DeLeo and Trump on Health, Plus Medicare Cuts?, and more...

DeLeo Cites Hospital Excellence, Promises New Reform Bill

As has been his tradition during his tenure as Massachusetts House Speaker, last week Robert DeLeo laid out priorities for the new legislative year, including a vow to take up healthcare reform “in the coming months.”

“We have much to be proud of – near universal insurance coverage, the best hospitals in the world, and a slower cost growth than the rest of the country,” DeLeo said. “But we must always remain vigilant, especially as the healthcare landscape continues to change dramatically.”

He said the House’s reform legislation will “maximize the impact of our existing infrastructure and will include new strategies to bring down costs, improve quality and enhance access.”

Specific strategies he mentioned include:
“Supporting our community hospitals and community health centers. These institutions are both economic engines and safety nets within our districts. Shielding patients from bearing the burden of rising healthcare costs and ensuring that they have all the information necessary to make informed decisions. Empowering businesses by giving them an expanded toolbox. Increasing pharmaceutical spending transparency while cultivating our reputation as an international leader in research and innovation.”

DeLeo also said it is an “equally vital time for addressing mental health,” adding, “I am currently working with the Chairs of Education and Mental Health, as well as the Child Advocate, to coordinate efforts as we again prioritize children’s long-term social, emotional and academic success by investing in early childhood mental health services.”

The life sciences sector, in which Massachusetts hospitals play an important role, will receive “financial support” this session, DeLeo said, adding that the state investment is needed to maintain the commonwealth’s competitive edge.

One of Many SOTU Promises: Lowering Rx Prices

Presidential State of the Union addresses have historically been long on spectacle and applause lines and short on specifics, and last Tuesday’s address by President Donald Trump was no different. As has been the case with previous State of the Unions, the speech was both lambasted and lauded, as well as combed through by interest groups to gauge a president’s thinking on their key issues. A big healthcare takeaway was the statement by President Trump that, “One of my greatest priorities is to reduce the price of prescription drugs.” He said, “In many other countries, these drugs cost far less than what we pay in the United States. And it’s very, very unfair. That is why I have directed my administration to make fixing the injustice of high drug prices one of my top priorities for the year. And prices will come down substantially. Watch.”

In Massachusetts, the Center for Health Information & Analysis (CHIA) identified prescription drug costs as the leading driver of healthcare cost growth in the state. In its 2017 Annual Report on the Performance of the Massachusetts Health Care System, CHIA noted that from 2015 to 2016, healthcare expenditures in Massachusetts increased by $1.9 billion. Payments to pharmacies for prescription drugs increased by $547.6 million, or 6.4%, from 2015. This increase accounted for 27.5% of overall medical expenditure growth, the highest of any service category.  More recent figures will be released by the state in March.

U.S. Rep. Joe Kennedy III (D-Mass.) delivered the Democratic response to the president’s speech. Speaking from Fall River, Kennedy decried the divisive nature of the current political culture, saying, “They are turning American life into a zero-sum game ... where we can guarantee America’s safety if we slash our safety net. [Where] we can extend healthcare to Mississippi if we gut it in Massachusetts.” Kennedy added, “We choose a better deal for all who call this country home ... We choose a healthcare system that offers mercy, whether you suffer from cancer or depression or addiction.”

While Congress Delays, Medicare Moves Forward on Therapy Caps

Physical, speech, and occupational therapists were discouraged last week when CMS posted a statement saying that it would begin the process to implement the statutorily required therapy cap – a requirement from the 1997 Balanced Budget Act that Congress has since prevented from being implemented through a series of short-term delays.

The most recent Congressional exception to the Medicare therapy cap expired on December 31, 2017. If implemented, the cap in 2018 would apply when expenses for Medicare patients in physician, speech, and occupational therapy reach $2,010. 

The therapy cap exception is one of several “Medicare extenders” that have often been extended for one and two years; these extenders are under consideration to be included in the larger federal spending bill for the remainder of FY2018, which must be addressed by February 8 (see story below). Prospects for a permanent repeal of therapy caps looked promising late last year when the House included a permanent repeal in the Medicare extenders package that the House Ways and Means Committee approved. But as other issues dominated Congressional attention, the extender package along with therapy caps failed to garner the urgency needed for action. 

The CMS notice did provide some breathing room by stating that starting January 31, CMS will begin to release therapy claims under a “rolling hold” for 20 days to help minimize the number of claims requiring reprocessing if the extenders package, including the therapy caps exception, is passed.  The CMS action brings attention to all the expired Medicare policies included in the extenders package, including payments for Medicare dependent hospitals, low-volume adjustment hospitals, rural ground ambulance add-on, rural home health add-on, among others.

Will the New Spending Bill Once Again Target Medicare?

As Congress works on a federal spending bill for the remainder of 2018, hospitals are concerned that negotiations over how to raise budget caps may result in further Medicare cuts as Congress seeks the funding sources to pay for any new spending.

Ever since the 2013 sequester which set into law across-the-board budget cuts, Congress has agreed on a few occasions to raise the budget caps. Negotiations are now underway to raise the cap once again with Republicans generally calling for more Defense spending and Democrats seeking more domestic, non-defense spending.

Last week, The Coalition to Protect America's Health Care, which MHA supports, said the desire by many in Congress and the Administration to raise the spending caps for some programs, could in turn trigger deep cuts to Medicare payments to hospitals to pay for those increases.  Why is the Coalition concerned? Because using Medicare as a piggybank is a common occurrence in D.C.  Since 2010, federal hospital funding has been cut by $149 billion.

The Coalition this week is running this 30-second TV spot on major cable channels.

Collaborative Magnet Hospitals

It’s not easy getting “Magnet” designation from the American Nurses Credentialing Center (ANCC).

Hospitals that fulfill the long and demanding process to receive the designation have demonstrated transformational nursing leadership, empowerment of nurses throughout the organization, and exemplary professional practice and collaboration to ensure high-quality patient outcomes.

Magnet hospitals focus on building a collaborative culture among not only the nursing staff, but others in the hospital and even through community outreach.

Last week, Massachusetts General Hospital announced that it earned Magnet designation for the fourth consecutive time. In 2003, Mass General became the first hospital in Massachusetts to earn the four-year designation from the ANCC.

In addition to MGH, current Magnet hospitals in Massachusetts are Baystate Medical Center, Boston Children's Hospital, Dana Farber Cancer Institute, Hallmark Health Lawrence Memorial Hospital and Melrose Wakefield Hospital campuses, Lowell General Hospital, South Shore Hospital, and Winchester Hospital.

Training Potential CEOs: Massachusetts Health Leadership College

Nominations are open for the 2018 Massachusetts Health Leadership College, which provides a remarkably high-level of skill-building and education for hospital and healthcare executives. Over the nine years of its existence, more than 80 fellows have been graduated, many of whom have gone on to become CEOs.

Current research points to a strong need for education programs designed to support the executive development of future Massachusetts healthcare leaders. The Massachusetts Health Leadership College was developed to address that need and represents an innovative approach to assessing and promoting the development of tomorrow’s executive leaders.

To run the program, MHA is partnering with Phillips, DiPisa & Associates, one of New England’s leading executive recruitment firms, and with faculty from the acclaimed Center for Creative Leadership.

Classes for the 2018 Leadership College begin April 13, 2018. Nominations will be accepted based on qualifications and on a first-come, first-served basis. Enrollment is limited to 20, and the deadline for nominations is March 1, 2018. For additional information, please contact Kirsten Singleton, executive director of MHA’s Center for Education & Professional Development, at (781) 262-6053 or ksingleton@mhalink.org.

AHA’s Foster McGaw Nominations Open

The AHA, along with Baxter International Foundation and the Health Research & Educational Trust, is accepting applications through April 6 for the 2018 Foster G. McGaw Prize. The prize honors healthcare organizations that have demonstrated exceptional commitment to community service. Applicants should showcase strong leadership within their community, a commitment to service and care, partnerships that help meet community needs, a breadth and depth of community service initiatives, and a high level of community involvement. The winner will receive a $100,000 prize, and the top three finalists will receive $10,000 each. For more information, visit here.

UMass Memorial Medical Center in Worcester was a McGaw Prize finalist in 2017. Massachusetts General Hospital won the award in 2015 and was a finalist in 2011. Baystate Health was a finalist in 2006, and Cambridge Hospital was the winner in 1993.


Trinity Health of New England has named Dr. Reginald J. Eadie as the system's new president and CEO, effective March 26. Trinity is the parent company of Mercy Medical Center in Springfield. Eadie was most recently SVP and COO for Detroit Medical Center (DMC). He previously was president and CEO at several DMC hospitals. He also served as CMO at Harper University and Hutzel Women's Hospitals in Detroit. Roger Spoelman has served as interim leader of Trinity New England since Christopher Dadlez stepped down at the end of 2017.

Last week, Governor Charlie Baker appointed Dr. John Christian Kryder to the 11-member Health Policy Commission (HPC). Kryder is a primary care physician who is currently an Executive Partner at Flare Capital, a Boston-based healthcare technology investment group. In addition to chairing the Board of Directors at a telemedicine services organization, InfiniteMD, Kryder also recently served as an advisor at GE Ventures. Previously he was a clinical instructor in medicine in the Medical Engineering and Medical Physics Program at Harvard Medical School, HST Division. Kryder currently serves on the Board of Trustees at Tufts Medical Center. 

The director of the U.S. Centers for Disease Control and Prevention (CDC), Dr. Brenda Fitzgerald, resigned last Wednesday after news reports showed she had invested in tobacco company stocks after her appointment to the CDC. She previously had been criticized by members of Congress for conflicts of interest due to her investments in drug and insurance companies; she was unable to testify before Congress on various matters as a result of those conflicts. Dr. Anne Schuchat is serving as acting CDC director.

John LoDico, Editor