Massachusetts Senate President Karen Spilka (D-Ashland) said at the Health Policy Commission cost trends hearing last week that the Senate is crafting its own healthcare reform bill this session and that some elements of it – but not all – mirror what Governor Baker proposed in his health bill released October 18.
 
Like Baker’s legislation, the Senate bill would focus on behavioral health, prescription drug prices, expanding scope of practice for some providers, and “surprise billing,” Spilka said. She also indicated that the Senate may look at provider price variation, which is a topic that Baker skirted in his bill.
 
Hospitals found much to like in Baker’s proposal, especially its elements that would expand the use of telemedicine and adopt the nurse licensure compact in Massachusetts. While hospitals support an end to surprise billing – that is, removing patients from billing disputes between providers and insurers – hospitals hope the Senate bill adopts the so-called “baseball style” arbitration method that New York state currently uses to resolve the billing disputes. Baker’s bill adopts a more troublesome benchmark rate-setting procedure.

Last week, House Speaker Robert DeLeo and Senate President Karen Spilka outlined their legislative agendas prior to the November 20 deadline concluding full formal legislative sessions for 2019. Two bills scheduled for action, HB4089/SB2357, championed by Rep. Danielle Gregoire (D-Marlborough) and Sen. John Keenan (D-Quincy), would permanently ban all flavored tobacco products, including e-cigarettes, vaping products, and menthol cigarettes. Both bills sit before the House and Senate Ways & Means Committees.
  
MHA is a member of the Tobacco Free Mass. coalition that supports the bills’ provisions that would ban flavored tobacco products, including mint, wintergreen, and menthol flavors. Menthol is a flavor, but it is also a numbing agent, allowing the smoker to inhale more deeply and become more addicted. It also increases the absorption of nicotine into mouth tissues. The faster the nicotine absorption, the more addicted the user becomes. According to recent data, 54% of high school students that smoke use menthol cigarettes, and more than 90% of tobacco-using African American youth smoke menthol cigarettes.
  
MHA and Tobacco Free Mass. support a comprehensive flavor ban that covers all flavors and products.

The state’s Health Policy Commission (HPC) held its annual cost trends hearing last Tuesday and Wednesday, taking a deep dive into the Massachusetts healthcare system and its expenses.
 
Massachusetts, in the latest available data, 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, while continuing to be a national leader in quality.
 
Other states, including Oregon, Connecticut, and Rhode Island attended the hearings to learn more about the success of the cost growth benchmark, which Massachusetts first implemented in 2012.
 
Several hospital CEOs told the HPC, which is funded entirely through assessments on hospitals, ambulatory surgical centers, and insurers, that additional cost reduction is their goal and offered to continue collaborations with the HPC to bring about further positive change. Alternative payment contracts, patient medical homes, reducing administrative burdens, shifting patients from academic medical centers to community hospitals within a system are among the many initiatives underway to reform the multi-billion healthcare system, executives said. 
 
During the two-day hearings, the HPC convened its first ever panel addressing administrative complexity in the healthcare system, noting that for the second year in a row, premium retention grew rapidly for both merged market and larger employer plans in 2018. Insurer administrative costs were the fastest growing category.
 
The commission is charged annually with identifying challenges the state has in meeting the statutorily set cost growth benchmark and, if it is missed, identifying drivers and solutions for future success.

Berkshire Health Systems’ Director of Nutritional Health Pete Gazzillo penned a recent opinion piece in which he discusses what may be a shocking statistic to many – that at least 10% of the households in Berkshire County, or about some 14,300 people, suffer from hunger.
 
“Those neighbors, nearly a third of them children, are food insecure, meaning they don’t have reliable access to a sufficient quantity of affordable, nutritious food,” Gazzillo wrote. “Even if they have enough to put on the table some days, more often than not they don’t.”
 
In the Berkshires, Gazzillo noted that two leading nonprofits focusing on hunger – Berkshire Bounty and Backyard Bounty of the Berkshires – merged “to maximize efforts to collect and distribute fresh produce and other food to those in need.”
 
The health system, like many hospitals in the commonwealth, is also addressing the problem by forming partnerships with schools, restaurants, philanthropies, churches, and others to bring food to those who need it. For example, Fairview Hospital, part of the Berkshire system, partnered with the Berkshire Hills Regional School District’s Summer Project Connect for at-risk students to develop a summer backpack program, which sends food home for the students and their families during summer weekends.
 
Lahey Hospital & Medical Center, part of Beth Israel Lahey Health, has partnered with World PEAS to hold regional farmers markets that make fresh fruits and vegetables more accessible and affordable for seniors in the community.
 
Mercy Medical Center, a member of Trinity Health of New England, used its Transforming Communities Initiative to help Springfield groups get funding for a Culinary & Nutrition Center that provides healthy food to 30,000-plus students.
 
Cape Cod Healthcare is yet another of many hospitals and health systems that is focusing on food as a way to improve the health of its populations. On the Cape, the health system’s community benefits program partners with the Cape Cod Commercial Fisherman’s Alliance and the Family Food Pantry to provide fresh fish to the community at market or near-market rates.
 
U.S. Representatives James P. McGovern (D-Mass.), the chairman of the House Rules Committee, has made fighting hunger a legislative priority throughout his career. In September, McGovern, along with Rodney Davis (R-Ill.) announced the introduction of a bipartisan bill – The Healthy Breakfasts Help Kids Learn Act – to expand access to healthy school breakfasts for students across the U.S.

The National Academies of Sciences, Engineering, and Medicine last week issued a 312-page report showing that as many as half the nation’s doctors and nurses experience substantial symptoms of burnout.
 
Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being builds upon many similar studies, such as the one produced this year by MHA and the Massachusetts Medical Society that termed physician burnout a public health crisis that not only affects caregivers but the health and well-being of the American public. 
 
The National Academies’ report concludes that burnout is a critical issue that needs immediate action, but that it is also a “complex multi-factorial problem that is not easily solved.”
 
“Multiple work system factors contribute to clinician burnout (e.g., high workload, administrative burden, poorly designed technologies) and stem from decisions or actions taken at various levels in health care: the local frontline care delivery level, health care organizations, and multiple policy and regulatory actors in the external environment,” the authors write.
 
Key issues identified include:
• “Clinician burnout needs to be tackled early in professional development, and special stressors in the learning environment need to be recognized.
• “Stakeholders in the external environment have an important role to play in preventing clinician burnout as their decisions can result in increased burden and other demands that affect clinician burnout. Every attempt at alignment and reduction of requirements to reduce redundancy is essential.
• “Technology can either contribute to clinician burnout (e.g., poorly designed electronic health record technologies) or potentially reduce clinician burnout (e.g., well-functioning patient communications, clinical decision support) if it is well designed, implemented, and integrated into clinical workflow. The report reiterates several recommendations of previous IOM and National Academies of Sciences, Engineering, and Medicine reports to improve usability, workflow integration, and inter-operability of health information technology.
• “Medical societies, state licensing boards, specialty certification boards, medical education and health care delivery organizations all need to take concrete steps to reduce the stigma for clinicians of seeking help for psychological distress, and make assistance more easily available.”

A U.S. House Energy and Commerce Subcommittee on Oversight and Investigation hearing last Wednesday got very testy very quickly as U.S. Rep. Joseph Kennedy (D-Mass.) pressed CMS Administrator Seema Verma to defend the administration-endorsed efforts to impose work requirements on Medicaid recipients.
 
Kennedy cited studies showing that CMS-approved Medicaid work requirement plans in Arkansas led to 18,000 people losing coverage, with other such losses occurring in New Hampshire. He asked Verma to cite a single study showing that work requirements improve health.
 
When Verma noted that studies may show that employment has a positive influence on health, Kennedy interrupted, saying, “You guys [CMS] run healthcare programs across the country. I am certain you understand the difference between correlation and causation. Healthier people may work. Work doesn’t necessarily make people healthier. You’re imposing policies on millions of people across the country. Can you show me one study that says that is a good policy?”
 
Verma responded that people want to find a pathway out of poverty.
  
Kennedy later tweeted, “Medicaid work requirements are just conservative healthcare policy experiments with human subjects … Stop playing with people’s lives.”
 
Republicans on the committee argued that the hearing was unnecessarily partisan, pointing to its inflammatory title – Sabotage: The Trump Administration’s Attack on Health Care.

The Schwartz Center for Compassionate Healthcare has named the six finalists for the 2019 National Compassionate Caregiver of the Year Award, which recognizes those who “make a profound difference through their unmatched dedication to compassionate care.”
 
The 2019 NCCY Award finalists are:
• Justin N. Baker, M.D., St. Jude Children’s Research Hospital, Memphis, Tenn. Baker is chief of the division of quality of life and palliative care at St. Jude and medical director of the Quality of Life for All team.
• Joanne B. Glusman, Bryn Mawr Hospital, Main Line Health, Bryn Mawr, Penn. Glusman is a clinical social worker on the palliative care team and an off-shift crisis social worker.
• Elizabeth T. Heyne, Children’s Health, Dallas. Heyne is a certified physician assistant in the Neonatal Intensive Care Unit.
• Jude Ierardi, St. Elizabeth’s Medical Center, Boston. Ierardi is a manager in the radiology department.
• Sophia L. Maurasse, M.D., McLean Hospital, Belmont, Mass. Maurasse is the medical director of the 3East Girls Intensive and Step-Down Programs at McLean.
• Kari Rosenkranz, M.D., Dartmouth-Hitchcock Medical Center, Lebanon, N.H. Rosenkranz is the medical director of the Comprehensive Breast Program at the Dartmouth-Hitchcock Norris Cotton Cancer Center.
The award recipient will be announced on November 21, at the 24th annual Schwartz Center healthcare dinner at the Boston Convention and Exhibitions Center. Governor Charlie Baker is scheduled to deliver the main address.

The Massachusetts Health Council’s (MHC’s) 2019 annual awards gala last Tuesday featured the popular chefs competition, where teams from a number of Massachusetts hospitals and other care providers vie for the top award by preparing tasty and healthy fare for attendees. This year, attendees gave first place to Signature Healthcare Brockton. Second place went to Beth Israel Deaconess Medical Center, a member of Beth Israel Lahey Health, and third place to Brigham and Women’s Hospital. The Brigham also received the Chef's Choice Award, as voted by a panel of experts, including chefs Joanne Chang (Flour Bakery and Myers+Chang), Jose Duarte (Taranta Restaurant), and Andy Husbands (the SmokeShop), as well as Corby Kummer, senior editor for The Atlantic magazine and restaurant critic for Boston Magazine. 

 
This year’s MHC individual honorees were Boston Mayor Marty Walsh; Monica Lowell, VP of Community Benefits at UMass Memorial Health Care; and Vic DiGravio, VP of Strategy for eHana and former president & CEO of the Association for Behavioral Healthcare. MHC also presented an outstanding workplace wellness award to Boston MedFlight.

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

Friday, November 15; 9 a.m. - 2:15 p.m.
MHA Conference Center, Burlington, Mass.

Health systems are undertaking extraordinary work to calibrate their margin, mission, market position, and operating model. 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 and recent downturns in hospital inpatient and ambulatory volumes 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 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. Visit here for more information.