06.08.2020

Voices on Racism. Telemedicine Works.

Healthcare, Inequity, and Action

The ongoing focus and actions on race in the United States has resulted in the healthcare community taking stock of its responsibilities and responses to inequity. Throughout the commonwealth and nation, healthcare interests addressed racial disparities in care, hiring practices, underserved communities, and other long-standing problems. To their credit, hospitals and the caregivers they employ do abide by a central tenet of treating everyone who comes though their doors with respect and with high-quality care. But it is clear much more must be done. Here are just a few voices on the issue:

1) Nurses outside of Brigham and Women’s Hospital knelt silently for 8 minutes and 46 seconds in honor of George Floyd, who was murdered by police in Minneapolis on May 25.
 

2) “Despite the rage and hatred that seems to be advancing in our country, Baystate Health can take a stand for something better. We can uphold our core values of respect, integrity, teamwork, and lifelong learning, which are every bit as important in our lives in our communities as they are in our work environments. I condemn what happened to George Floyd, as well as the attitudes that led up to it, as wrong and unacceptable for our community. I want us to ensure a safe place for everyone – a place where caring connections can be made, both for the good of our employees and the diverse communities we serve.” -- Mark Keroack, M.D., President & CEO, Baystate Health, in a letter to his community

 
3) “Recent events, including COVID, have shined a bright light on the structural racism and inequities that so many of our patients and colleagues confront every day. Boston Medical Center is a place of healing and, I hope, a beacon of comfort to the patients, families, and communities we serve. We would not be able to live our mission without having committed to understanding, engaging, and working to stop both the highly publicized tragedies and the day-to-day injustices. This always has and always will be central to our work at BMC. -- Kate Walsh, Boston Medical Center President & CEO, in a tweet about doing the work needed.

 
4) “Beth Israel Lahey Health stands in solidarity against racism & hate. We affirm our commitment to work together each day to constructively address disparities in our community & foster an inclusive culture. Our hearts go out to all who have been impacted by violence & injustice.” -- BILH’s June 1 tweet, which it followed with a blank post on #blackouttuesday

 
“Systemic racism is a sickness just as potent as the diseases we treat every day, and Massachusetts is not immune. MHA stands with those across the commonwealth who are raising their voices to deliver a critical message: Black Lives Matter. They are the voices of our patients, our caregivers, and our neighbors. We recognize that we must be a part of the solution. We are committed to using the very tenets our healthcare system is built upon - compassion, collaboration, and healing – to advocate for chronically underserved communities and act as conduits for change. Our members share a sacred responsibility to value every life, and we know that responsibility must extend beyond the walls of our hospitals and medical offices.” -- From MHA President & CEO Steve Walsh’s statement

 
6) “Continued acts of aggression and excessive force against African American communities, a result of unjust systemic inequities these communities face, cannot be tolerated. It is not one incident. Repeated acts, over time, have an insidious, devastating impact on individuals, families, and communities, directly impacting the attainment of well-being— both physically and mentally.” -- American Academy of Nurses statement released June 1.

Telemedicine Tested – and Succeeds

If there is a positive that has come out of the very dire COVID-19 environment, it’s that telemedicine has lived up to all of the benefits its proponents have touted in recent years. Conducting medical consults through interactive live audio-video platforms or through the telephone, and sharing images and videos has ensured that people have continued to receive quality care when they couldn’t visit hospitals and other care facilities in-person. This includes a significant number of behavioral health visits. Telemedicine is bringing care to underserved communities, as well. Last week, Attorney General Maura Healey, in a speech on race before the Greater Boston Chamber of Commerce, pointed specifically to telehealth and community hospitals as essential components to helping erase the “systemic under-investment in the health of low-income and communities of color” and the so-called digital divide. Because of the state’s still-standing emergency declaration and subsequent Baker Administration executive orders and coverage bulletins, telehealth visits for state employees and for those covered by commercial health insurance companies and MassHealth recipients are being paid at the same rate as in-person health visits.

“Telemedicine has proven to be an essential tool in the healthcare system under the ‘new normal’ and it should be recognized and reimbursed permanently as in-person visits,” said MHA’s President & CEO Steve Walsh. “Providers and patients have been satisfied with telemedicine as a convenience and our state has reduced the transmission of COVID-19 by allowing people to stay in their home while receiving the same high-quality care through telemedicine as they received when they visited their primary care provider in-person. It’s a game-changer.”

Congressional Leaders Ask: Where’s the Medicaid Money?

A bipartisan coalition of Congressional leaders wrote U.S. Health & Human Services Secretary Alex Azar last Wednesday asking for the prompt release of federal funding to help Medicaid providers. After two COVID-19 relief bills appropriated $175 billion in provider funds, only about $75 billion has been distributed. In the letter, Senators Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.), along with Representatives Frank Pallone, Jr. (D-N.J.) and Greg Walden (R-Ore.), note that “providers that depend on Medicaid for a large source of their payments have not yet received a meaningful allocation from the [federal COVID-19 fund]. Many of these providers are safety net providers that operate on thin profit margins, if at all. The COVID-19 pandemic has strained their already scarce resources, threatening their ability to keep their doors open in the midst of a declared public health emergency.” The four officials ask HHS to reveal its timeline for release of a dedicated tranche of funds for Medicaid-dependent providers, as well as the methodology HHS will use to distribute the funds. They are also critical of HHS waiting until May 1 to request Medicaid-dependent provider information from states, and ask for an explanation of the delay. Grassley is chair of the Senate Committee on Finance and Pallone chairs the House Committee on Energy & Commerce. Wyden and Walden are the ranking members of those two committees.

MassHealth Responds to MHA/Hospital Request on Enrollments

The Executive Office of Health and Human Services (EOHHS) last week announced a new 90-day retroactive eligibility policy for MassHealth applicants affected by the COVID-19 emergency. This had been an early MHA priority request based on MHA member feedback when the effects of the pandemic first began. It was evident that an extended lookback period would be needed given the social distancing obstacles facing patient financial counselors and applicants to complete applications. The longstanding MassHealth retroactive eligibility policy allows only 10 days coverage prior to the date of application. The 90-day retroactive coverage is now available only to members who applied on or after March 1, 2020, and who are under the age of 65.

Virtual Webcast: The Final 2021 Hospital Inpatient PPS Rule

Wednesday, August 19; 1 p.m. - 3:30 p.m.

Join us at MHA’s annual program to review the final IPPS inpatient rule. We’ll cover all of the critical changes and updates important to hospitals. Learn from expert speaker Valerie Rinkle during this virtual session as she covers important updates surrounding the 2021 IPPS 2021. The webcast will include engaging virtual components such as breakout sessions, polls, and networking features. The webinar will focus on: financial updates to standardized amounts, changes to codes and MS-DRG groupings; new technologies approved for add-on payment and how to ensure appropriate payment given caps; uncompensated care, including codification of bad debt policies that would affect charity care and disproportionate share; and market-based pricing, including a new requirement to report median negotiated payment rates via the cost report. Register here.

John LoDico, Editor