stabilization; they should be maintained for at least two years,” Baker said, adding, “I cannot stress enough how critical it is for federal cost-sharing reduction payments to be resolved affirmatively in order to maintain market stability and to constrain rate increases.”

Senator Elizabeth Warren (D-Mass.), a member of the HELP Committee, on Thursday was strongly critical of President Trump’s dithering on the CSRs.

Baker testified along with Governors Steve Bullock (D-Mont.), Bill Haslam (R-Tenn.), Gary Herbert (R-Utah), and John Hickenlooper (D-Col.). In his testimony Baker also called for “broader parameters for insurance market reforms that include greater latitude for states to meet the unique needs of their residents.” Specifically he called for states to be allowed to broaden so-called Section 1332 waivers, such as the one Massachusetts will be submitting shortly to create a premium stabilization fund in the event Congress does not appropriate funding for cost-sharing reductions. Baker and the other governors also pointed to rising pharmaceutical costs as a major problem.

AHRQ has funding available for large research projects in two areas: preventing healthcare-associated infections (HAI) and efforts for Combating Antibiotic-Resistant Bacteria (CARB). The application deadline for both of these funding opportunities is October 5, 2017. The HAI research projects should advance the knowledge of HAI detection, prevention, and reduction. CARB research project proposals should address ways to promote appropriate antibiotic use, reduce the transmission of resistant bacteria, or prevent HAIs in the first place. These funding opportunities are open to researchers in all healthcare settings: long-term care, ambulatory care, acute care hospitals, and those focusing on transitions between care settings. Companion funding opportunities are also available for demonstration and dissemination projects for both HAI and CARB. For more details, visit here.

Fraud & Abuse Update

Wednesday, October 25; 9 a.m. – 12 p.m.
MHA Conference Center, Burlington, Mass.

Over the last few years, the Departments of Justice and Health & Human Services have increased their scrutiny of healthcare providers, resulting in a broad range of investigations from the FBI, U.S. Attorney Offices and the FDA at hospitals, skilled nursing facilities, and other providers. Healthcare providers should be aware of the trends and areas that the federal government is pursuing and must be prepared in light of the developments in integrated care delivery models that include mergers, accountable care organizations, and affiliations.  All provider organizations are encouraged to attend this timely session where we plan to review current government scrutiny and provide guidance on how to respond if an inquiry is initiated. Giselle Joffre, a partner with MHA’s member law firm Foley Hoag (and a former Assistant U.S. Attorney within the Civil & Criminal Divisions of the U.S. Attorneys Office in Boston) will be presenting along with other healthcare law experts from Foley Hoag. This workshop will include presentations on recent false claims act investigations, anti-kickback statute investigations; and allegations of improper billing practices. Learn more, including registration information, here.