Vaccines, a Drug Proposal, Weather Webinar, and more ...

Removing the Religious Exemption for School Vaccinations

MHA last week testified in favor of proposed legislation that would eliminate the religious exemption as a reason to refuse vaccinations for school admittance.
Specifically, MHA endorsed House Bill 3999, An Act relative to vaccines and public health, which would eliminate the religious exemption for school-age children, and expressed support for provisions of Senate Bill 2359/House Bill 4096 that would increase state data collection on vaccination rates to help stakeholders identify of regions of concern.
MHA’s Senior Director of Strategy and Government Advocacy Emily Dulong testified before the Joint Committee on Public Health, saying that the state’s 95% vaccination rate is impressive, but that “there are still pockets of the commonwealth that struggle with noticeably high vaccine rejection numbers, endangering the health of immuno-compromised patients with a medical exemption and that of children too young to be inoculated.”
She added, “Use of the religious exemption to refuse vaccinations has risen significantly in recent years, at a level that does not appear to mirror expanded religious practice by Massachusetts residents. No major religion formally opposes vaccines. This is important to note, as more than 75% of current vaccination exemptions in Massachusetts cite religious reasons. Over the last 30 years, use of the religious exemption for children in the commonwealth has grown by 500%.”
Dulong testified on a panel with Todd Foy, manager of government affairs & public policy at the Mass. League of Community Health Centers; and Carlene Pavlos, executive director of the Massachusetts Public Health Association. The Massachusetts Medical Society has also endorsed H3999.
The bill’s author, Rep. Andres Vargas (D-Haverhill), delivered an impassioned defense of his legislation. “I have sat with parents who have used the religious exemptions and can say the majority are good-hearted people who just want what is best for their kids,” the State House News Service quoted Vargas as saying. “Unfortunately, figuring out what is best for your kids is increasingly difficult in the era of pseudoscience, digital misinformation campaigns and people who profit from the anti-vax movement … The science is settled. Vaccines are safe and incredibly effective. They are constantly cited as one of the greatest human advances, saving millions of lives and billions in healthcare dollars.” Vargas said the debate on the bill shouldn’t be about the science behind vaccines, but rather about whether there exists a religious right “to put other children at risk in schools across the commonwealth for no science or medically based reason.”

EOHHS Proposed Rx Rule Raises Concern

The Executive Office of Health & Human Services has issued draft regulations governing pharmacy services delivered to MassHealth patients. While the regulations contain some interesting cost-saving proposals relating to 90-day versus 30-day supplies of drugs and rules relating to cash payments, one proposal relating to drugs purchased under the 340B program is raising concern among hospitals.
The federal government created the 340B program to provide drug discounts to hospitals and clinics serving low-income patients, including pediatric, disproportionate share, and critical access hospitals. Under the 340B program, manufacturers of prescription drugs are required to offer 340B hospitals and clinics outpatient drugs at or below a set ceiling price as a condition of having these drugs covered through Medicaid. 
Under the proposed rules MassHealth would have new authority to designate and exclude from MassHealth coverage certain high-cost drugs that are purchased under the 340B program. MHA is concerned with the proposal as it would establish an unclear process for determining which drugs would be excluded, as well as have the ultimate effect of restricting a federal benefit intended to support qualified hospitals.
“The 340B program is a federal benefit afforded to qualified providers in recognition of their limited funding available to serve low-income patients,” said MHA’s Senior Director of State Government Finance and Policy Dan McHale. “The notion of putting conditions on MassHealth covered drugs in connection to this federal benefit raises significant alarm. These hospitals depend highly on the 340B financing to support the care they provide to MassHealth patients. It will be critical that any efforts to achieve pharmaceutical cost savings within the MassHealth program not negatively affect healthcare providers.”

The Twisted Path to “Transparency”

Since 2013 in Massachusetts, if you wanted to find out the charge on an admission, procedure, or service, providers are required to respond to your request within two working days. Health insurance companies are required to have toll free phone numbers and websites that enable consumers to request and obtain, in real time, the estimated or maximum allowed amount or charge for a proposed admission, procedure, or service. In terms of so-called “price transparency,” Massachusetts has a system up and running that, while imperfect, nonetheless gives consumers an opportunity to receive an estimate of the costs they’ll face.
Last month, CMS issued a final national rule that would require hospitals to make their standard charges public. Under the CMS rule, hospitals would have to reveal the negotiated rates they reached with insurers, which due to the inherent complexity of the system, often bears absolutely no relation to the costs the consumer will pay.
Last week, the American Hospital Association (AHA), along with other hospital groups, sued the federal government to stop imposition of the negotiated rate rule. The hospitals argue that CMS lacks statutory authority to require public disclosure of individually negotiated rates between commercial health insurers and hospitals. They say the provision violates the First Amendment by compelling the public disclosure of individual rates negotiated between hospitals and insurers in a manner that will confuse patients and unduly burden hospitals.
In October the Massachusetts Attorney General’s Office released a report showing that just a small percentage of people in the commonwealth seeking care use price transparency tools; those who do employ them don’t hold their providers to the estimates they were given, according to the report. To date, strategies that have been used to get consumers to use the tools have often failed. 
So while Massachusetts has made the effort to create tools that give a rough estimate of potential costs, few people are using them. At the same time, the Trump Administration is promoting the posting of gross charge amounts and private negotiated details that bear little relation to costs – which, according to the AHA lawsuit, is probably illegal.

Dec. 10 Webinar: Preparing for Bad Weather

As global temperatures rise, storms and flooding are becoming more frequent and severe, forcing communities and facilities to address patient surge, transport, power and utility disruptions, and more. MHA is holding a webinar tomorrow – Tuesday, December 10 at 10 a.m. – that will feature three health systems that have “weathered the storm,” including flooding, “bomb cyclones,” blizzards, and tornadoes. Participants can learn how the systems planned for the events, including emergency preparedness efforts in the days leading up to and during the event, as well as longer-term investments in infrastructure and planning. There will also be a segment on leveraging the commonwealth’s climate preparedness resources. There’s still time to sign up for the free webinar by clicking here.

Opioid Use Disorder Training for ED Nurses

Chapter 208 of the Acts of 2018, last year’s opioid law, required that emergency departments and satellite emergency facilities have the capability to initiate patients on medication for opioid use disorder. Boston Medical Center’s Office Based Addiction Treatment/Training and Technical Assistance program, funded through DPH’s Bureau of Substance Addiction Treatment, has been hosting a series of trainings for ED nurses to help them assess and treat patients presenting to the ED with opioid use disorder.
Times and locations of the next series of trainings are as follows:
Wednesday, December 11: Massachusetts General Hospital, Boston; 9:30 a.m. to 1 p.m.
Monday, December 16: Boston Marriott Newton, Newton; 8 to 11:30 a.m.
Wednesday, December 18: DoubleTree by Hilton, Rockland; 8 to 11:30 a.m.
Thursday, December 19: Boston Medical Center, Boston; 8 to 11:30 a.m.

Attendance at these trainings is strongly recommended for emergency department nurses. Click here for further details and a registration link.

Semi-Annual Health Report: The Plans are Making Money

MHA’s Semi-Annual Health Plan Performance Report is being sent to the association’s members this week. The report, which covers the period between January 2015 and June 2019, presents an analysis of the financial position of health plans in Massachusetts by looking at a variety of measures, including: plan membership, premium rates, medical and administrative expense trends, and profitability, liquidity, and solvency statistics. It gives providers information about health plan market share, and it presents trends in premium rates to employer groups. The report includes figures important to evaluate a plan’s financial condition: net worth, net income, total premium revenues collected, and medical expenses. The most recent report shows that most of the plans had healthy profit margins in the first half of the year.


Gary Shaw is the new president and CEO of Nantucket Cottage Hospital, effective today. Shaw most recently served as president of Cambridge Medical Center in Minnesota, an 86-bed facility that is part of Allina Health system. Prior to that, Shaw was the hospital administrator of the Alaska Native Medical Center in Anchorage, Alaska. He has 20 years of service in the U.S. Navy’s Medical Service Corps, where he rose to the rank of lieutenant commander. Shaw succeeds Dr. Margot Hartmann, who had served as Nantucket Cottage Hospital’s president and CEO since 2010. She stepped down from that role in September 2019 and Jeanette Ives Erickson, R.N., has served the hospital as interim president and CEO. Shaw has a B.S. from Southern Illinois University and a master of science degree in operations management from the University of Arkansas-Fayetteville.

Lean in Healthcare Certificate Program at Emerson Hospital, Concord, Mass.

Starting: Friday, January 10, 2020, and running 8 sessions total
8:30 a.m. - 4:30 p.m.

Hospitals are challenged continually to improve quality and reduce costs as they deliver improved care to patients. At the same time, complex processes and equipment and supply issues can frustrate the efficient delivery of care. This course teaches leaders, managers, and staff how to apply real process-improvement and problem-solving techniques in an actual hospital setting. The intense eight-day course provides participants with hands-on experience learning and applying both the technical science and social science of lean. The technical science of lean focuses on learning and applying lean tools and techniques, while the social science aspect of it focuses on people and organizational development. Both are necessary for an effective lean implementation. After completing this program, participants will be able to demonstrate a solid understanding of lean principles, learn about the tools that can improve the bottom line, and determine key improvement opportunities and how to apply the tools within their own facilities. Learn more about specific dates, costs, and how to register by clicking here.

John LoDico, Editor