04.11.2016

Safety net eligibility rules delayed but concerns remain, and more...

Safety net eligibility rules delayed but concerns remain

The effective date for a series of rule changes that the state proposed to determine who is eligible for services from the Health Safety Net (HSN) has been delayed from April 1 to June 1. MHA, its member hospitals, and many other groups had strongly objected to the changes. The Health Safety Net helps to finance care provided to Massachusetts low-income residents who are uninsured or underinsured.

One proposed change to the eligibility rules includes altering the retroactive date of coverage. Currently, many patients who get coverage under the Health Safety Net are covered for six months retroactive from their application. The Executive Office of Health and Human Services (EOHHS) plans to change that to only 10 days retroactive coverage. The concern among hospitals caring for the uninsured and underinsured is that patients don’t always apply for coverage at the time they receive care and only realize they need financial assistance after they receive a bill. Other changes to the eligibility rules include a new deductible for those earning between 100% and 150% of the federal poverty level (FPL) and the elimination of partial HSN coverage for those earning between 300% and 400% FPL.

MHA testified in strong opposition to the proposed changes, all of which will become effective June 1 unless further action is taken. In a letter to EOHHS, MHA wrote, “Unfortunately, the proposed regulatory changes weaken that safety net and, as a result, shift costs to low-income patients and hospitals. These cost-shifts are also likely to affect commercial payers and the business community in some degree in the form of higher premiums.”  In March, many legislators led by Sens. Jason Lewis (D-Winchester) and John Keenan (D-Quincy) also weighed in and sent a letter to EOHHS, decrying the HSN changes and stating, “The erosion of HSN eligibility will be an impediment to necessary medical care for residents and lead to consumer medical debt and bad debt at hospitals and health centers.”

In addition to the two-month delay in the implementation of the controversial changes, EOHHS also announced that it would introduce a new eligibility policy that had not been proposed previously.  The policy called “presumptive eligibility” would permit hospitals and community health centers to use a simplified application for determining patients eligible for the Health Safety Net temporarily instead of the full application that is used for all state programs, including MassHealth and ConnectorCare.  MHA has concerns with the proposal and urged EOHHS to not adopt it at this time.

“We appreciate that EOHHS is attempting to address some of our concerns; unfortunately this proposal does not materially address the issues related to retroactive coverage and also raises significant program integrity questions,” said MHA’s Dan McHale. “Hospitals seek to first determine if uninsured applicants are eligible for MassHealth and other state healthcare programs. Caution in changing this practice is needed.”

In a related note, there has been no resolution yet to the funding reduction of the Health Safety Net. Governor Baker’s FY2017 budget proposal eliminates the state’s customary $30 million contribution to the HSN, which affects the program in FY2016.  This reduction results in a cost shift to hospitals, as any funding shortfall is paid for solely by hospitals in addition to the $165 million tax on hospitals. The current shortfall is estimated at $90 million. 

Advocacy continues on hospital tax fixes

Last week, hospitals continued to educate legislators about their concerns with Gov. Charlie Baker’s new $250 million tax on hospitals. As part of the effort, MHA delivered to all state representatives and state senators a one-page overview (see below) of the governor’s tax proposal and the modifications needed.  At the direction of its Board of Trustees, MHA has developed language to modify the tax in order to establish needed safeguards and ensure the hospital tax is fully transparent and used for its intended purpose. The modifications sought would establish a defined sunset for the tax that aligns with the 5-year term of the state’s new Medicaid waiver and would ensure that hospitals are made “whole, as a class” on a timely basis every year in line with the stated intent of the governor’s proposal. MHA’s language would not affect the tax rate on hospitals and would not affect the federal waiver revenue opportunity. The one-page overview also points to the importance of mitigating the losses that will be incurred by those hospitals that will be net payers. Without mitigation measures, such hospitals would collectively experience tens of millions of dollars in loses each year the tax is in effect. It is anticipated the House Ways and Means Committee will release its version of the FY2017 state budget on Wednesday. 

MHA supports expanding dental care to underserved

Preventable oral care conditions are driving more people to hospital emergency rooms and driving up healthcare costs, according to a new study from the state’s Health Policy Commission (HPC).

Children and adults covered by MassHealth are six and seven times more likely, respectively, to visit an ED for preventable oral healthcare conditions compared to the rate of their commercially insured counterparts.

And one tenth of the state’s population lives in an area that has a professional shortage of dental care.

The study results were presented at a joint meeting of HPC’s Cost Trends & Market Performance and Quality Improvement & Patient Protection committees on Wednesday.

It has long been established that oral healthcare is a key component of overall health, and that oral infections are a risk factor for heart and lung disease, osteoporosis, low-birthweight, and diabetes.  HPC found that when access to dental care is limited, patients may seek care for preventable oral health conditions in EDs, and the cost to the health system for doing so is four to seven times greater than the cost of going to a dentist office.

MHA supports authorizing the establishment of an Advance Dental Hygiene Practitioners (ADHP) level of practice, and endorses a bill in the state legislature (SB2076) that would do that. SB2076 permits ADHPs, once they have successfully completed additional training, to deliver basic dental care to under-served populations. ADHPs would practice under the general supervision of dentist and take advantage of telehealth technology to share patient records with dentists and consult with them on complicated cases. The intention of the legislation is to bring basic dental care to students in schools, to the elderly in nursing homes, and to low-income patients in community health centers – the very people who are currently underserved across the commonwealth.

Rising healthcare costs? Look at drug price hikes

The Reuters news service published an analysis last week that showed how prices for four of the top 10 prescription drugs in the U.S. increased by more than 100% since 2011 and the six others went up by more than 50%.

“Together, the price increases on drugs for arthritis, high cholesterol, asthma and other common problems added billions in costs for consumers, employers and government health programs,” Reuters reported in the April 5 article.

The arthritis drug Humira (AbbVie, Inc.) led the increase at 126%, followed by arthritis drug Enbrel (Amgen Inc.) and multiple sclerosis drug Copaxone (Teva Pharmaceutical Industries Ltd) at 118%.

In response, the drug companies said discounts and rebates have to be factored into the drugs’ costs.  Pharmacy benefit managers countered that argument, saying that even after discounts they were facing drug price increases of 10% a year.

Making a decision about your care

National Healthcare Decisions Day (April 16) is when a special focus is put on encouraging people, ages 18 and over, to seriously think about what level of life-sustaining care they want or how care should be provided in the event they are no longer able to make decisions for themselves. The theme for 2016 is "It always seems too early, until it’s too late."

Among other things, National Healthcare Decisions Day helps people understand that advance healthcare decision-making includes much more than living wills; it is a process that should focus first on conversation and choosing an agent.

In the commonwealth, one organization that can serve as a resource is Honoring Choices Massachusetts, which provides healthcare information and planning documents and tools that helps people ensure that their healthcare choices are understood and honored throughout their lives. MHA is a collaborating partner of Honoring Choices Massachusetts.  Honoring choices Massachusetts is devoting the entire week (April 11 to 16) to educating the public and providers about the importance of advance planning.

A good place to start to make a plan is by appointing an Agent in a Health Care Proxy and giving your Agent information about the kind of care you want in a Personal Directive. Honoring Choices Massachusetts lays out the entire process on its informative webpage.

MHA sets May 16 for major equity of care program

In November 2015, MHA’s Board of trustees signed on to AHA’s Equity of Care Campaign – a national effort to eliminate healthcare disparities.  Massachusetts hospitals that signed on to the #123forEquity pledge are recognized on this website.

Now MHA -- with the support of the HRET and MA Hospital Engagement Network -- has scheduled a full-day conference on the equity of care issue on Monday, May 16 at MHA’s Conference Center in Burlington.

Featured speakers include Tomas Leon, president and CEO, Institute for Diversity of the American Hospital Association; Kinneil Coltman, director of Diversity and Language Services, 21st Century Healthcare; and Peggy Harris, FACHE, assistant VP, Diversity & Inclusion, Carolinas HealthCare System.

Please register for this important conference by using the form below.

Kindred sells off its Mass. hospitals

Kentucky-based Kindred Healthcare announced on Tuesday that it would sell to Curahealth LLC 12 of its long-term acute care hospitals, including three in Massachusetts: Kindred Hospital Boston, Kindred Hospital Boston North Shore (Peabody), and Kindred Hospital Northeast – Stoughton.  The selling price for all 12 hospitals was $27.5 million.

In memoriam - Dr. Suzanne Wedel

The Massachusetts healthcare community lost a remarkable member with the passing on March 31 of Dr. Suzanne Wedel, the CEO of Boston MedFlight for nearly 27 years.  Dr. Wedel was only 60 years old when she died of ovarian cancer.  She is remembered not only as a compassionate caregiver who was committed to the thousands of patients Boston MedFlight served each year, but also as someone who possessed a savvy business sense to keep the non-profit running.  MHA President & CEO Lynn Nicholas said Dr. Wedel was a person whose job demanded that she be well connected and well respected by each of the hospitals and institutions with which she dealt. The fact that she was so well liked, as well, makes her passing especially sad, Nicholas said.  Donations in her memory may be made to the Suzanne Wedel XOXOUT Ovarian Cancer Fund or to Boston MedFlight.

2016 lean in healthcare certificate program at Franciscan hospital for children

STARTING: FRIDAY, APRIL 29 (8 SESSIONS TOTAL); 8:30 A.M. - 4:30 P.M.
FRANCISCAN HOSPITAL FOR CHILDREN, BRIGHTON, MASS.

In this program, participants will learn the fundamentals of continuous improvement in a classroom setting. They will then work in teams to apply the principles and tools of continuous improvement in an actual healthcare process at Franciscan Hospital for Children in Brighton. Each day participants will be introduced to appropriate best practices to address the challenges facing healthcare professionals. This learn-by-doing method will prepare students to return to their own workplaces with the confidence to implement continuous improvement methodologies.

This essential program was developed to provide the healthcare professional with the knowledge and experience needed to effect positive change within their own organizations. Participants will learn the critical step which they can take to assure dramatic, continuing improvements. The program will be held Franciscan Hospital for Children in Brighton so that a combination of classroom and hands-on learning can take place.

John LoDico, Editor