Nurse Licensure, the RFA, Cost Trends, and more ...

A Ready-Made Solution to the Nursing Shortage

Legislation pending in the State House would quickly increase the supply of well-qualified nurses who would first have to undergo rigorous background checks, and then make the nurses available to fill vacancies in underserved areas, or quickly respond to patient surges due to disasters. The legislation would also allow Massachusetts nurses to continue follow-up care with their out-of-state patients once those patients leave Massachusetts, and permit nurse educators to teach via technology and help increase the registered nurse (R.N.) pipeline.
H1944, An Act Relative to Nurse Licensure Compact in Massachusetts, allows R.N.s to have one multistate license from the state in which they reside, with the privilege to practice in their home state and all others that are members of the Compact. The bill is especially timely for Massachusetts where hospitals are facing an R.N. vacancy rate of 5.3% and are struggling to fill 1,200 full-time, budgeted nursing positions.
“Adoption of the NLC in Massachusetts would provide an immediate solution to the nurse staffing challenges that beleaguer acute care hospitals and other healthcare providers by permitting qualified out-of-state nurses to care for patients across the care continuum,” MHA’s Sr. Director of Strategy and Government Advocacy Emily Dulong testified before the Joint Committee on Health Care Financing last Tuesday. “It would also enhance our members’ ability to respond to the rapidly changing landscape of healthcare delivery, increase access to quality nursing care for patients in more rural parts of the state and in community-based settings, and allow for better emergency preparedness and more rapid staff response in times of disaster.”
The licensing requirements under the Compact are more stringent than those in Massachusetts. In addition to meeting 11 uniform licensure requirements, a nurse who wishes to obtain a multistate license must meet his or her home state’s requirements and submit to a federal criminal background check. (Currently, nurses applying for state licensure in Massachusetts are not required to undergo a background check, although they typically go through one upon employment in a hospital.)
“A line we’ve often heard that is meant to create fear around the quality of care provided by Compact nurses is, ‘Would you really want a nurse from Georgia, or the Carolinas, or Arizona, providing care to your patients?’” Dulong told the committee. “Our response is very straightforward: if every nurse in the country has to pass the same test, and the requirements for national licensure are more stringent than those in the commonwealth, the answer is unequivocally, ‘Yes’.”
In addition to MHA, groups supporting the Nurse Licensure Compact include the Organization of Nurse Leaders, American Nurses Association Massachusetts, National Council of State Boards of Nursing, Massachusetts Association of Colleges of Nursing, Massachusetts-Rhode Island League for Nursing, Emergency Nurses Association Massachusetts State Council, Conference of Boston Teaching Hospitals, Case Management Society of New England, Night Nurse, Maxim Healthcare Services, AARP Massachusetts, Home Care Alliance of Massachusetts, Atrius Health, and Fresenius Medical Care North America.

State Releases 2020 MassHealth Contract

The state has released the 2020 RFA – the main contract between the MassHealth program and acute care hospitals serving Medicaid patients.
This year leading up to the RFA, and following rate reductions in 2019, hospitals and the state engaged in improved discussions about how Medicaid underpayments are affecting the delivery of care in Massachusetts. RFA stands for “Request for Applications.” The contract goes into effect on November 1.
The RFA payment changes in 2020 are projected to yield a $53.5 million improvement to acute care hospitals, both through reimbursement from MassHealth as well as from managed care entities, which reimburse hospitals using the RFA’s rates. Significant improvements in language related to the new 30-day readmission penalty are also included.
New in RY2020, MassHealth will provide $9 million in added financial support for inpatient behavioral health services provided at disproportionate share hospitals. (This is part of the total $53.5 improvement.)
MHA President & CEO Steve Walsh credited the state and hospital community for the recent discussions, adding, “Our goal is to further expand upon these improvements and we look forward to working collaboratively with the Executive Office of Health & Human Services and the Baker Administration as it develops a fiscal plan for 2021. We are committed to advocating for the resources needed to appropriately support hospitals and the MassHealth program.”

Mark Your Calendars and Register: HPC Cost-Trends Hearings

The Massachusetts Health Policy Commission is holding its 2019 Health Care Cost Trends Hearing on Tuesday and Wednesday, October 22 and 23, at Suffolk University Law School, 120 Tremont St., Boston. The hearing is a public event at which elected officials, policymakers, researchers, and healthcare market participants convene to address challenges and discuss opportunities for improving care and reducing costs in the commonwealth.
The hearings will be live streamed but anyone can attend in person by filling out this registration form
Among those scheduled to speak are Governor Charlie Baker, Attorney General Maura Healey, House Speaker Robert DeLeo, and Senate President Karen Spilka. The hearings will explore, among other things, the growth in hospital and pharmaceutical spending, strengthening the primary care system, behavioral health, and reducing administrative complexity.
A Wednesday panel focusing on provider market trends and cost drivers will feature: Thomas Croswell, president and CEO, Tufts Health Plan; Sandra Fenwick, CEO, Boston Children’s Hospital; Kim Hollon, president and CEO, Signature Healthcare; Dr. Anne Klibanski, president and CEO, Partners HealthCare; Dr. Steven Strongwater, president and CEO, Atrius Health; and Dr. Kevin Tabb, president and CEO, Beth Israel Lahey Health.
See the full agenda and sign up today for this don’t-miss healthcare event by clicking here.

State Meets Cost Growth Benchmark

The state’s Center for Health Information & Analysis (CHIA) last Tuesday released its annual report on the performance of the Massachusetts healthcare system, concluding that total healthcare expenditures (THCE) per capita from 2017-2018 matched the state’s cost growth benchmark of 3.1%. Massachusetts has consistently fallen below national per capita growth and the state has not exceeded its spending target since 2015.
As the entire system continued to move in the right direction, there were some expenditure outliers. The growth in prescription drug spending was 5.8%, accounting for the majority of the state spending growth. Hospital outpatient spending growth moderated from 5.1% in the prior year, but at 3.8% was still above the benchmark. Inpatient spending growth was 3.7%. Why hospital costs in the most recent report are higher than expected could be due to a variety of factors, including those beyond the control of hospitals, such as pharmaceutical and labor costs, an aging workforce, physician recruitment, and new technology. In addition, an increasing proportion of Massachusetts residents are aged 65 and over, and policy-driven efforts to move lower-acuity and less medically complex patients to outpatient settings continue to increase.
As in past years, CHIA’s report is preliminary and subject to change.

Why Do Drug Prices Increase? Good Question

Drug prices are increasingly dramatically. But why? A recent report by the Institute for Clinical and Economic Review looks at nine drugs that experienced substantial price increases over a two-year period (2016 to 2018) and attempted to see if there was new evidence of the drugs’ improved safety or effectiveness that could explain the price hikes. ICER found that seven of the nine drugs – Humira, Rituxan, Lyrica, Truvada, Neulasta, Cialis, and Tecfidera – saw net price increases of between 9.8% and 32.5%, but that those increases were unsupported by new clinical evidence. Two other drugs – Genvoya and Revlimid – had new clinical evidence associated with them, although ICER concluded that the new evidence does not necessarily justify the price increases. Which leads to the still-unanswered question: What’s behind the price increases?

Medical Errors Prevention Coalition Seeking Presentations

The Massachusetts Coalition for the Prevention of Medical Errors is seeking proposals for presentation at its April 29, 2020, Forum at the Doubletree in Westborough. This program will include a focus on organizational strategies that accelerate improvement on all goals, not only patient safety, but also efficiency, patient experience, quality outcomes, and clinician and staff satisfaction and engagement.
The Coalition is particularly interested in presentations related to strategies that accelerate improvements in safety and other organizational goals, and that build improvement into daily work, including:
• organizational learning systems, that engage clinicians and staff in seeing and solving problems/reducing frustrations/improving processes;
• patient and family engagement strategies;
• leadership approaches;
• improvement and safety culture (including reducing staff burnout/enhancing engagement; and building teamwork and communication);
• win/win initiatives that produced substantial improvements, such as saving staff time while improving care, improving EMR usability and safety, etc.; and 
• improvements in reducing diagnostic errors; care transitions/handoffs; health information technology; and settings other than inpatient.
If you are interested in presenting your work during the 2020 Forum, please prepare a summary using this form and e-mail it to the Coalition’s Amelia DeFelice at adefelice@macoalition.org by Monday, November 18. (If you are planning on submitting a proposal, please let Amelia know as soon as possible, and include the topic, to assist the Coalition in its planning.)

Do You Have Thoughts on Healthcare-Community Partnerships?

Massachusetts is seeking input on the design of a new initiative called “Moving Massachusetts Upstream” (MassUP). The Health Policy Commission, along with DPH, MassHealth and other state agencies issued the request for information (RFI) last week, asking groups to weigh in on the plan to help healthcare providers and community-based organizations work together to address upstream (i.e., social, environmental, and economic) challenges, and “enable sustainable improvements in community health and health equity.”
MassUP will include an investment opportunity to support such partnerships. According to the RFI notice, “MassUP also will include the establishment of an interagency policy alignment working group, through which state agencies will proactively work toward alleviating policy barriers to addressing the social determinants of health in the commonwealth.”
Any organization or individual interested in the MassUP initiative (e.g., a community organization, healthcare provider, social service agency, local government body, etc.) is invited to submit a response to this RFI. Responses are due by 3 p.m. on October 25.

Congratulations Dr. Kaelin

William G. Kaelin, Jr., M.D. – the Sidney Farber Professor of Medicine at Dana-Farber Cancer Institute and a professor of medicine at Harvard Medical School and Brigham and Women’s Hospital – has been awarded, along with two other scientists, the 2019 Nobel Prize in Medicine. Kaelin, Sir Peter Ratcliffe of the University of Oxford, and Dr. Gregg Semenza of Johns Hopkins University, were honored for deciphering the mechanism that enables cells to sense and adapt to changes in oxygen abundance. The three were not formal scientific collaborators, but each worked on the problem separately.
“We’re all incredibly proud of Dr. Kaelin – and hopeful for the promise this means for patients here and everywhere,” said Dana-Farber President and CEO Laurie Glimcher, M.D.

In Memoriam – James Lyons

James Lyons, Jr., the president of Cape Cod Hospital from 1981 to 1999, and chairman of MHA’s Board of Trustees from 1985 to 1986, passed away on October 6. He was 85. Before his post on the Cape, Lyons was president of St. Anne’s Hospital in Fall River. He is credited with uniting Cape Cod and Falmouth hospitals, stabilizing their finances, and laying the foundation for the well-respected healthcare system that exists on Cape Cod today.

Creating Paths to Sustainable Operating Margin, Mission,
and Market Essentiality

Leading health systems are undertaking extraordinary work to calibrate their margin, mission, market position, and operating model. Margin pressure is now the new normal. Despite traditional margin improvement initiatives in such areas as supply chain, throughput, clinical documentation, and revenue cycle, margins continue to decline. Fee-for-service reimbursement cuts, both past and future, promise to cost the sector billions as structural reforms are addressed. Recent downturns in hospital inpatient and ambulatory volumes due to affordability problems have exacerbated provider margin gaps. Fortunately, for many large systems, the “boat vs. dock” or “volume vs. value” decision does not have to be one or the other, but rather how much change can an institution handle and how fast. The ultimate call to action is for organizations to calibrate future margins, missions, and market positioning with their operating model and underlying technology platforms. This conference -- scheduled for Friday, November 15, from 9 a.m. to  2:15 p.m. at MHA Conference Center, Burlington, Mass. -- will look at effective current strategies for improved ROI across an enterprise. We’ll look at population health, finance automation, EMRs/digital technology, clinical re-design, and management of medical groups. The focus will be on tactics for margin improvement and we’ll highlight best practices from top health systems across the country. Click here to view the agenda and panels, and to register.

John LoDico, Editor