New Opioid Management Policy

MHA Task Force Issues Opioid Policy for All EDs

MHA’s Substance Abuse Prevention and Treatment Task Force on Thursday issued a nine-point, provider-developed guidance document that hospital emergency departments (EDs) can adopt to help address the misuse of opioid prescriptions. This is phase one of the task force’s three-part effort, which will also include developing prescribing practices within ambulatory care settings and physician practice settings.

The nine principles establish baseline recommendations for opioid screening, prescribing practices, and working with patients prior to prescribing an opioid pain medication in a Massachusetts emergency department.  The policy also recognizes that each patient’s medical condition is unique, so it is not intended to interfere with or supersede the professional medical judgment of a treating clinician.  The Emergency Department Opioid Management guide is below.

There are many reasons why opioid pain medications find their way into society, and one source is prescribing practices within hospitals and other healthcare settings, said MHA’s V.P. of Clinical Affairs and task force Co-Chair Pat Noga, R.N., PhD.  “This new policy strikes a solid balance between recognizing the benefits of appropriate pain management and the potential risks inherent in opioid prescription medications,” she said. “Our efforts today are just one way Massachusetts hospitals and health systems are stepping up to do our part to fight this epidemic, which is claiming and ruining too many lives.”

In creating its ED opioid management policy, the Task Force examined policies and practices adopted in other states, and also considered internal practices developed by hospitals within Massachusetts.

“The tragedy of substance abuse has many root causes, and it will take a comprehensive approach to effectively tackle the situation,” said Lynn Nicholas, FACHE, president & CEO of MHA. “Massachusetts hospitals, health systems and affiliated physician practices have a crucial leadership role to play in helping to find and implement solutions.”

The policy has attracted positive feedback from other provider group and patient advocates, among others. Chris Herren, a former professional basketball player and founder of The Herren Project, which provides treatment navigation, education, and hope to those suffering from addiction, said, “As someone who has seen first-hand how harmful opiate addiction can be, I applaud MHA and the Substance Abuse Prevention and Treatment Task Force for taking on this issue with care, compassion and courage.”

Herren’s interaction with Beth Israel Deaconess Hospital—Plymouth President Peter Holden, the co-chair of the task force, led to Holden’s impetus to initiate an effort with MHA for hospitals to take a leading role in finding a solution to the opiate crisis.

“This policy is our ‘opening salvo’ against the opioid abuse epidemic, the first of many steps our hospitals will take as part of our increasingly active role in the fight against inappropriate access to and misuse of prescription opioid pain medication,” Holden said.

The task force is made up of front-line experts from MHA’s members, including emergency room physicians, pain specialists, and addiction services physicians, among others. For a complete list of Task Force members and online resources, visit MHA’s Substance Abuse Prevention and Treatment Task Force website here.

Will Care Coordination be Hurt by HMO-to-PPO Shift?

A key component of the new, reformed healthcare marketplace involves coordinated care, which could be defined simply as ensuring that a patient’s care – from his or her primary care physician, through the use of specialists, hospitals, post-acute treatment, and even end-of-life care – is all managed cost-efficiently by employing, among other things, electronic health records, good case management, and communication. Even payments from insurers and, increasingly, public health programs, reward coordination.

Now a new report from the state’s Center for Health Information and Analysis (CHIA) raises a caution about the continued success of the current trend. CHIA reports in The Performance of the Massachusetts Health Care System Series: Managed Care Membership in the Massachusetts Market that between 2011 and 2013 more and more Massachusetts residents are moving out of Health Maintenance Organizations (HMOs) and into Preferred Provider Organization (PPOs). Since HMOs are built around networks of providers, they’re an integral part of coordinated care. PPOs allow more flexibility, allowing a patient to go out of network (although the patient may have to pay more to see a non-network provider). Also for the new delivery models to be successful, patients need to be “attributed” or matched with a primary care doctor. While that’s a requirement for HMO members, there is no such requirement for PPO members.

CHIA notes in its report that the HMO-to-PPO shift “may have implications for patient care coordination and for Alternative Payment Methodology adoption in the Commonwealth, as both are associated with HMO products.”

As for why people are shifting, CHIA notes that while not consistent across all insurers and markets, HMO premiums are higher than those of PPOs (although HMO members had, on average, lower cost sharing and higher benefit levels than PPO members). 

President's Budget not Particularly Helpful to Hospitals

On Monday, President Barack Obama released his budget proposal for FY 2016, which includes proposals to reduce healthcare spending by $423.1 billion -- $350 billion of which would come from cuts to providers. Of particular concern is reduction of so-called “market basket updates” for inpatient rehabilitation facilities (IRF), long-term care hospitals (LTCH), and home health agencies by 1.1% points each year 2016-2025. (A market basket is a measure of all the goods and services that a specific organization must purchase to provide care.)

The president also proposes reducing bad debt payment to hospitals; reducing indirect medical education payments by 10% beginning in 2016; reducing payments to critical access hospitals; and, reducing payments to off-campus hospital outpatient departments.

The proposed cuts are very bad news for hospitals that have been constricting themselves at the same time that they are undertaking innovative care delivery models within ever-shrinking operating margins. The good news is that a president’s budget proposal is usually dead on arrival. The House Budget Committee will begin work on its own document soon and while the president’s proposal will not be considered in mass, individual provisions are often adopted in the Congressional blueprints. In the Massachusetts delegation, Rep. Seth Moulton serves on the House Budget Committee.

Have an Idea to Build the Nursing Supply?

Building the nursing supply has always been a prime focus of the Massachusetts hospital community, nurse leaders, and the state’s Department of Higher Education (DHE). Over the past several years, MHA, DHE, and the Organization of Nurse Leaders – MA & RI (ONL) have tri-chaired the Massachusetts Nursing and Allied Health Initiative Advisory Committee to advance this goal. Last week, DHE announced a new round of grant funding for programs that focus on seven distinct priority areas.

Proposals to advance the nursing profession must address at least one of the following priorities:

1. Employer best practices that support and encourage nurses to advance their education from associate’s degrees to bachelor of science in nursing (BSN) degrees
2. Replication of a successful LPN to BSN model in another region
3. Increasing the supply of nurses to serve as faculty
4. Implementing a broader and deeper integration of the Nurse of the Future Nursing Core Competencies© across the commonwealth
5. Research that provides a detailed descriptive survey/analysis of the administration and operation of simulation labs by the community of users in nursing education programs (or academic partnerships)
6. An evidenced-based description of what’s on the simulation horizon
7. Nurse residency program
8. Undergraduate clinical preceptorships nursing request for proposals.

Deadline for submission of a proposal is Friday, March 13, by 4 p.m.  And there will be an informational conference call on the process on Thursday, February 12 at 10 a.m. For complete details on the entire process, please visit the DHE website here.

Revenue and "PGSP" Forecasts Made

State leaders have issued a revenue forecast for Fiscal Year 2016, agreeing that the state will bring in $25.479 billion, or 4.8% more than FY2015.

The consensus forecast was made by Secretary of Administration and Finance Kristen Lepore, Senate Ways and Means Chair Karen Spilka (D-Ashland), and House Ways and Means Chair Brian S. Dempsey (D-Haverhill).

The Department of Revenue and private groups, such as the Massachusetts Taxpayers Foundation, all historically make estimates that are reviewed by the three leaders, who then reach consensus on a number. The administration and the legislature then use the number to help craft their versions of the state budget.

Also agreed to was the state’s potential gross state product (PGSP) growth benchmark for calendar year 2016. The payment-and-delivery-system reform law, Chapter 224, requires the three leaders to develop a PGSP, which the Health Policy Commission then uses to set the state’s healthcare cost growth benchmark.

The 2016 PGSP is 3.6% – the same as it was for 2015. Chapter 224 specifies that through 2017 the healthcare cost growth benchmark will be the same as the PGSP. After that, the healthcare cost growth benchmark can be as much as 0.5% below the PGSP. 

MHA Begins Workforce Programs in Spring

MHA begins Workforce Transformation Grant training programs this spring, focusing on training in two areas: motivational interviewing and teamwork. Ideal participants for the motivational interviewing training are frontline staff member that directly interact with patients – including physicians, advanced practitioners, registered nurses, licensed social workers, and medical assistants that are looking to advance their motivational interviewing skill set. The team training is a “TeamSTEPPS Master Training Course” that equips patient safety leaders with the skills to develop, implement, evaluate, and sustain team training programs in their facilities. Developed by the Agency for Healthcare Research and Quality and the Department of Defense Patient Safety Program, TeamSTEPPS has rapidly become the industry standard for teamwork training. Anyone interested in more information on either or both of these trainings can contact MHA’s Education Department Associate Stacey Higgins at shiggins@mhalink.org.

New Phone Tool for Fighting the Flu

In the middle of flu season, hospitals and physicians are bombarded with phone calls from patients seeking help. Now the CDC’s National Center for Immunization and Respiratory Diseases has come up with this handy flow chart that helps medical office workers determine if the patient should come in for a visit, or if they first should be advised to try an antiviral treatment.  DPH’s weekly flu report shows that influenza in the Bay State continued to rise steeply throughout January.

Transitions at Partners and Hallmark

Dr. David Torchiana is the new president & CEO at Partners HealthCare, effective in March. Torchiana succeeds Dr. Gary Gottlieb, who has led Partners since 2010 and who announced last year that he is stepping down to lead Partners In Health, the non-profit that provides care in impoverished countries (and which is not affiliated with the health system he led).  Torchiana currently serves as chairman and CEO of the Massachusetts General Physicians Organization – the largest physician group practice in New England with more than 2,000 doctors. Among his achievements, he is credited with having led Massachusetts General Hospital’s Care Management Program, which Partners says serves as the cornerstone of its population health management initiative. Torchiana graduated from Yale in 1976 and Harvard Medical School in 1981. He became chief of cardiac surgery at MGH in 1998 and CEO of MGPO in 2003.  The Chairman of the Partners HealthCare Board of Directors, Edward Lawrence, said of the appointment, “During times of uncertainty in the healthcare environment, Dr. Torchiana will be a leader who provides stability and lends a voice of assurance that Partners HealthCare wants to help address the challenges and be part of a solution.”

Michael Sack, FACHE, president and CEO of Hallmark Health System – the parent of Lawrence Memorial Hospital of Medford and Melrose Wakefield Hospital – announced last Monday that he intends to retire by the end of February. Sack has led Hallmark for 12 years. Hallmark’s Executive V.P. for Strategy and External Affairs and past Board Chairman Alan Macdonald has been named interim CEO while the system conducts a search for a new leader. Sack is currently in the middle of his one-year chairmanship of the MHA Board of Trustees, a position that he will relinquish upon retirement. Peter Holden, president & CEO, Beth Israel Deaconess Hospital-Plymouth, and the MHA Board’s current vice-chair, will become chair upon Sack’s retirement.  James Herrington, chair of Hallmark Health System’s Board of Trustees, thanked Sack for his service and said, “He has ably led Hallmark Health through a period of tremendous and fundamental change, and his skills, experience and wisdom will be missed.” 

Planning and Budgeting for Department Managers
Friday, March 13, 2013
9 A.M. - 12:30 P.M. 
MHA Conference Center at Executive Park,  Burlington, Mass.

Place story copy here.

John LoDico, Editor