Latest GOP Bill: Still Slashes Medicaid, and more...

Latest GOP Bill: Still Slashes Medicaid, Now Increases Insurer Risk

The latest version of the Republican healthcare reform bill that the U.S. Senate leadership released on Thursday would still drastically cut federal Medicaid funding to Massachusetts and lower the insurance subsidies for those residents purchasing insurance in the state’s insurance exchange, resulting in more people in the state becoming uninsured. The new version of the Better Care Reconciliation Act (BCRA) also contains a new provision allowing health insurance companies to offer stripped-down policies that do not have to meet current Affordable Care Act guidelines. Such policies, the insurance industry itself claims, will destabilize the market by separating healthy and sick customers into separate pools, thereby increasing risk, and generally making it difficult for people with preexisting conditions to get affordable coverage.

Even as the healthcare community reacted to the BCRA – MHA called it a “travesty masquerading as healthcare policy”; the AHA “unacceptably flawed” and America's Essential Hospitals a “token effort” to placate the previous version’s numerous critics – Senate leadership vowed to bring the measure to a vote next week. The CBO is expected to release its score on the new proposal on Monday; the big question is whether the GOP redraft will cause the CBO to revise its estimate of 20-million-plus people losing coverage that it estimated would occur under BCRA 1.0.

“Nothing in the revised GOP healthcare bill released today would be an improvement over current law for either our patients or our hospitals, and, in fact, in nearly every instance the proposal would leave patients and healthcare providers much worse off,” said Mike Sroczynski, MHA’s V.P. of Government Advocacy. “The GOP’s latest attempt to repeal and replace the Affordable Care Act does not improve access to care, it does not improve quality of care, it does not  increase resources to provide care, and it does not lower the cost of care for those most in need. MHA and our members are opposed to this travesty masquerading as healthcare policy.”

Tufts Medical Center Says No to MNA’s Unreasonable Demands

Union nurses at Tufts Medical Center left their patients’ bedsides on Wednesday to strike after negotiations broke down over how the nurses’ retirement packages would be structured.

Although the Massachusetts Nurses Association (MNA) called it a 24-hour strike and made a show of attempting to return the work on Thursday, the ruse was generally recognized to be a mere publicity stunt. As the hospital had announced previously to the public and nurses in numerous forums, any replacement nurses must be hired for a minimum number of days and that any attempt by the MNA nurses to return to work after one day of striking was not practical.

In a staged “encounter” at the hospital on Thursday, the nurses claimed they were being “locked out.” TMC officials repeated what they had said all along – the nurses could return on Monday.

“The MNA’s own documents reveal that the union deliberately timed the strike to be ‘most harmful to the hospital,’ which is completely irresponsible,” said MHA’s President & CEO Lynn Nicholas, FACHE. “The targeted action will ultimately harm the nurses themselves and cost millions that will be drawn from the funding the hospital had available for nurses' wage increases.”

According to statements from both sides, the issue that led to the strike was not about staffing or the generous pay package Tufts MC offered, but rather about the nurses’ pension plan. The hospital – like most private sector employers – wanted to move the nurses from their current defined-benefit pension plan to a defined-contribution plan similar to the common 401(k). The MNA, on the other hand, wants to move its pension plan and its inherent risks to a plan shared by New York sanitation workers and a for-profit hospital group. That pension fund is run by the International Brotherhood of Teamsters.

“Tufts Medical Center has been both responsible and responsive in these negotiations,” MHA’s Nicholas said. “The hospital contracted and trained replacement nurses to ensure that even with the union’s efforts to damage the hospital and disrupt patient care, Tufts Medical Center will continue its mission uninterrupted, and patient care will remain at the center of everything they do. By continuing a hostile approach to interactions with Tufts Medical Center and other hospitals that employ its nurses, the MNA union leadership has shown in very concrete actions that they are not only willing but eager to put themselves before patients.”

Mega Deal: BIDMC, Lahey, Mount Auburn, Anna Jacques, The Baptist

The deal that had been announced early this year and discussed since then has finally been signed – Beth Israel Deaconess Medical Center and Lahey Health, along with New England Baptist Hospital, Mount Auburn Hospital, and Anna Jacques Hospital this week inked a formal agreement to create a new healthcare system.

The deal now faces extensive scrutiny from federal and state authorities. If ultimately approved, the new system would contain the following hospitals: Lahey Health Systems’ Lahey Hospital and Medical Center, Lahey Medical Center-Peabody, Beverly Hospital, Addison Gilbert Hospital, BayRidge Hospital, and Winchester Hospitals; BIDMC’s BID Medical Center, BID-Milton, BID-Needham, and BID-Plymouth; plus Anna Jacques Hospital, Mount Auburn Hospital, and New England Baptist Hospital.

Dr. Kevin Tabb, the current CEO of the Beth Israel Deaconess system, would become the CEO of the new, as yet unnamed, system. The hospitals within that system would retain their names and licenses and maintain their own boards but would be under the governance of the new system board. The new system would be the second largest in the state after Partners HealthCare.

Groups Call for a Closer Focus on Pharmaceuticals

First a quick refresher: when the state released information earlier this year about how all the parts of the Massachusetts healthcare system are meeting the state’s healthcare cost growth benchmark of 3.6%, a few points became very clear: first, the rates of growth for hospital inpatient (2.2%) hospital outpatient (2.9%) and physician services (1.9%) all fell well below the 3.6% benchmark.  And second, the factor that has consistently exceeded the benchmark, causing the state’s entire healthcare system to miss the mark, has been pharmacy spending. Pharmacy spending accounted for a full one-third of overall growth in the state’s total health care expenditures.

This past week, a broad coalition of organizations, including MHA, and those representing  employers, health plans, and physicians called for passage of legislation (House Bill 3223 and Senate Bill 627) to promote transparency in prescription drug prices.

Specifically, the bills (filed by Representative Christine Barber (D-Somerville) and Senator Linda Dorcena Forry (D-Dorchester)) would direct the Health Policy Commission to identify up to 15 prescription drugs whose prices increased by 15% or more over the last 12 months, 50% or more over the last five years, or a new drug whose price may have had a significant effect on the state's cost benchmark. Additionally, drug manufacturers that propose to increase their prices by 10% or more would be required to notify the HPC 30 days before the increase takes effect, and pharmaceutical and biotech companies would be required to testify under oath as part of the HPC's annual healthcare cost trends hearings.

"In Massachusetts, hospitals have been joined by the entire healthcare community in the effort to contain costs and advance access to safe, accessible and efficient care for all," said Lynn Nicholas, President and CEO of the Massachusetts Health & Hospital Association. "In order for the Commonwealth's reform initiatives to succeed, all stakeholders must work cooperatively. As rising pharmaceutical costs are a key driver of overall increases in health care spending, pharmaceutical companies need to be included in the conversation."

Organizations supporting the bills include: MHA, Massachusetts Medical Society, National Federation of Independent Business, North Shore Chamber of Commerce, Massachusetts Association of Health Plans, and Springfield Regional Chamber.

CMS’ Proposed 340B Drug Rule Will Harm Low-Income Patients

CMS is proposing massive changes to the 340B drug program that will make prescription drugs more expensive to low-income patients and the safety-net hospitals that serve them.

The Trump Administration’s proposal, contained in the proposed outpatient prospective payment system rule released on Thursday, proposes to pay for affected drugs (other than vaccines) purchased through the 340B program at the average sales price (ASP) minus 22.5%, rather than ASP plus 6%. The 340B program only involves certain hospitals serving disadvantaged populations: disproportionate share hospitals (DSHs), children’s hospitals and cancer hospitals exempt from the Medicare prospective payment system, sole community hospitals, rural referral centers, and critical access hospitals.

“It is unclear why the Administration would choose to punitively target 340B safety-net hospitals serving vulnerable patients, including those in rural areas, rather than addressing the real issue: the skyrocketing cost of pharmaceuticals,” American Hospital Association EVP Tom Nickels said on Thursday. “CMS repeatedly cites the fact that Medicare expenditures on drugs are rising due to higher drug prices as an impetus for its proposal....Yet, its proposed 340B policy change does nothing to directly tackle this issue.”

The 340B program has garnered bipartisan support since its creation in the early 1990s, but has been criticized by the pharmaceutical industry, which has generally enjoyed steadily increasing profits over the same time.

"The patients who benefit from the much-needed 340B program are the ones who will have their access to care threatened,” AHA’s Nickels said.

QUALITY CORNER: BID–Needham Creating a Hospital Culture of Safety

In 2013, during a period of significant institutional growth, Beth Israel Deaconess Hospital–Needham (BID–Needham) began an organization-wide effort to enhance its commitment to patient safety, employee engagement, and patient and staff satisfaction.

As a result if its efforts, BID-Needham’s scores on the AHRQ Culture of Safety Survey rose to the 98th percentile rank within one year of implementation and have been sustained since then, with the hospital’s 2016 survey scores remaining in the 96th percentile. This effort was led by the hospital’s executive leadership team with the engagement and full support of the board of directors.

For its efforts, BID–Needham was the winning entry in the “Enhancing Culture and Leadership” category of the 2017 MHA Compass Awards. Entries in each of the six Compass Award categories were voted on by non-Massachusetts judges from across the U.S., who assessed the entries “blind” – meaning there were no details to identify the hospital competing.

Since 2010, BID–Needham has conducted, through an approved vendor, the Culture of Safety survey. In 2013, the hospital set out to  evaluate the hospital’s culture and the physicians’ and employees’ feelings about workplace satisfaction. Over the next year, a comprehensive evaluation of existing processes, procedures and behaviors was conducted throughout the hospital with a message to all staff and physicians of a renewed commitment to patient safety and staff engagement to find solutions.

Following the broad assessment, a hospital initiative entitled “Drive” was developed in partnership with leadership and direct line staff members. Drive focused on leadership development and accountability, employee engagement, and improving the patient experience. As part of the cultural transformation process, goals included increasing transparency and consistency of communication, creating a just and learning culture and encouraging confidence in the safety event reporting system and follow-up. Multi-disciplinary workgroups were implemented and included leadership and direct care givers. Commitment to patient safety was always central to the goals.

Since implementing the initiative BID–Needham has seen sustainment of staff confidence in the safety culture as well as improved job satisfaction. Additionally, because of the improved transparency of communication and teamwork, the hospital is able to respond more quickly and be proactive when it identifies potential problems via monthly quality surveillance (e.g., fall prevention, skin integrity, and medication events). Patient satisfaction, through HCAHPS scores, has seen consistent improvement.

Asked in the Compass Award application to list the three lessons learned, BID–Needham wrote: 1) Leadership and Board support are essential for driving transformational changes; 2) Staff engagement and partnership with leadership is essential to driving sustainable change; and 3) Transformational change occurs with commitment and organizational purpose.

Telemedicine Coalition Expands; Hearing on Bill Set for Tuesday

The Joint Committee on Financial Services, chaired by Rep. Aaron Michlewitz (D-Boston) and Sen. Jamie Eldridge (D-Acton), will hold a hearing on HB578/SB549, An Act Advancing and Expanding Access to Telemedicine Services, on Tuesday. The legislation ensures parity in insurance coverage for telemedicine services at the same payment rate as in-person treatment; streamlines the credentialing process for Massachusetts licensed clinicians using telemedicine services within the state; and ensures a uniform and consistent approach that fosters innovation when defining telemedicine services.

Telemedicine is the remote diagnosis and treatment of patients through on-line communication. It improves care and makes it more efficient by giving patients more convenient access to primary care providers and greater access to specialists located outside their geographic area. This can be particularly helpful for hard-to-access services such as behavioral health or surgical consults, and for patients with disabilities and mobility limitations, major distance or time barriers, or transportation limitations.

tMed, the Massachusetts Telemedicine Coalition, of which MHA is a founding member, has been growing since its inception in January and now has 28 members. A complete list of the membership as well as a detailed discussion of the bill that will be heard on Tuesday is here.


Dr. Rick Weiner will become CEO of Winchester Hospital, effective October 1, replacing Dale Lodge who is retiring. Weiner will also serve as Winchester’s CMO. He joined the Winchester Hospital medical staff in 1987, and currently serves as V.P. of Medical Affairs for Winchester Hospital. Weiner received his medical degree from the University of California at Irvine and completed his general surgery residency at Tufts Medical Center, followed by a fellowship in vascular surgery at Lahey Hospital & Medical Center. He has served as chair of MHA’s Physician Leadership Council. Also, Kathy Schuler, R.N., will assume the dual role of COO and CNO at Winchester. She currently serves as CNO and V.P. of Patient Care Services.  Winchester Hospital is part of the Lahey Health system.

Pediatric Case Management Conference
Care Across the Continuum:
Managing the Patient, Plan, and Payer

Monday & Tuesday, Oct. 16-17; 9 a.m. to 4 p.m.
MHA Conference Center, Burlington, Mass.

Working with pediatrics requires very strategic case management to ensure the best care. This comprehensive program is designed to turn pediatric case management challenges into strategies and real-time solutions. We’ll focus on managing pediatric care transitions while also teaching practitioners how to keep an eye on important aspects of the revenue cycle. This exciting 2-day program will take a deep dive with experts and leaders in the field and practitioners who are working on innovative solutions to ensure the best and most efficient care for these vulnerable populations. We encourage you to bring a team from your organization to learn the current best practices to take back and use with your pediatric cases.  Learn about full program details, costs, and registration information here.

John LoDico, Editor