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Voices in Healthcare

Relief on ACA repeal, but individual insurance market needs urgent attention

The Massachusetts Health & Hospital Association and our members are immensely relieved that the latest GOP Senate healthcare proposal was defeated. Now Congress can – and should – focus on our nation's most important short-term healthcare issue, which is stabilizing the individual insurance market.

We are extremely grateful to our two senators for their steadfast opposition to the repeal efforts, and for their outstanding leadership throughout the Senate deliberations. MHA looks forward to continued collaboration with our entire congressional delegation, the Baker Administration and all other stakeholders to build upon the solid foundation of the Affordable Care Act and make good healthcare policy better.

Nurses’ Union Deliberately Trying to Sabotage Hospitals

As reported in the press, the Massachusetts Nurses Association (MNA)'s own documents reveal that it is planning to strike at Tufts Medical Center at a time that is "most harmful to the hospital." Such action is not only harmful to the hospital, it also is harmful to nurses and others on the caregiving team, and is inexcusable. This type of irresponsible behavior hurts the nurses themselves, since costs of managing a strike will come from funding the hospital has available for nurses' wage increases, and more importantly it shows that the MNA leadership is putting themselves before patients.

The union leadership is also trying to put negative "spin" on pre-emptive steps by Baystate Franklin Medical Center to keep patients safe despite a one-day MNA strike at the hospital. The union knows that when it uses a one-day strike as a negotiating tactic, any replacement nurses must be hired for a minimum of three, or sometimes five, days. So what the MNA calls a "pre-emptive lock-out" is actually the hospital bringing replacement nurses in with enough time to bring them up to speed, and then fulfilling their three-day minimum contract requirements. This is a necessary and responsible action by hospitals and something MNA leadership should understand.

The nurses' union previously has also deliberately coordinated planned strikes in Massachusetts to take advantage of limited nurse replacements. I agree with Boston Globe columnist Joan Vennochi who wrote, "Interrupting patient care is a risk that everyone, including the union, should work hard to avoid — stat."

The MNA union leadership continues to take a hostile approach to interactions with the hospitals that employ its nurses. This is unfortunate, unnecessary and wrong. It not only harms hospitals, but has the potential to disrupt care.

Climate Change: How our healthcare community is making a difference

The recent op-ed on the healthcare community's climate preparedness from Boston Medical Center President & CEO, Kate Walsh, and Partners HealthCare President & CEO, David Torchiana, was a stark reminder of the grave and very real threat that climate change poses to the health of our nation, and highlights yet another way that Massachusetts hospitals and other healthcare providers are front and center in the effort to keep our residents healthy, not just care for them when they need it.

The article focuses on Boston healthcare facilities' work with the Boston Green Ribbon Commission, to advance energy renewal and efficiency projects to reduce greenhouse gas emissions by 2020 (we are years ahead of schedule, by the way). But hospitals, health systems and other providers across the state are hard at work to reduce their carbon footprints and lead their communities to a healthier future. Massachusetts hospitals have been working closely with their communities to develop and implement a variety of innovative environmentally sustainable steps. MHA continues to work with our members to share hospital best practices and other resources to enhance statewide goals of reducing our overall carbon footprint.

Protecting the environment directly results in benefits to public health. At a time when both efforts seem to be under increasing attack, Massachusetts hospitals, health systems and other providers remain steadfast and continue to innovate to safeguard patients, their families and loved ones on every front.

Continued ACA Repeal Efforts Are Bad for Our Nation’s Health

MHA and our member hospitals, health systems and other providers have made great strides in healthcare payment and delivery reform, thanks to Massachusetts' groundbreaking health reform law of 2006 and the Affordable Care Act (ACA). 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.

But continued efforts by President Trump and Republican congressional leaders to repeal the ACA will severely damage the progress we have made. Today's House passage of an amended version of the American Health Care Act (ACHA) seeks to end our nation's very solid advances toward accessible, high-quality care for all residents and will likely send many of those in the country back to the "bad old days" when pre-existing conditions put both coverage and care out of reach for millions of Americans and insurance for lower-income patients was inadequate or non-existent.

The ACHA, as written, will halt the advances our state and country have made in healthcare access, affordability and delivery. Most troubling, it would put health coverage in jeopardy for many Americans, particularly for older and sicker patients. 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 also remains strongly opposed to the repeal of the ACA. And we applaud the many Massachusetts leaders such as Governor Charlie Baker who have joined our entire Congressional delegation by going on record with their opposition to the current repeal/replace effort, citing the threat posed to Massachusetts’ near universal health insurance coverage for its residents and the potential loss of millions of dollars in vital federal funding for healthcare.

MHA and our members are likewise distressed by this latest effort to roll back the progress and benefits achieved under the ACA, and we're grateful that our entire Massachusetts Congressional delegation stands uniformly opposed to such measures.

None of the proposals or amendments that have been put forward in Congress would maintain the insurance coverage that currently exists as a result of the ACA, or continue the quality and delivery system improvements now underway. They would, in fact, be extremely harmful to our nation's health. With lives in the balance, hospitals, healthcare professionals and patient advocates across the country will be redoubling our efforts in the weeks and months ahead to defeat the House bill.

Healthcare Planning: Take the First Step!

This is national Healthcare Decisions Week, and throughout the month of April, MHA is re-doubling its effort to bring attention to the importance of advance healthcare planning – the process you want your loved ones and caregivers to help you carry out if you become seriously ill.

If you have a plan in place and discussed it with those close to you, it will ensure that your family will not be burdened with making tough decisions on your behalf if you become seriously ill, and that your wishes will be carried out. Having a plan in place can also avoid disputes between family members who may have differing ideas about the care you should, or should not, receive. And avoiding those disputes, which often occur in care settings, assists the caregivers at your bedside as well; they will be able to provide the care you wish without conflict.

The decision week is an initiative of The Conversation Project, working collaboratively with the Institute for Healthcare Improvement. This month, MHA is reaching out to educate our staff, the surrounding community, and our membership on the importance of advance healthcare planning. We've provided all MHA employees with a "Getting Started Tool Kit" from Honoring Choices Massachusetts, and have also offered and provided the tool kits to several of our neighbors in "The District" – the Burlington, Mass. executive park where our offices are located. This toolkit allows any competent individual over the age of 18 to:

• Choose a healthcare agent in a healthcare proxy;

• Write down their choices for care in a personal directive; and

• Learn how to talk to their care providers to align their care to their choices.

There are a lot of moving parts to advance care planning, but much of the information available to the public is clearly written, with easy-to-follow steps. And while the decision to begin a conversation about serious illness and end-of-life care is almost always a difficult one to make, avoiding such a conversation now may make things more difficult for you, your loved ones, and your healthcare providers further along in your life.

PatientCareLink, the healthcare quality and transparency website MHA co-sponsors with the Organization of Nurse Leaders – MA, RI, NH & CT (ONL), Home Care Alliance of Massachusetts (HCA) and Hospital Association of Rhode Island (HARI), also contains a great deal of information about advance healthcare planning; click on "Healthcare Planning Throughout Your Life" under the For Patients & Families Tab, or "Serious Illness Care" under Improving Patient Care.

Please join me and the rest of the MHA community in taking this important first step to make your own healthcare plan. Knowing you have control over your care even in serious situations is of tremendous value, both to you and your loved ones.

A Repeal of the ACA Would Turn Back the Clock for Massachusetts and the Nation

Hospitals and other healthcare providers are a foundation for good in the United States, but our nation’s very solid progress toward accessible, high-quality care for all residents is now under siege as a result of the misguided campaign led by President-elect Trump and Republican congressional leaders to dismantle the Affordable Care Act (ACA).

MHA is strongly opposed to the repeal of the ACA, and is one of the founding members of the new Massachusetts Coalition for Coverage and Care. This broad alliance of consumers, providers, health insurers, businesses, labor unions, and faith organizations is working to further educate policymakers in Massachusetts and Washington DC about the serious consequences that will result if the Affordable Care Act is repealed. We are also working to identify actions that the state and others can take to protect coverage and care for our residents.

Our greatest concern with repeal is the threat it poses to the coverage expansions that have dramatically reduced the number of uninsured in Massachusetts, as well as the advances underway to reform how healthcare is paid for and delivered.

Massachusetts leads the nation in the percentage of its residents with health insurance coverage – at 97%. But contrary to what seems to be popular opinion here, there is tremendous risk to that progress if the ACA is repealed and/or replaced, including the loss of millions of dollars in federal funding.

Massachusetts has been a pioneer in expanding health coverage over the years, including our state's historic 2006 health reform law that served as a model for the ACA. 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.

With 10 years now passed since then-Governor Mitt Romney signed our initial health reform initiative into law, we can proudly say that the commonwealth's is better off healthcare-wise than it was in 2005. And I know we share this sentiment with other Massachusetts healthcare providers, insurers, the employer community, government leaders, and, most importantly, Massachusetts consumers and families. Yet all of these advances will be directly endangered if the ACA is repealed.

The ACA, like Medicare in 1965, has had its growing pains, but the benefits of the program far exceed any ongoing problems. As with any comprehensive law, it has been a work in progress. We are still reviewing all the potential impacts of repeal, but the immediate threats of coverage and Medicaid waiver losses, the end of quality initiatives, and the financial strain that will be placed upon hospitals are all extraordinarily troubling.

To my knowledge, no proposal has been floated that would actually maintain the insurance coverage that currently exists as a result of the ACA, or that would continue the quality and delivery system improvements now underway.

While I'm confident that the healthcare culture here in the commonwealth will continue to prioritize the advances we have made, the loss of federal support for affordable health coverage could have severe consequences in Massachusetts, as well as nationwide. We should not turn back the clock on the strong progress we have made.

Why healthcare is Voting NO on Question 4

Massachusetts voters will consider an initiative to legalize the commercial sale of marijuana in November of 2016. After studying this issue and consulting with a variety of experts and clinical leaders committed to improving public health, we recognize that there are compelling clinical and public policy reasons for not expanding the use of marijuana within Massachusetts. The Massachusetts Health & Hospital Association is proud to be part of a large coalition of healthcare, business, and community leaders – joined by a bipartisan group of state and local leaders – all aligned with the Campaign for a Safe & Healthy Massachusetts to oppose Question 4.

Click here to view the campaign’s new television ad, which makes a very strong case against the insertion of commercial marijuana into our communities.

The legalization of commercial marijuana poses a direct threat to the public health and safety of our patients and communities and raises significant concerns for healthcare organizations.  In addition, the news coming out of the few states that that have legalized the commercial sale of marijuana – such as Colorado and Washington State – is troubling. The stakes are too high for Massachusetts and the reasons for opposition are clear.

Here's why MHA and its members are against Question 4:

  • Edibles. The commercial marijuana industry model relies heavily on the sale of “edibles” – THC-laced products that look like, and are packaged as, lollipops, gummy bears, and other sweets targeted at the youth market. My peers in Colorado, where marijuana is legal, say edibles account for nearly 50% of all marijuana products sold in that state and emergency rooms are routinely treating children accidently ingesting these irresponsible products, whose unregulated THC levels can reach an astounding 95%.
  • Impaired driving. Each day we see drivers crossing marked lines as they read texts or surf the web. Add impaired drivers using legal marijuana to that mix and you have a recipe for disaster. The number of traffic deaths due to marijuana-impaired drivers doubled the year after Washington State legalized marijuana, and Colorado has also seen a spike in impaired driving deaths. There's no breathalyzer test for marijuana, making it difficult to deter or prosecute these impaired drivers.
  • Home grown allowances. Question 4 would allow anyone over 21 to grow marijuana in their homes even over the objections of neighbors. The tax revenue-enhancing arguments of pro marijuana supporters is undercut by the fact that allowing a homegrown marijuana industry will create a new black market for the product as it has already done in Colorado.
  • Increased teen use. Since becoming the first state to legalize, Colorado has also become the number one state in the nation for teen marijuana use, making an increase in Massachusetts a similar certainty. According to studies by the National Academy of Sciences and other organizations, marijuana use by adolescents can impair brain development, impact long-term career growth, and even lower IQ.
  • Impact on our communities. Question 4 limits the ability of communities to set limits on the number of marijuana producers and sellers that could open in Massachusetts. In the wake of its legalization vote, Colorado, now has more marijuanashops than the number of McDonald's and Starbucks combined. There are serious potential family and social consequences statewide, with disadvantaged communities in particular facing adversely effects.
  • Adverse mental health impacts. Creating a legal commercial marijuana industry in Massachusetts would increase use among children and harm the cognitive development of young people. The Massachusetts chapter of the National Alliance on Mental Illness (NAMI) warns that marijuana use poses a increased danger for those with mental illness and young people predisposed to mental illness.

For healthcare providers and state regulators, there are also serious conflicts with federal law. Massachusetts has already decriminalized possession of recreational amounts of marijuana, and legalized its use for medical purposes. Question 4 is not a small step forward; it is a giant leap too far – especially for the well-being of our children. The legalization of the commercial marijuana industry will foster a dangerous climate that will yield poor public health consequences and challenges to the resources of our healthcare system. Our state's acceptance of a misguided ballot question will weaken Massachusetts collectively – not strengthen us.

Massachusetts hospitals have always been at the forefront of promoting public health, and the prospective legalized commercial sale of marijuana in our commonwealth poses a number of significant healthcare-related problems. MHA, its member hospitals, healthcare systems, other healthcare providers and healthcare community leaders from around the state have a clear message –Vote NO on Question 4.

MHA’s Name Changes as Delivery System Evolves

After 80 years representing hospitals throughout the commonwealth – the Massachusetts Hospital Association has changed its name to the Massachusetts Health & Hospital Association. We arrived at the new name after discussion among our membership and board of trustees, who approved the name change at our annual meeting in July.

The change reflects our members’ expanding role within the evolving world of healthcare reform. As the healthcare system becomes more value driven, each component of that system is increasingly focused on maintaining a person’s health throughout their lives – as opposed to healing them when they fall ill. Because healthcare is team based and collaborative, played out in numerous venues throughout the course of an individual’s life – from neonatal screenings to end-of-life care – we wanted to reflect the multiplicity of health in our name.

With the incorporation of “health” into our new name and identity, MHA will also expand our focus and leadership efforts in public health and wellness, ranging from sweeping health crises such as Zika, natural disasters and the opioid epidemic, to initiatives that place our members at the forefront of efforts to eliminate tobacco use in Massachusetts. And we’re working vigilantly to defeat Question 4 on the November state ballot, which would commercialize the use of recreational marijuana.

The name change also includes a new logo (thank you, Fassino Design of Waltham, MA!) that reflects the contemporary nature of the association’s approach to healthcare and reform in Massachusetts as well as our expanded membership. In addition, the logo’s double “H” appears dynamic and is moving up. This design element was deliberate, signifying that hospitals are in an ascendancy of effectiveness and are stepping up in the arena of “whole person health” through comprehensive healthcare.


Some things won’t change, however. We’ll still be known by the “MHA” acronym because that well-known abbreviation carries strong brand equity that signifies influence and stability in the healthcare and legislative arenas.

Most importantly, we still will remain the state’s most respected advocate for Massachusetts hospitals whether they operate as teaching or community hospitals, post-acute facilities, long-term acutes, inpatient rehabs, public hospitals, investor-owned facilities, safety net or non-safety net hospitals.

Our membership, with hospitals at its core, now increasingly includes non-hospital service providers, such as physician group practices, home health entities, senior living interests, hospice, pharmaceutical, medical device, and imaging businesses, as well as accounting and law firms with healthcare specialties, among many other groups. What unites us all as MHA members is the unwavering commitment to building and maintaining a strong and effective healthcare system. MHA looks forward to working on that collaborative goal in the decades to come.

Support the Nurse Licensure Compact: It Benefits Patients and Nurses Alike

There's an amendment to the Senate Ways & Means Committee budget being debated this week that can improve patient care and simultaneously save nurses money by reducing the burden of holding and paying for multiple licenses in several states. It's amendment #622, filed by Sen. Don Humason (R-Westfield), which would adopt the National Nurse Licensure Compact here in Massachusetts.

Similar to a driver's license, which allows someone to be licensed in one state and also have the privilege of driving in other states, the Nurse Licensure Compact allows nurses to receive a multistate license in the state they reside, with the privilege to practice in both their home state and all other states that are members of the NLC.

Massachusetts has long been an innovator and model when it comes to providing high quality patient care. But on this effort, Massachusetts is lagging badly. Twenty-five states have already adopted the NLC, including Rhode Island, New Hampshire and Maine. But our commonwealth notably remains on the sidelines.

Membership in the NLC would reduce licensure costs and streamline the process for Massachusetts nurses looking to work across state lines, as well as for nurses from other Compact states looking to work here. Such licensure in the commonwealth is currently done by endorsement, and the process can be administratively burdensome, time-consuming, resource-intensive, and may unnecessarily delay registered nurses from starting a new job, joining a new patient care team and providing care.

For example, an organization that employs nurses working telephonically in multiple states has found that seeking licenses state-by-state (licensure by endorsement) costs double what it costs to employ nurses from Compact states. And local nurses seeking licensure by endorsement for their work in a telemedicine program had a nine-month lag between their initial application and the time they received their licenses. That is a huge time and resource burden for both nurses and healthcare organizations.

Over 14,000 nurses in Massachusetts would directly benefit from joining the NLC by eliminating the burden of maintaining multiple, costly licenses for every state that they practice in. The nursing community strongly supports this legislation and it has been endorsed by the Organization of Nurse Leaders of Massachusetts, Rhode Island, New Hampshire and Connecticut (ONL) and the American Nurses Association of Massachusetts. Even union nurses – many who work in case management programs providing critical follow-up care to patients – support the amendment. According to a survey from the National Council of State Boards of Nursing, 60% of union nurses in Massachusetts support joining the Nurse Licensure Compact.

By joining the NLC, Massachusetts can help ensure the availability of licensed nurses during natural or man-made disasters, which do not recognize state lines. Membership in the NLC clarifies the authority to practice for nurses currently engaged in tele-nursing, interstate practice, or other models of contemporary nursing practice that are part of the healthcare reform efforts of the Affordable Care Act and the commonwealth's Chapter 224 cost containment law. Eliminating existing regulatory barriers and uncertainties allows nurses to provide patient-centered care across the continuum of care, wherever patients need it and in a manner that is cost-effective.

The Massachusetts Board of Registration in Nursing's role in patient safety and public protection is also enhanced through the NLC by ensuring earlier identification of nurses facing adverse actions in other states, as only NLC member states can access the database of actions that may be pending against a licensed nurse in other states. This information-sharing also facilitates an accurate understanding of the nursing population. When we know how many nurses we have regionally, and where and when they work, employers and other stakeholders can design appropriate strategies for education, recruitment, employment, training and retention. This will improve healthcare quality and patient safety both now and in the future.

Massachusetts should join the Nurse Licensure Compact. It is the right thing to do to ensure patients receive the best possible care. Joining the NLC aligns with our state's proud history, current reality and future aspiration as a leader in healthcare quality and innovation.

Massachusetts One Step Closer to Raising Tobacco Purchasing Age to 21 Statewide

The Massachusetts Senate just moved us one step closer to improved efforts to reduce tobacco use and nicotine addiction in the commonwealth. I commend Senate President Stan Rosenberg and the members of the Senate for their approval this week of a strong and comprehensive bill that, among other things, could make Massachusetts the second state in the nation behind Hawaii to raise the minimum age to purchase tobacco from 18 to 21 statewide.

Senator Jason Lewis, Senate chair of the Joint Committee on Public Health, and Senate Majority Leader Harriette Chandler deserve particular recognition for their leadership on this important issue, in conjunction with Tobacco Free Massachusetts, the state's leading organization to reduce tobacco use in the commonwealth (and of which MHA is a proud member). MHA testified at the State House last July in favor of many of the provisions included in this bill, which include a prohibition against the sale of tobacco and nicotine-delivery products to anyone under age 21, adds e-cigarettes to the smoke-free workplace law and prohibits the sale of tobacco in pharmacies and other health care facilities. 

Seventy-six percent of MHA-member hospitals already self-report as having fully achieved tobacco-free status, which means their grounds are completely tobacco-free, including parking lots and garages, with no exceptions. Some Massachusetts hospitals have taken their commitment a step further, and joined MHA in no longer hiring tobacco users. While some of the state's 351 cities and towns have already limited tobacco sales to those 21 and older, a consistent, statewide age limit of 21 is the most appropriate approach to discourage tobacco use and subsequent addiction among the young people of Massachusetts. Research from the US Surgeon General has shown that over 90 percent of smokers start by age 18, so raising the tobacco purchasing age limit to 21 statewide can help decrease smoking, vaping and other tobacco use rates in the Bay State overall.

Tobacco and nicotine use is the leading cause of preventable illness and premature death in Massachusetts. It costs the state more than $4 billion annually in healthcare costs. In addition, tobacco consumption results in hundreds of millions of dollars in lost productivity due to illness and premature death.

Increasing the age at which individuals can buy cigarettes – or any tobacco product – is a common sense way to promote population health. A combination of state laws, prevention programs, and community-based education will help decrease the prevalence of youth smoking. 

MHA and our member hospitals and health systems strongly support the collective provisions of this legislation, which we believe are essential steps in the effort to eliminate tobacco use and its harmful impact on public health.

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