Governor Charlie Baker released his proposed FY 2021 state budget last week, and it contains, for the second year in a row, an update to MassHealth spending of less than 1%.
 
Under the Baker proposal, MassHealth is funded at $16.772 billion in FY21, a 0.6% increase from FY20; the proposed budget assumes MassHealth enrollment will rise by 0.7%. Because of federal-state Medicaid cost sharing, the net state cost of the FY21 MassHealth budget is $6.740 billion, or 40% of the total.
 
Provider rate reimbursement is essentially held flat in FY2021, although the budget contains a targeted investment of $11 million for fee-for-service rates at inpatient psychiatric hospitals. There are other investments in behavioral health, fulfilling the administration’s focus on improving this sector of the healthcare system.
 
The proposed budget contains language allowing for $15 million in state funding for the health safety net, but the budget language is “permissive” in nature, meaning the state “may” fund “up to” $15 million. In recent years, the budget appropriated amount has been sent to the safety net; in previous years it was not.
 
After years of level funding, the governor proposes a $31.07 million budget for Center for Health Information and Analysis (CHIA), which represents a 13.3% increase relative to the FY2020 appropriation. The governor recommends a $10 million budget for the Health Policy Commission (HPC), a 1.7% increase. Acute care hospitals, ambulatory surgical centers, and insurers are responsible for funding the expenses of CHIA and the HPC. 
 
The governor’s budget is considered a starting point for the budget deliberations that will occur over the next six months. The House budget is due in April.

The Department of Public Health (DPH) last week informed hospitals and other providers that they should be on the lookout for patients who have recently traveled to Wuhan and who present with fever, respiratory problems, or interactions with a known coronavirus patient.
 
Airports in Los Angeles and San Francisco, and JFK in New York, which receive the majority of travelers from Wuhan, are screening passengers, as is Chicago-O’Hare and Atlanta’s Hartsfield-Jackson. Boston’s Logan International is not formally screening passengers but some travelers on one flight from Hong Kong were screened by EMS personnel last week, according to the Massachusetts Port Authority.
 
Last Thursday, Chinese authorities closed Wuhan’s train station and airport and halted ferry, subway, and bus service. Wuhan has a population of 11 million people. Other large cities in China were also subject to the travel lockdown, affecting more than 35 million people. Chinese hospitals in the affected Hubei province were being overrun and were turning away patients, according to international media outlets.
 
In Massachusetts, where the risk factor was considered low, DPH says if a facility has a patient that meets the warning criteria, the patient should wear a surgical mask and be evaluated in a private room with the door closed, ideally in an airborne infection isolation room, if available. Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and use eye protection. And the provider should contact DPH.

Fulfilling an identified need in the Massachusetts healthcare system, MetroWest Medical Center’s Leonard Morse Hospital announced last Tuesday that it would narrow its focus almost exclusively on behavioral healthcare.
 
The Natick hospital informed the Department of Public Health that it intends to close its emergency room and surgical units by May. In place of the facility’s acute care services, the MetroWest hospital would focus on child, adolescent, adult, and geriatric psychiatric care, sleep lab services, and imaging.
 
MetroWest, a member of Tenet Healthcare, said it would expand services at Framingham Union Hospital, which is located 5.2 miles from Leonard Morse. Harding said Framingham Union would upgrade its emergency department, hospital infrastructure, and clinical equipment, and invest in its cardiovascular service line and wound care.
 
“Behavioral health is a challenge in our community, and it is critical we optimize our services to help address the issue,” said CEO of MetroWest Medical Center Andrew Harding.

According to the most recent patient experience survey from the Massachusetts Health Quality Partners (MHQP) – the fifteenth such annual survey – 74% of primary care providers in the commonwealth ask their patients about behavioral health concerns, such as if they’re feeling sad, empty, depressed, worried or stressed. That’s up from just 50% of providers in 2013.
 
MHQP said primary care providers are even better asking about behavioral health concerns with patients who have a chronic condition. Providers asked 75.3% of patients with a chronic condition if they have behavioral health concerns, and the score rose to 83.6% when that chronic condition was depression.
 
Hospitals have been devoting more resources to behavioral healthcare. Governor Baker’s sweeping healthcare reform bill released last October would compel insurance companies and providers to increase combined expenditures on primary care and behavioral health by 30% over three years.

The U.S. Supreme Court will not undertake an expedited review of the Affordable Care Act (ACA), meaning that a case about the health law’s constitutionality will not appear before the court, if at all, until October 2020, and a decision on it will occur after the presidential election.
 
MHA and 32 other state hospital associations on January 15 filed an amicus brief with the U.S. Supreme Court, asking it to resolve the legal challenges to the ACA that are now being fought in federal courts. The Supreme Court’s one-line decision announcing it would not take up the case seems to put the issue of whether the ACA’s individual mandate is legal and, if it’s not, whether the whole ACA is therefore invalid back before a U.S. District Court, with the possibility that the Supreme Court could still intervene in the fall.

Telemedicine in 2020: Making the Leap to Implementation

Friday, February 28; 8:30 a.m. - 2:15 p.m.
MHA Conference Center, Burlington, Mass.

In today’s healthcare ecosystem, consumer-centric care is the focus and telemedicine is tailor-made for it. However, regulatory, legal, and payer complexities have often delayed progress in this area. Massachusetts has a strong tMED coalition pushing for faster implementation, and this program will highlight the growing opportunities becoming available. We’ll feature case studies by local hospitals along with one of the nation’s most advanced telemedicine programs, Jefferson Health, a 14-hospital system in Greater Philadelphia. We’ll also look at some of the more challenging issues that have hindered telemedicine implementation and strategies to get beyond them. MHA members from Partners HealthCare, Boston Children’s Hospital, and Heywood Healthcare will join other distinguished presenters for this important program about an innovative way to improve care and advance access to all parts of the commonwealth. Learn more and register by visiting here.