Governor Charlie Baker last Tuesday unveiled HB4033, “An Act Relative to Combatting Addiction, Accessing Treatment, Reducing Prescriptions, and Enhancing Prevention (CARE Act)” – his second major bill since taking office that addresses the opioid crisis.

Last Thursday, the MHA Board of Trustees, after being briefed on the bill from MHA staff, voted unanimously to support the legislation. In particular, the board offered praise for the provisions of the governor’s proposal that would increase access to treatment for substance use disorder, create additional tools to prevent opioid misuse, and expand education and intervention efforts. They asked MHA staff to work with the administration and legislature to implement the provisions in an effective manner.

MHA President & CEO Steve Walsh said, “We commend Governor Baker for his continued focus on addressing the insidious opioid epidemic in our commonwealth. We're committed to working collaboratively with the Baker Administration and legislature on policy solutions. And the hospital community will continue its many ongoing efforts at the local level to battle against substance use disorder and addiction.”

How do you change the ways hospitals prescribe opioids in an effort to ensure that they are both assisting patients while not contributing to the opioid crisis?  Massachusetts hospitals have helped answer that question with a series of well-thought-out and comprehensive prescribing guidelines that a special MHA Task Force created and that hospitals across the state have agreed to adopt.

The work of MHA’s Substance Use Disorder Prevention and Treatment Task Force is detailed at this webpage on Patient CareLink. That work has garnered national attention, and last week MHA’s V.P. of Clinical Affairs Pat Noga, R.N., FAAN, and V.P. of Clinical Integration Steven Defossez, M.D. were invited by the Texas Hospital Association (THA) to attend a work session as THA began to draft its own guidelines.

After a presentation detailing the long process MHA undertook to draft and get consensus on the guidelines, Noga and Defossez participated in worktable sessions with Texas hospital personnel to help draft guidance language.

 A study released last week in JAMA Cardiology confirmed what many previous studies have proposed: for certain conditions there may be unintended consequences associated with the effort to reduce readmissions – namely, increased mortality. 

The article – Association of the Hospital Readmissions Reduction Program Implementation With Readmission and Mortality Outcomes in Heart Failure – based its findings on a study group of more than 115,0000 patients at 416 U.S. hospitals participating in the American Heart Association Get With The Guidelines Heart Failure registry.

Among fee-for-service Medicare beneficiaries discharged after heart failure hospitalizations, implementation of the federal Hospital Readmissions Reduction Program (HRRP) was associated with a reduction in 30-day and 1-year readmissions, but an increase in 30-day and 1-year patient mortality, according to the study.

“These findings raise concerns that the HRRP, while achieving desired reductions in readmissions, may have incentivized hospitals in a way that has compromised the survival of patients with [heart failure],” the authors wrote.

The authors asked if the high financial penalties associated with readmissions caused hospitals to focus more on observation stays or shifting inpatient-type care to emergency departments.  The readmission penalties have been shown in numerous studies to unfairly target disproportionate share hospitals and academic medical centers “where higher readmission rates in these hospitals are associated with the higher case-mix complexity and lower socioeconomic status.”  If these hospitals are penalized financially, they find it harder to care for more vulnerable and sicker populations, the researchers said. In a secondary analysis, the authors “observed a trend toward increasing the use of home and inpatient hospice” in the readmission penalty program phase compared to the pre-implementation phase.

The authors didn’t form a definitive conclusion about why heart failure mortality may increase while readmissions decrease, but said their study shows that the Hospital Readmissions Reduction Program as it relates to heart failure patients “may require reconsideration.”

The Massachusetts State Senate recently passed a sweeping healthcare reform bill that contains a series of aggressive readmissions reduction goals and harsh penalties for not meeting the benchmarks.  While Massachusetts has a higher-than-national average in hospital readmissions, the state’s heart failure mortality rate is the second lowest  in the U.S., according to the federal government’s influential Hospital Compare website.

The Massachusetts House and Senate last Tuesday both passed the ACCESS bill that guarantees women access to preventive healthcare, including contraception coverage, without co-pays. The bill now awaits Governor Baker’s signature.

Efforts at the federal level to limit access to contraceptives spurred action on the bill at the state level. MHA was a supporter of the legislation, offering testimony earlier this year that stated: “With the implementation of the Affordable Care Act (ACA), American women have experienced the single biggest advancement in healthcare access in a generation. Right now, more than 55 million women in the United States, including 1.4 million women in Massachusetts, have access to preventive services with zero cost sharing. This vital access is under serious threat on the federal level. [The state bill] would protect and expand access to contraceptives by requiring insurers in Massachusetts to cover all FDA-approved contraceptive methods without cost-sharing, including coverage of over-the-counter contraceptives without a prescription.”

The Massachusetts Health Leadership College – a partnership between MHA, Phillips, DiPisa & Associates, and the Center for Creative Leadership – graduated its class of 2017 on November 16. The class included healthcare leaders from hospitals around the commonwealth from a wide range of service areas and administration. Graduation speaker Karen Mattie, a member of the class, commented on the high value of the learning and coaching the Leadership College provided, and emphasized the lifelong relationships participants have forged.

The graduates are: Katharine A. Eshghi, Esq., SVP, general counsel, UMass Memorial Health Care; Justine DeFronzo, RN, associate chief nursing officer, Emerson Hospital; Tina M. Griffin, DNP, FNP, V.P., patient care services & CNO, Athol Hospital;  Brian Patel, M.D., chief, Emergency Services, Sturdy Memorial Hospital; Sabrina M. Granville, SVP HR, Circle Health and CHRO, Wellforce; Thomas Kesman, MD, orthopedic surgeon, Reliant Medical Group; Joanne C. Doherty, associate VP, human resources, UMass Memorial Medical Center;  Steven M. Defossez, MD, V.P., clinical integration, MHA; Karen Mattie, dir., rehabilitation services, Boston Medical Center; Bill Morley, Faculty Center for Creative Leadership; Camille Preston, Faculty Center for Creative Leadership; Margaret Foley, RN, director, Care Management, Emerson Hospital; Michelle C. Corrado, PharmD, FACHE, chief pharmacy officer, Hallmark Health.

The U.S. House passed a $1.5 trillion tax cut bill last Thursday while the U.S. Senate continued work on its own tax cut proposal.  The largest difference between the two bills (at least form a healthcare point of view) is that the Senate indicated it would include a provision to eliminate the Affordable Care Act’s individual mandate – that is, the requirement that individuals purchase insurance or face tax penalties. The mandate is considered a central pillar of the ACA.  The House bill that passed without any Democratic votes does not contain any such ACA-hobbling provision.

The American Hospital Association, American Medical Association, America’s Health Insurance Plans, American Academy of Family Physicians, Blue Cross Blue Shield Association, and Federation of American Hospitals all signed a letter to Congressional leadership last Tuesday decrying efforts to scuttle the individual mandate.

They wrote, “Under current law, the individual mandate is one of the primary incentives for individuals to enroll in coverage. Eliminating the individual mandate by itself likely will result in a significant increase in premiums, which would in turn substantially increase the number of uninsured Americans.”

Last week President Trump announced the nomination of Alex Azar to the position of Secretary of the U.S. Department of Health and Human Services (HHS), selecting a person with considerable experience in both government and the health sector. Azar is currently the president and founder of Seraphim Strategies, an Indiana-based consulting firm focused on drug and insurance issues. Previously, he served as president of pharmaceutical giant Eli Lilly. During the George W. Bush Administration, he was HHS general counsel and then deputy secretary.  An attorney, Azar was also a partner with the law firm Wiley Rein LLP.  As an attorney, Bush Administration official, and then Lilly executive, Azar has a considerable written record on his views and advocacy, including his opposition to the Affordable Care Act. His defense of drug price increases is expected to capture considerable attention as he begins his Senate confirmation process over the next few months.

Congratulations to Rana Awdish, M.D., the recipient of the 2017 National Compassionate Caregiver of the Year presented by the Schwartz Center at its annual dinner November 16. Dr. Awdish is a critical care medicine physician and director of the Pulmonary Hypertension Program at Henry Ford Hospital in Detroit, Michigan.  She has written and spoken nationally about her experiences as a patient in her own institution when she suffered a serious illness, and has used her perspective as a patient and physician to address gaps in patient-caregiver relationship.

Two students at UMass Amherst have been diagnosed with invasive meningococcal disease serogroup B within the past few weeks. DPH put out an advisory last week noting that while the risk of invasive meningococcal disease in any single university student is very low  and that a connection is clear between the two cases, providers nonetheless should be on the alert for any such cases – especially form the UMass Amherst population. Immediately report all suspect cases of meningococcal disease to the DPH at (617) 983-6800. Suspect cases in Boston should be reported to the Boston Public Health Commission at (617) 534-5611.  The additional vigilance is needed as students are leaving campus for the Thanksgiving break.

MHA's 51st Annual Mid-Winter Leadership Forum

Friday, January 26, 2018; 9 a.m. to 2:45 p.m.
Sheraton Framingham Hotel

Don't miss MHA's most informative leadership meeting of the year, which this year features:

Healthcare's Hottest Topics: A panel discussion moderated by MHA's President & CEO Steve Walsh will take a deep dive into payment reform, the opioid crisis, and the many other challenges facing hospitals and the healthcare system.

Telemedicine: Healthcare's Biggest Game Changer? We'll look at how the regulatory climate is warming up to telemedicine and the affect it is already having in helping to transform and improve care.

Washington Update:  Jim Braude, host of WGBH’s Greater Boston and special invited guest John King, anchor and chief correspondent at CNN, will provide a lively discussion on the latest political developments.

A full agenda is coming soon, but click here now to register.