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Voices in Healthcare


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.

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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.

MA Legislature Takes Big Steps to Prevent Youth Tobacco and Nicotine Addiction

Kudos to the state legislature's Joint Committee on Public Health (chaired by Sen. Jason Lewis (D-Winchester) and Rep. Kate Hogan (D-Stow)), for its recent release of a comprehensive bill to reduce tobacco use and nicotine addiction among young people. An Act to Protect Youth from the Health Risks of Tobacco and Nicotine Addiction (SB 2152), initially sponsored by Senate Majority Leader Sen. Harriette Chandler (D-Worcester) and House Health Care Financing Chairman Rep. Jeffrey Sanchez (D-Jamaica Plain), is a comprehensive redraft of legislation that would prohibit the sale of tobacco products to anyone under age 21; prohibit the use of e-cigarettes at schools and in any workplace; requires child-resistant packaging for e-cigarettes; prohibits tobacco vending machines; and bans the sale of all tobacco and nicotine delivery products in pharmacies and other healthcare institutions.

MHA testified at the State House in July in favor of many of the provisions included in this bill, which is also supported by Tobacco Free Mass., the state's leading organization to reduce tobacco use in the commonwealth, and of which MHA is a member. Increasing the age at which individuals can buy cigarettes – or any tobacco product – is a common sense way to promote population health. According to the US Surgeon General, almost no one starts smoking after age 25, and almost 90% of smokers started by age 18. A combination of state laws, prevention programs, and community-based education will help decrease the prevalence of youth smoking. While some of the state's 351 cities and towns have limited tobacco sales to those 21 and older, many others have set the limit at age 18 or 19. 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, and thereby decrease smoking, vaping and other tobacco use rates in the Bay State overall.

As SB2152 also prohibits the sale of tobacco products at healthcare facilities, Massachusetts hospitals have historically adhered to the policy outlined in this bill on a voluntary basis. In fact, over 76% of MHA members have completely tobacco-free campuses and several hospitals have joined MHA in establishing employment practices that screen for tobacco use. We clearly understand the detrimental effects tobacco products have on the health of all individuals and the negative impact these products pose to the recovery process of patients. Our hospitals strive to improve the health of all patients and we believe that it's counterproductive to the collective mission of hospitals and healthcare providers – including pharmacies – if tobacco products are sold where healthcare treatment is offered.

In addition, SB2152 prohibits the sale of nicotine delivery products – e-cigarettes and their ilk – to anyone under age 21. E-cigarettes are not defined by federal law as tobacco products. This means that they are not regulated by the Food & Drug Administration and have had no safety or efficacy evaluation. This regulatory void means it's appropriate for the state to intervene to protect young people from the impact of these products. The legislation mirrors many of the provisions that the Attorney General has implemented in regulations to prohibit the sale of electronic smoking devices to those under age 18 and protect children from unsafe packaging of liquid nicotine. As more and more youth utilize tobacco products other than cigarettes, the provisions of this bill will go further to help ensure that any tobacco or new nicotine delivery products stay out of the hands of minors.

Tobacco use remains the number one cause of preventable death in the nation, with smoking alone causing over 480,000 deaths per year (including via second hand smoke). In addition, hundreds of millions of dollars are lost each year in lost productivity due to illness and premature death caused by tobacco consumption. MHA and our members strongly support these efforts collectively and individually to end tobacco use in Massachusetts and elsewhere in the nation.

Looking Back, Looking Forward on the Massachusetts Healthcare Front

As 2016 kicks off in earnest with a traditional New England cold front, MHA's member hospitals, health systems, physician groups and caregivers can reflect on the many accomplishments and challenges we have faced in the past year, and anticipate our ongoing and future efforts to make healthcare even more safe, high-quality and cost-effective in the future.

The latest Health Policy Commission (HPC) 2015 Cost Trends Report provides an important look at our state’s healthcare landscape. It reveals progress and challenges across the board, but I was particularly pleased to note some of the outstanding progress Massachusetts hospitals have made in bending the cost increase trend.

The HPC report specifically notes that commercial hospital and physician spending grew just 1% per capita in 2014, significantly below the state's cost growth benchmark of 3.6%.

Hospitals and physician groups are leading the way in reducing the growth in healthcare spending, even in the face of government underpayment for care provided to those enrolled in state and federal healthcare programs like Medicare and MassHealth. They deserve recognition for these efforts.

This continued reduction in the cost trend for hospital-related services is the result of numerous proactive efforts large and small. I believe the best way to advance this success is to escalate the movement to alternative payment models.

More transparency and a rigorous conversation are also in order regarding prescription drug prices as a driver of healthcare trends. Providers are limited in what they can do to mitigate cost escalation in this area, but it is clear that reducing total healthcare spending requires attention to all components of the overall cost trend. Just think what the cost trend would have looked like had we not had such significant increases in drug costs.

To use a cold-weather analogy, we have to be careful not to focus too much on individual threads when we should be looking at the entire sweater. The sooner the market can move to alternative payment in all delivery settings, the sooner we will get more comprehensive connected care, better quality and, as a byproduct, lower expenditures.

Looking ahead, there are two particular challenges that will engage hospitals and care providers in the New Year.

First is an onerous ballot initiative that seeks to regulate hospital pricing at the ballot box. This proposal is seriously flawed, overly simplistic and could potentially move Massachusetts healthcare reform in the wrong direction after years of real progress.

MHA's board of trustees, which represents hospitals of all types and sizes across the commonwealth, voted unanimously to oppose this "regulation from the ballot box" proposal. We already tried healthcare price regulation and ultimately rejected it as inflexible and fraught with unintended consequences. Instead we have moved to a hybrid system that involves both government and the market; there is great wisdom in having a balanced approach. We should be extremely cautious about attempts to essentially go back to the past to adopt a system that couldn't adapt to the comparatively simple healthcare system of the 1980s. Given the rapidly changing healthcare payment system of today, we need a different approach.

Current reforms—namely the healthcare cost containment law, Chapter 224 – haven't been fully implemented. Alternative payment models are expanding, there is greater integration of care, healthcare information technology is improving, and greater transparency will bring information to the public and policy makers that will promote better care and efficiency. The status quo isn't perfect, but it has helped drive progress at a macro level. Meanwhile, concerns have been raised about how the market system has been operating and the resulting variation in prices for individual providers. Such issues can be examined and resolved without engaging in the charged environment of a political campaign.

Perhaps most importantly, the ballot initiative doesn't address one of the greatest contributors to hospitals' financial challenges: low government reimbursement. For hospitals that are under financial stress, a common denominator is government underpayment for the cost of care. For the many hospitals that are overwhelmingly reliant upon government reimbursement, the real solution is adequate government reimbursement.

The second long-term challenge is confronting and defeating the opioid addiction crisis in our commonwealth.

The hospital community appreciates the leadership that the Governor, House Speaker, and Senate President have brought to this crisis. We are committed to promoting proposals that recognize that any solution has to call for action from all the key stakeholders: providers, insurers, government, law enforcement, and communities.

As hospitals we recognize our special responsibility to identify and implement solutions. The priority remains our patients. Hospitals must effectively use their resources and skills to both prevent and treat substance use disorders. Hospitals should be accountable for the care they provide, but they must also be allowed to use their best clinical judgment to meet the needs of each patient suffering from, or in danger of suffering from, an addiction, without disadvantaging other patients who have pressing medical needs such as managing chronic pain.

Hospitals are open to changing how addiction is addressed as a matter of urgent public concern. But any limitations on the clinical judgment of physicians should be done in a way that recognizes that caring for patients, especially in an emergency situation, is not a simple "either or" decision. Not all patients and situations are equal, therefore some level of professional discretion is necessary and in the best interest of patients; but at the same time there should be transparency and accountability to address any individual providers or circumstances that may be contributing to the problem.

And collectively we must work to ensure that preventive resources are widely available across the state so that there is less need to turn to hospital emergency departments to treat addictions. Rather than being housed in hospital emergency departments, those in need of on-going care and support should have a place to turn to in their local communities.

MHA has been working for months with member hospitals across the state to galvanize efforts within the hospital community to address the opioid crisis. Our Task Force on Substance Use Disorder Prevention and Treatment has already produced a first-in-the-nation standardized guidance for hospital Emergency Departments and is now working on guidance for other hospital departments and facilities.  Progress is being made, but so much more needs to be done before the affliction of substance abuse is no longer ruining and ending lives within our communities.

We see the bills now working their way through the state legislature as further opportunities to collaborate and identify creative, compassionate, and flexible solutions to address this intractable problem. We are all united in our common goal to help, in the most effective manner, patients and families suffering through this terrible crisis.

May 2016 be the year we achieve these goals.

A Quality Move by BCBSMA

The announcement this week by Blue Cross Blue Shield of Massachusetts that they will provide some of the nation's most comprehensive benefits for end-of-life discussions and care is an excellent move that appropriately focuses on both quality of care and quality of life across the board.

It is a compassionate and common sense approach that helps patients first and foremost – as it should. Improved access to information and support surrounding end-of-life can also have the added benefit of helping to manage costs when hospital care may not be needed or desired and other options could serve patients better.

While Medicare will begin covering end-of-life discussions between physicians and patients in 2016, I believe open and honest conversations about a person's end-of-life wishes and care preferences should ideally begin well before age 65, let alone before a person becomes seriously ill. Expanding end-of-life benefits to all patients, regardless of their age, is the right approach.

MHA applauds the Blue Cross effort, and hopes that other insurers state- and nation-wide follow BCBSMA’s great example.

A nurses' union's imprudent mandatory staffing effort returns

Earlier this week, the Massachusetts state legislature's Joint Committee on Public Health heard – yet again – testimony on a nursing union's misguided legislation to mandate one-size-fits-all nurse staffing ratios. And as we've done for the past 15 years, MHA, our member hospitals and the Organization of Nurse Leaders of MA/RI/NH/CT (ONL) voiced strong opposition to mandated nurse staffing ratios in Massachusetts.

This editorial in the Boston Herald gives a good overview of the hearing and the shortcomings of the union’s unwise proposal.

The union has it wrong on every level. The importance of registered nurses does not need to be artificially inflated by mandating the use of registered nurses when patient care does not require it. Respecting the professionalism of registered nurses does not mean that legislators remove bedside nurses' discretion to determine what staffing levels meet a patient's needs. Supporting registered nurses does not mean that the job security of other dedicated members of the caregiving team and those who support the teams must be threatened.

There is a reason that in the 20 years since a California nurses union campaigned to pass a registered nurse staffing mandate that not one other state in the country has adopted such a radical approach: it doesn't work. It is not controversial to say that providing care to patients in a hospital setting is as complex as it is important. It is too important and complex to be done by a fixed formula.

When you look closely at what the union proposes in their legislation, they prove that their proposal is fatally flawed. In California, their law dictates that the staffing levels in hospital medical-surgical units be 5 patients to one nurse. But in Massachusetts they would dictate that the ratio in such units be 4 to 1. At the national level, the union calls for telemetry units to be staffed at a 1:3 ratio, but in Massachusetts the union would mandate that telemetry units be staffed at a 1:4 level. So it is evident that by their own tacit admission there is no single staffing ratio that can apply to all patients in similar units regardless of the severity of a patient's illness, the experience and education of nurses, and the composition of the caregiving team supported by other medical resources.

The union also claims that there are many studies that support their position. I encourage everyone to look at those studies. We have and so has ONL, and we found that none of the studies support the union's claims. Not one. The studies point out that nursing care is important. We couldn't agree more. They demonstrate that variation in nursing care and other factors can make a positive impact on patient care. We agree. But what they don't say is that there is a predetermined, set staffing formula that meets the needs of every patient in a unit.

Massachusetts is in the forefront of ensuring that every person has access to high quality care that is effective and affordable. We are making great strides towards achieving those goals, and hospitals are fully engaged in that effort. That is why hospitals increasingly are paid not simply to provide services, but by determining that the care they provide produces good outcomes for our patients. And we are in the midst of a transformation where caregivers are increasingly working to keep patients healthy so that they do not need to be in hospitals. What the union proposes runs counter to what healthcare reform is all about in Massachusetts.

On average, 75% of hospital costs are used to pay for those who work in hospitals. The largest portion of hospitals workers are nurses and Massachusetts nurses are the highest paid in the country, except for one state – California. So it's easy to understand that increasing the number of nurses in hospitals without tying such increases to the actual care needs of patients will have serious implication for all the others who work in hospitals. It will even drive up the cost of nurses in non-hospitals settings such as home healthcare and community health centers.

Despite union claims to the contrary, the quality of care in Massachusetts is good. In fact, on the critical measures of Patient Care experience and Mortality measures, Massachusetts out-performs California. If the union's mandated staffing formula could deliver quality care as they claim, then after more than 20 years of experience, California should be leading the entire country in quality care measures – but it isn't.

Is there more we can do? Absolutely. That is why MHA and ONL have filed legislation to increase transparency about not only staffing, but also patient outcomes. And because research shows that nursing education is a critical component in improving care, the legislation promotes an increase in the number of registered nurses with 4-year college education. This legislation focuses on the needs of patients and respects the professional status of nurses. It’s the right focus.

So we're achieving a great deal with more to do. And there are different ways to achieve improvement. But the evidence is clear that government – as opposed to nurses and doctors by the bedside - making staffing decisions is not an answer, it's a problem.

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