Health insurance companies generally reimburse providers less for providing behavioral healthcare as opposed to physical healthcare. And insurers’ “prior authorization” mandates often result in insurance companies – rather than the treating clinician – making decisions about a patient’s care. The provider directories that insurance companies issue, listing which doctors are within a network and where patients can access behavioral healthcare, are often out of date and inaccurate, which makes it difficult for people to access needed care. 
 
Those long-standing, documented facts have been known for years, but have remained unresolved. But last Thursday, Massachusetts Attorney General Maura Healey reached a settlement with insurance companies operating in Massachusetts over their alleged violations of the state’s health parity laws.
 
The “assurances of discontinuance” Healey filed in Superior Court means that insurers will change the way they determine reimbursement rates for outpatient behavioral health services at all provider levels, including psychiatrists, psychologists, and social workers. Healey said this will generally result in higher reimbursement for such services.
 
They also agreed to limit prior authorization for certain behavioral healthcare. Specifically, Fallon Community Health Plan through its administrator Beacon Health Strategies “will no longer require prior authorization for routine behavioral health office visits or for inpatient mental health admissions after treatment in an emergency department,” according to a media release from the AG’s office. Harvard Pilgrim Health Care and AllWays Health Partners, working through Optum, will no longer “overrule healthcare providers’ decisions on what constitutes appropriate care, including decisions about the appropriate type of treatment and frequency of visits.” Healey also went after Harvard Pilgrim and Blue Cross Blue Shield of Massachusetts for imposing prior authorization requirements on patients who sought substance use disorder treatment out of network or out of Massachusetts – in clear violation of state law.
 
Blue Cross Blue Shield, Harvard Pilgrim, AllWays, Fallon, Optum, Beacon Health Strategies, United Behavioral Health, and Tufts Health Plan all agreed to “robust provider directory audits” and timely corrections to them, and all agreed to pay a total of nearly $1 million to a fund that the AG’s office will use “to promote initiatives designed to prevent or treat substance use disorders, increase access to behavioral healthcare services, or otherwise assist Massachusetts behavioral healthcare patients.”
 
Response to AG Healey’s action was swift, bipartisan, and favorable across the healthcare continuum. Massachusetts Health and Human Services Secretary Marylou Sudders said, “The result of the Attorney General’s investigations will help ensure that parity and improve access for individuals seeking behavioral health treatment. Behavioral health is at the heart of Governor Baker’s healthcare bill, which proposes important shifts in our system that will enable us to address access, affordability and availability, and will ensure Massachusetts’ continued leadership in healthcare.”
 
Earlier this month, the Massachusetts Senate passed the Mental Health ABC act that would, in part, strengthen Massachusetts parity laws and give the Division of Insurance the authority to more strictly enforce parity.
 
MHA President and CEO Steve Walsh said, “Wholesale prior authorizations have rankled skilled providers in the commonwealth for many years, and the chronic underpayment of those who provide mental healthcare and substance use disorder care to our citizens has been a long-standing problem. In one important and powerful action, AG Healey has taken a meaningful step toward resolving these seemingly intractable problems and, in doing so, has improved the health of the commonwealth and the lives of our front-line caregivers.

The Center for Health Information and Analysis (CHIA) and MHA have released a report detailing proposed solutions to account for social risk factors in the public reporting of all-payer, unplanned hospital readmissions. CHIA reports regularly on unplanned hospital readmissions; however, recent national research provides evidence that social risk factors should be accounted for in the measurement of a hospital’s readmissions performance.
  
In response to the emerging consensus on the issue, CHIA convened a workgroup of representatives from state agencies, hospitals and health systems, provider and payer groups, and methodology experts to discuss if, and how, to incorporate social risk factors into readmissions data. MHA co-chaired this statewide workgroup.
 
CHIA in conjunction with the workgroup developed an enhanced risk-adjustment model for its all-payer readmissions analysis. The model includes patient- and community-level risk factors, such as poverty, education, housing, and food insecurity. In a preliminary analysis of reporting under the new model, readmission rates of hospitals serving a high proportion of Medicare and Medicaid patients declined more than any other hospital cohort, from 16.5% to 16.3%. 
 
“There is a growing body of evidence that social risk factors influence access, utilization, and the quality of healthcare,” said MHA Vice President for Clinical Affairs Patricia Noga, R.N., Ph.D. “It’s important to understand the challenges hospitals face that are beyond their control, and to learn from those facilities that successfully reduce readmissions despite these challenges.”
 
The workgroup’s recommendations are consistent with national trends. CMS recently began accounting for social risk factors in its Hospital Readmissions Reduction Program by noting the proportion of dually eligible Medicare and Medicaid patients when assessing hospital performance. Dual eligibility is often an indicator of poor socioeconomic conditions.
 
CHIA plans to create a pilot with select hospitals to field questions and obtain additional feedback prior to implementing the recommended changes statewide. This enhanced methodology will be incorporated into CHIA’s next annual readmissions report.
 
“Adjusting for social risk factors will allow for more equitable comparisons of readmission rates, which are increasingly being viewed as a performance measure of a hospital or health system,” said Ray Campbell, CHIA’s executive director.

No one is downplaying the concerns about the COVID-19 virus that has affected numerous countries and has even roiled the financial markets. But in a conference call with hospital leaders last Thursday, DPH Commissioner Monica Bharel, M.D., reminded the healthcare community that the risk from the virus in Massachusetts is still considered low, that there has been only one confirmed case in the state, and that the regular flu to date is a more serious healthcare concern that has affected 30,000-plus people.
 
The individual with the single confirmed case of COVID-19 in Massachusetts is doing well and is “self-isolated,” Bharel reported. Hospitals have had some concerns with personal protection equipment supplies but those have been handled by regional health and medical coordinating coalitions and the concerns have not yet reached the level of requiring DPH involvement. All hospitals have surge capacity plans in place.
 
Bharel encouraged hospitals to review this preparedness assessment tool available from DPH’s dedicated COVID-19 website, and noted that the state’s epidemiology help line is available 24/7. (Hospital personnel on the conference call said the assistance received from the state’s help line to date has been invaluable.) Lawrence Madoff, M.D., the medical director of DPH’s Bureau of Infectious Disease and Laboratory Sciences, participated on the call. Bharel also asked the healthcare community assistance in countering the “prejudice and xenophobia” that has surrounded COVID-19 outbreak. 
 
The following day, DPH announced that the State Public Health Laboratory has received approval to begin testing patients for COVID-19, in accordance with guidance from the U.S. Centers for Disease Control and Prevention. The CDC's new guidance for evaluating persons for COVID-19 is here.
  
Clinicians who have patients they think may have symptoms consistent with COVID-19 and who meet the current CDC definition of a Person Under Investigation can contact DPH to receive authorization to submit specimens for testing. Testing at the state laboratory will speed up obtaining test results. MHA has put together an internal COVID-19 task force to assist and coordinate with its membership, the state, and the American Hospital Association.

The controversial “public charge” federal rule went into effect on Monday, February 24, making it more challenging and confusing for immigrants to apply and access available healthcare coverage offerings, including Medicaid and other low-income programs.
 
In August 2019, the Department of Homeland Security released a final rule that changes the definition of a public charge when determining whether to approve certain immigrants seeking to live legally in the United States or obtain legal status through a green card, among other immigration routes. Among other factors, the new rule now includes the use of non-emergency Medicaid when evaluating certain individuals (children and pregnant women are exempt). MHA, along with healthcare providers and other advocates across the country, had strongly opposed the rule from the outset.
 
Many legal immigrants have access to healthcare insurance offerings in the U.S., including Medicaid. Other immigrants ineligible for Medicaid can still access programs that do not fall under the definition of benefits subject to public charge; these include the Health Safety Net and MassHealth Limited. MHA’s concern, which is shared by other patient advocates, is that immigrants, whatever their status, will simply forego applying for these programs altogether rather than take any risk of having these benefits later used against them in an application for an immigration status determination. That is, the challenge of ensuring people have access to available affordable health coverage offerings has been made even more complicated by the new public charge rule, which could lead to individuals and families avoiding needed health insurance as well medical care. This document from Health Care For All details the issue further.
 
MHA, along with Health Law Advocates and Health Care For All, is holding an MHA members’ briefing on the issue this Wednesday, March 4. MHA members can register by the end of today, March 2, by contacting MHA Leanne Banks at lbanks@mhalink.org.

The Massachusetts Coalition for the Prevention of Medical Errors, Massachusetts Medical Society, and MHA are joint providers of a forum entitled “Driving Improvement and Patient Safety through Engagement of Clinicians, Staff, Patients, and Families” on Wednesday, April 29 from 7:30 a.m. registration to 3 p.m. adjournment.
 
This year’s program was organized to help healthcare leaders achieve substantial and rapid improvement in patient safety/ outcomes, efficiency, and patient experience. There is also a focus on strategies to improve work processes to help reduce the stress on clinicians and staff that can contribute to burnout. 
 
At the April 29 forum, clinical and administrative leaders in hospitals and physician groups can learn organizational strategies that accelerate improvement by supporting and empowering clinicians and staff to improve workflows, thereby addressing processes which waste time or produce little value for patients. These strategies can improve both patient care and the experience of the workforce.
  
One presenting organization has experienced an 80% decline in serious safety events, a 90% reduction in potential malpractice claims, and a 90% reduction in employee injuries. Another has achieved a 51% reduction in hours per month that nursing leaders spend in patient care service-based meetings, allowing them to spend more time engaging staff to identify and address problem processes.
 
The forum is for clinical and administrative leaders from all disciplines, C-suite leadership and board members, operational managers, quality-safety-risk leaders and staff, patient and family representatives, policymakers, and anyone interested in performance improvement and patient safety.
 
For the full program announcement, agenda, accreditation information, and registration, please click here.

The U.S. House of Representatives last Friday passed H.R. 2339 – The Reversing Youth Tobacco Epidemic Act of 2019 by a vote of 213-195. The bill prohibits the sale of flavored tobacco products that appeal to kids, including flavored e-cigarettes, flavored cigars, and menthol cigarettes. The bill also raises the age of sale for tobacco products to 21, which would further reduce youth tobacco use, and it would ban the online sales of tobacco products (which often have no age verification requirements). H.R. 2339 also cracks down on the marketing strategies of tobacco companies to prevent them from sponsoring sports, music, and other events.
 
Last fall, MHA signed a coalition letter to the Massachusetts delegation asking them to sign on to the law. Rep. Ayanna Pressley and Rep. Joe Kennedy did endorse the bill and on Friday the entire delegation voted Aye. In Massachusetts, 20.1% of high school students use e-cigarettes. Over half of youth smokers – and 70% of African American youth smokers – smoke menthol cigarettes. In Massachusetts, 10.5% of high school boys smoke cigars.

The eighth annual Communication, Apology, and Resolution Forum hosted by the Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI) takes place on Friday, May 8 from 9:30 a.m. to 3:30 p.m. at the Massachusetts Medical Society, 860 Winter Street, Waltham. The event is free. Registration opens in March.
 
MACRMI is a Massachusetts alliance of patient advocacy groups, healthcare facilities and their insurers, and statewide provider organizations committed to transparent communication, sincere apologies, and fair compensation in cases of avoidable medical harm. Through MACRMI’s Communication, Apology, and Resolution (CARe) process, patients and families who experience adverse medical events are provided full communication about the facts of the event, and have the opportunity to ask questions and receive timely, honest answers. In cases of preventable injury, providers and healthcare organizations apologize, discuss with patients what will be done to prevent the error from recurring, and work with their insurers to give patients a fair and timely resolution and, if appropriate, compensation, without the patient having to resort to litigation.

A U.S. District Court Judge in the Eastern District of Pennsylvania ruled last Tuesday that a safe consumption site (otherwise known as a supervised or safe injection facility) planned for Philadelphia did not violate federal statue and could open as early as this week. But just two days later, Safehouse, the non-profit behind the facility, said it would not open due to extensive community opposition and because the building owner announced he wished to sever the lease with the non-profit. Previous to the Safehouse decision, the U.S. Attorney for Eastern Pennsylvania William McSwain announced he would file an appeal of the ruling and requested that the judge stay his order to avoid, as McSwain said, a “literal street fight” between the site's proponents and opponents.
  
Communities in Massachusetts that are assessing the feasibility of safe consumption sites are watching the Philadelphia dispute closely. In Massachusetts, U.S. Attorney Andrew Lelling, like his counterpart in Pennsylvania, has vowed to oppose such facilities.

Optimizing Patient Flow & Throughput

Friday, March 20; 8:30 a.m. - 3 p.m.
MHA Conference Center, Burlington, Mass.

Hospital-wide patient flow is essential in achieving value-based health and delivering safe, high-quality care. Hospitals are examining how to provide the right care, in the right place, and at the right time while reducing costs and eliminating waste. Join us at this full-day program where we’ll look at patient flow from all aspects of the hospital’s operations. We’ll feature teams doing great work and showing the various innovations that can make all the difference in throughput from admissions to discharge. This program is geared toward clinicians, process improvement staff, or leaders seeking ideas for improving patient flow. Confirmed sessions include: Leading Through Influence: Managing People & Change; Shaving Minutes, Saving Dollars: Driving Operating Room Efficiencies; Bed Management & Length of Stay: Working Effectively as a Team; Reducing Length of Stay for Patients with Complex Needs; and Leveraging Information & Analytics to Improve Hospital Throughput. View the speaker list, full schedule, and registration details here.