MHA on State and Federal Funding; Non-COVID Surge

MHA to U.S. HHS: Thank You, but Please Improve the Next Round

In a letter to U.S. Health & Human Services (HHS) Secretary Alex Azar, MHA President & CEO Steve Walsh thanked HHS for recent COVID-19 funding, but added the methodologies the administration has used to date in parceling out the funds “have failed to recognize the full effect of COVID-19 challenges experienced in Massachusetts and has left too many of our hospitals without needed relief."

Walsh detailed how HHS’s “high-impact allocation formula” was not equitable “and failed its intended goal to aid the facilities most affected by the surge of COVID-19 patients, a significant number of which are in Massachusetts.” Because the pandemic surge hit differing parts of the country at different times, and the length of the surge varied by location, the HHS formula came up short, Walsh wrote. “For example, Massachusetts reached its peak after the April 10 cut-off used in the ‘high impact allocation’ and experienced a prolonged plateau thereafter. On April 10, our state reported 20,973 COVID-19 cases and since then more than 58,359 new cases have occurred as of May 12. During the approximately one-month period following the April 10 mark, this increase represents the fourth largest in the country whether measured on a straight count or per capita basis.”

MHA called on Azar to ensure the second “high-impact allocation” uses a methodology that “prioritizes hospitals that have not yet received hot-spot funds and are located in states with a high percent of COVID-19 cases. This targeted approach will more equitably reflect the financial plight of the hospitals most affected over the past two months by the triaging and caring for coronavirus patients.”

MHA to MassHealth: Rate Relief for Critical Part of the Care Continuum

To date, the Baker Administration has been very responsive to the hospital community’s clinical and financial concerns, imposing a number of regulatory directives and financing moves that have greatly assisted COVID-19 preparations and response. Financial support through Medicaid rate increases or supplemental payments has flowed to hospitals, nursing facilities, community behavioral health providers, physicians, ambulance companies, health centers, home health agencies, personal care attendants, and others. But in a letter to MassHealth last week, MHA detailed one component of the healthcare continuum that hasn’t received relief – long-term care and rehabilitation hospitals.

“Following inpatient acute care hospital stays, many COVID-19 patients require follow-up care to support their recovery, a process that is proving longer than typical due to respiratory illnesses,” MHA’s Senior Director of State Government Finance & Policy Dan McHale wrote to Acting Medicaid Director Amanda Cassel Kraft. “For many, this care is similar to that provided in intensive care units (ICUs), with close staff monitoring and added resources required. Many COVID patients require ventilator and tracheostomy care while also suffering from significant physical weakness and other medical conditions. Post-acute hospitals have also had to take enormous measures to protect their patient populations and staff from the virus – a significant challenge and priority given the vulnerabilities of the patients they serve. This has meant reconfiguring their facilities for the influx of COVID patients, dedicating staff to COVID positive and negative patients, and purchasing significant amounts of personal protective equipment."

MHA is seeking an enhanced MassHealth reimbursement rate to support these facilities, both in the form of a rate increase and restoration of the administrative day rate for all cases during the emergency.


New “Surge” Not All About COVID-19

As the state begins the process of re-opening, the healthcare community as well as society in general is rightfully concerned about how the easing of social distancing may result in a new surge of COVID-19 cases. But hospitals are also preparing for another sort of surge, relating to the sorts of things for which people regularly rely on hospitals. As people leave their houses and hit the highways, bike trails, mountains, lakes, beaches, and more, there most likely will be a wave of health cases resulting from non-homebound pursuits. Strains, accidents, social confrontations and more will, unfortunately but inevitably, result in ED visits and hospitalizations. Add that to the patients re-visiting hospitals to seek the care they have been deferring during social distancing – plus any surge in new COVID-19 cases – and hospitals could quickly be facing sudden and massive pressures.

MHA Joins Other Hospital Associations in Defense of ACA

MHA has joined 35 other state hospital associations in filing an amicus brief with the U.S. Supreme Court in support of the Affordable Care Act (ACA). At issue is a Fifth Circuit Court of Appeals ruling that found the ACA’s individual mandate unconstitutional. ACA critics argue if the individual mandate is unconstitutional, then the entire ACA must be scuttled. ACA supporters, including MHA, endorse severability, meaning that even if the individual mandate falls, the voluminous other parts of the ACA should survive. The associations argue that the appeals court erred in its individual mandate decision, and add: “But if this Court decides otherwise, amici concur that this Court should hold that the rest of the ACA must remain intact.” The hospital associations argue that the numerous delivery reforms in the ACA have redefined U.S. healthcare.

“Both [U.S. district and U.S. appeals] courts failed to recognize that the ACA’s delivery reforms have transformed the delivery of health care in the United States by providing more integrated, cost-effective care, while maintaining quality,” the brief reads. “And because there is no basis for concluding that Congress intended those provisions—which were enacted in separate titles and function independently of the ACA’s insurance-related provisions—to be inseverable, they, along with the other remaining provisions, should be left intact regardless of how the Court rules on the constitutionality of the minimum coverage provision.”

State Issues Reporting Mandate for New Pediatric Ailment

Last week saw an uptick in a new pediatric multi-system inflammatory syndrome (PMIS), which could be linked to COVID-19. DPH issued a clinical advisory calling for increased testing and mandatory reporting on cases that present with symptoms of the affliction. According to DPH, PMIS has features which overlap with Kawasaki disease and toxic shock syndrome. Inflammatory markers may be elevated, and fever and abdominal symptoms may be prominent. Other reported findings have included rash, myocarditis and other cardiovascular changes, impaired ability for blood to coagulate, and acute kidney injury. Some patients have required intensive care.

Of note, not all children with this inflammatory syndrome tested positive for COVID-19. But clinicians are finding that PMIS is “temporally related” to the coronavirus. On May 2, the International PICU-COVID-19 Collaboration, coordinated by Jeffrey Burns, M.D., chief of Critical Care Medicine at Boston Children’s Hospital, convened a Zoom conference to compare notes.

The Impact of COVID-19 on Health Disparities: Strategies for Addressing Health Equity

Tuesday, May 19; 1 - 1:30 p.m. EDT

COVID-19 has disproportionately affected lower-income communities and people of color. The healthcare system has a role to play in addressing systemic disparities faced by these groups while providing access to critical healthcare services. Join us for an in-depth discussion with Thea James, M.D., Vice President of Mission and Associate Chief Medical Officer at Boston Medical Center. We will discuss how COVID-19 has amplified existing health inequities and offer specific strategies for healthcare systems and leaders to address structural barriers to health equity during this pandemic and beyond. Click here to register.

John LoDico, Editor