Last week, The Republican newspaper, based in Springfield, issued this strong editorial entitled Nurse staffing by referendum is a bad idea, which, among other things, states that “If Massachusetts voters decide on nurse staffing ratios by referendum, it will rank among the least appropriate referendum options ever to appear on the ballot.” The editorial was prompted by a state Supreme Judicial Court challenge to Attorney General Maura Healey’s decision to certify the nurse staffing ratio ballot question. The SJC heard arguments on April 3rd and a decision on the matter is anticipated sometime in June.

The Massachusetts Nurses Association (MNA)-sponsored ballot question would force all hospitals in Massachusetts to adopt a rigid, one-size-fits-all, at-all-times, mandated registered nurse staffing ratio in every single unit of every hospital.

“Nurse staffing is a vital issue, but it's not one the voters of Massachusetts are equipped to determine in a fact-based, informed fashion,” The Republican editorial board wrote.

The House Ways & Means Committee version of the FY2019 state budget is expected to be released by the Committee this Wednesday. The release is considered to be the kick-off of the legislature’s budget season for FY2019, after Governor Baker filed his proposed budget earlier in January.

MHA will be keeping a watchful eye on the budget to determine how hospital priorities have been considered in the House Ways & Means proposal. One significant provision in the governor’s budget was his proposal to transition 140,000 MassHealth enrollees to ConnectorCare plans effective January 1, 2019. In its letter to Ways & Means Chairman Rep. Jeffrey Sánchez (D-Mission Hill), MHA reiterated its support for the proposal in conjunction with the creation of statutory protections for low-income patients to ensure they maintain comprehensive and affordable health coverage. The proposed transition requires approval from both the legislature and the Centers for Medicare and Medicaid Services (CMS).

MHA also prioritized the restoration of the state’s statutorily required $30 million contribution to the Health Safety Net Trust Fund, and the improvement of payment adjustments in the MassHealth reimbursement methodology for Disproportionate Share Hospitals. MHA also highlighted behavioral health funding, including funding to support community engagement of mental health and substance use disorder patients and loan forgiveness programs for recent clinical graduates in behavioral health professions.

Once the House Ways & Means budget is unveiled, House members will have the opportunity to file amendments. Debate on those amendments is expected the week of April 23.

The Massachusetts Public Health Council last week approved the proposed merger of bigthe Beth Israel Deaconess system, Lahey Health, three independent hospitals and a number of physician practices. This follows last month’s approval of the deal by the state Department of Public Health.

The proposal would create a new system consisting of the current Beth Israel Deaconess Medical Center, Beth Israel Deaconess Hospital–Needham, Beth Israel Deaconess Hospital–Plymouth, and Beth Israel Deaconess Hospital–Milton, along with the Lahey-owned Lahey Hospital & Medical Center, Beverly Hospital, and Winchester Hospital. Also included are the independent Anna Jaques Hospital, New England Baptist Hospital, and Mount Auburn Hospital. Under the proposed deal, the new system would control the following contracting entities: Beth Israel Deaconess Care Organization (BIDCO), the Lahey Clinical Performance Network and Lahey Clinical Performance ACO. Mount Auburn Cambridge Independent Practice Association, which currently contracts independently, would be brought under the umbrella of the new system.

The Health Policy Commission is expected to issue its full cost and market impact review of the merger, exploring how the creation of the new entity will affect overall healthcare costs in the state, in July. If the HPC finds a transaction is detrimental to the state’s overall healthcare system, it can refer its report to the Attorney General’s office for further review.

April is national healthcare decisions month, and the special week dedicated to encouraging advance care planning – making sure you can receive the medical care you want even if you are not in a position to articulate it yourself – starts April 16th.

Throughout April, the healthcare community is encouraging individuals and families to focus on the process that you want your loved ones and caregivers to follow if you become seriously ill. One of the easiest ways to start this process is to designate someone as your healthcare agent and make sure your agent knows your wishes by filling out a simple healthcare proxy.

The nonprofit organization Honoring Choices Massachusetts offers a free, online “Getting Started Toolkit” that walks you through easy steps to choose and designate a healthcare agent, and fill out a basic healthcare proxy document. The forms and information can be reviewed and downloaded here. You can also access the Honoring Choices forms and lots of additional information through PatientCareLink – Just click on “Healthcare Planning Throughout Your Life” under the For Patients & Families tab, or “Serious Illness Care” under Improving Patient Care.

Having a healthcare proxy and advanced care plan in place can ensure that your family will not be burdened with making tough decisions on your behalf and that your wishes will be carried out. Having a plan in place can also help prevent disputes between family members who may have differing ideas about the care you should, or should not, receive. Avoiding such disagreements in care settings also assists the caregiving team members, who will be able to provide the care you wish without conflict.