The OPPS Rule & Children's Health Bill

CMS Proposes Minimum Payment Updates, Onerous Posting Rules

The Centers for Medicare and Medicaid Services (CMS) last week released the proposed payment rule for outpatient services as well as the physician fee schedule rule. The rules provide the basis for how facilities and physicians are reimbursed under the Medicare program but also impose a series of conditions the groups must follow to receive the funding.
The outpatient prospective payment system (OPPS) proposed rule for calendar year 2020 would result in a net increase in outpatient Medicare payment rates of 2.0% on average over 2019. The most controversial non-payment-related part of the OPPS rule involves CMS’ proposal that hospitals publicly post a list of their “standard charges” – that is, gross charges and all negotiated rates for all items and services. CMS also requires the posting of negotiated rates of 300 “shoppable” services, defined as non-urgent services that are routinely provided and can be scheduled in advances.
While the public posting proposals seems to advance the idea of healthcare “transparency”, the fact is that revealing the private negotiated rates between hospitals and insurers allows commercial insurers to get a behind-the-scenes look at their competitors’ dealings with hospitals, which could, the American Hospital Association says, “fuel anticompetitive behavior.” By contrast, Massachusetts law requires providers to give information on price upon request by a patient; in addition health plans must provide real-time access and have a website with price information.
CMS also proposes in the rule to continue its cuts to the payment rate for certain drugs purchased under the 340B program to average sales price minus 22.5%. That plan has been rejected by the courts, but CMS intends to appeal. Hospitals argue that by proposing another year of cuts that have been determined to be illegal, the agency risks harming affected hospitals and reducing access to care. Instead, hospitals urge CMS to offer a plan to restore funds to the affected facilities.
CMS’ proposed rule for physician fees would update rates by 0.14% in calendar year 2020.

House Passes Comprehensive Children’s Health Bill

The Massachusetts House last Wednesday passed the Children’s Health & Wellness Act, which was a priority for House Speaker Robert DeLeo (D-Winthrop), and was guided through the legislative process by committee chairs Aaron Michlewitz (D-Boston), Jennifer Benson (D-Lunenburg), Danielle Gregoire (D-Marlborough), Claire Cronin (D-Easton), and Representative Christine Barber (D-Somerville), who has championed the issue of improving provider directories for patients.

MHA President & CEO Steve Walsh praised the House for unanimously passing the bill, which he said, “will help give a voice to our youngest, most vulnerable patients. It will ensure that when these children enter our healthcare system, they are set on a path that provides them with the access and protection they need and deserve. It will make finding appropriate caregivers easier and identify common pain points and solutions for access issues, including the creation of more accurate and accessible provider directories. It will also look for areas of advancement in pediatric behavioral health screening and care for children with complex medical needs. Certainly, success in these areas is crucial to creating a healthcare environment that serves the most fragile among us. We look forward to continuing our work with the entire legislature and the Baker administration to advance this measure and achieve the vital improvements to children’s healthcare in Massachusetts that it sets in motion.”

Baker Signs $43.3 Billion Budget, Issues No Spending Vetoes

Last Wednesday, Governor Charlie Baker signed a $43.3 billion FY2020 state budget, and did not issue a single spending veto. The final budget increases spending 3.3% over FY2019 estimates and is based upon $30.1 billion in tax revenue and a 1.4% growth in tax collections. The budget assumes an income tax rate reduction from 5.05% to 5% on January 1, 2020 – more than 20 years after voters approved a ballot question calling for a 5% income tax rate. The budget uses only $33.5 million in one-time revenues and deposits an additional $476 million into the state’s rainy day fund – bringing the balance of the fund to almost $3.3 billion by the end of FY2020. By signing the budget, the governor endorsed the legislature’s proposal to revise revenue projections by $600 million over and above the consensus revenue projections put forward in January. 
Governor Baker did return six budget amendments to the legislature with revised language. Among the revisions was MHA-endorsed language to protect the benefits of the federal 340B pharmaceutical discount program for safety net hospitals and the commonwealth. Under the provisions approved by the legislature, MassHealth would have to provide hospitals and the legislature with notice 270 days prior to implementing any restrictions that might interfere with a hospital’s access to discounted 340B pharmaceuticals. Under the governor’s revisions, MassHealth would instead have to provide notice 180 days prior to implementing any restrictions. The amendment is now incorporated into HB4017 and needs to be acted upon by the legislature when it returns in September. He also revised provisions in an outside section of the budget that require the Health Connector Board to provide 60 days’ notice to the legislature’s Health Care Financing and Ways & Means committees before it applies for any waiver under the Affordable Care Act. The governor recommended revising the language to provide a 30-day notice.

Mass. Hospitals Score High in National Rankings

Looking for a hospital at which to get a procedure performed? Talk to your doctor and family. Do your homework by consulting websites like MHA’s own PatientCareLink site or the federal government’s Hospital Compare. You can even check some of the more popular sites such as U.S. News & World Report’s annual rankings, which last week released its 2019 findings.
U.S. News ranked Massachusetts General Hospital as the second best hospital in the U.S., just behind the Mayo Clinic in Minnesota and just ahead of Johns Hopkins in Maryland. Brigham and Women’s Hospital was ranked at number 13 nationally. Last month, U.S. News ranked Boston Children’s Hospital at Number 1 in the children’s hospital category.
There are more than 5,000 hospitals in the United States. In addition to MGH, the Brigham, and Boston Children’s, the following Massachusetts hospitals were nationally ranked in one or more specialties: Beth Israel Deaconess Medical Center, Lahey Hospital and Medical Center, and New England Baptist Hospital – all part of Beth Israel Lahey Health; Dana-Farber Cancer Institute, Massachusetts Eye and Ear Hospital, McLean Hospital, and Spaulding Rehabilitation Hospital Boston. Dozens more Massachusetts hospitals received recognition for being “high performing” in various procedures/conditions.
Visit the U.S. News and World Report best hospitals rankings here.

MHA Board Chair Weighs in With Blog Posting

As healthcare in Massachusetts and the nation finds itself “on the precipice of transition and change,” the new chair of the MHA Board of Trustees Jody White weighed in with a posting to MHA’s Voices in Healthcare blog, outlining his thoughts about where he sees the health sector moving. White is President and CEO of Lowell General Hospital and Circle Health, and Executive Vice President of Wellforce. You can read his posting here.

Save the Date: Schwartz Center Dinner, Thursday, Nov. 21

The 24th Annual Kenneth B. Schwartz Compassionate Healthcare Dinner will be held on Thursday, November 21 at the Boston Convention & Exhibition Center. The reception will begin at 5 p.m. and the dinner and awards presentation at 7 p.m. Learn more about sponsorship opportunities here.

TeamSTEPPS Master Training Class

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals. It has become the gold standard in healthcare team training. The Master Training Course is a two-day, in-person course with a train-the-trainer approach. It educates participants on TeamSTEPPS Fundamentals, provides them with resources for training others, and ensures that they gain the knowledge and training required to implement and coach the behaviors needed to achieve positive results. The course will be taught by Karyn Baum, M.D., professor of Medicine & Interim Chief Medical Officer, University of Minnesota Medical Center, and Master TeamSTEPPS Trainer. We encourage hospitals to send three or more individuals to the trainings. The classes will be held Tuesday, September 24 & Wednesday, September 25, from 8 a.m. to 4:30 p.m. at MHA Conference Center, Burlington, Mass. Learn more here.

John LoDico, Editor