As the global effort to create a COVID-19 vaccine intensifies, MHA last week announced that it would form a member workgroup to identify and address issues relating to the planning for, rollout of, and communications about any vaccine. In the past few weeks, frameworks have been released – one from the CDC and one from the National Academy of Medicine – recommending that healthcare workers, patients with high-risk co-morbidities, and residents in long-term care facilities should have highest priority for access to a COVID-19 vaccine, when available. As such, any vaccine rollout will have a critical effect on the healthcare workforce, patients, and communities. In addition, the rollout of a COVID-19 vaccine is likely to be a highly complex endeavor as it is not yet known which vaccines will be available, at what time, with what efficacy, in what volumes, and with what storage, handling, or booster requirements. MHA sent out a request last week for members to nominate workgroup participants from a variety of disciplines.

  

The Health Policy Commission (HPC) last Thursday released a brief on the Telemedicine Pilot Investment Program it began in 2016, finding that the program “demonstrated that telemedicine can be an effective modality for expanding access to high-quality behavioral health care for high-need patient populations across a variety of settings.”
  
The HPC funded interventions through four organizations: the Pediatric Physician’s Organization at Children’s, Heywood Hospital, UMass Memorial Medical Center, and Riverside Community Care.
  
Noting that access to timely behavioral health services remains a challenge across the commonwealth, the HPC said that its pilot program allowed the four institutions to implement “innovative interventions to address these barriers and meet the behavioral health needs of populations that typically lack access to critical behavioral healthcare.”
  
The Heywood Hospital school-based telemedicine program for adolescents reduced school days missed by an average of six days for students enrolled in the program. The Pediatric Physicians’ Organization at Children’s program reduced the wait time for psychiatric assessments, and the UMass program led to the increased initiation or maintenance of medication for addiction treatment.
  
The House and Senate healthcare bills (HB4916 and SB2796) now being debated in conference committee each contain elements that would solidify the continued use of telehealth as a tool in the Massachusetts healthcare system – a goal that MHA supports. 
  

More than 350 clinical and executive healthcare leaders from across Massachusetts tuned in virtually last Thursday for MHA’s Annual Leadership Forum, entitled Healthcare Reimagined. The full-morning online session was broadcast live and featured notable healthcare thought leaders, equity and inclusion experts, and a COVID-19 survivor who spent several months in Massachusetts caregiving facilities to recover fully from the deadly virus.
  
MHA Board Chair and Lowell General Hospital and Circle Health President & CEO Jody White delivered opening remarks, and Governor Charlie Baker recorded a video greeting, praising MHA and Massachusetts hospitals for their “life-saving, game-saving, and heroic” efforts during the past nine months of the pandemic.
  
Physician and health reporter Mallika Marshall, M.D. served as emcee of the forum, as well as moderator for a panel entitled Health Equity and the Urgency of Now. Panelists Thea James, M.D., from Boston Medical Center and an MHA Board member; Frank Robinson, from Baystate Health; and Carl Sciortino from Fenway Health tackled pressing questions about systemic racism in healthcare and health disparities. The three talked not only about health programs to help affected communities and populations, but the fact that long-standing, underlying racist policies that have deliberately barred quality housing and economic growth in communities are the direct contributors to poor health outcomes.
  
“Unless we address the root causes of why people have those [health] gaps, things never, ever change,” James said.
  
Questioning one’s commitment, continual self-assessment, and measuring each policy decision with the “intentionality to disrupt systems” are some of the ways the panel suggested individuals and institutions can make diversity, equity and inclusion gains in the healthcare space.
  
Atul Gawande, M.D., founder and Chair of Ariadne Labs and Cynthia and John F. Fish Distinguished Chair in Surgery at Brigham and Women’s Hospital, discussed in his keynote address how Massachusetts healthcare and health sciences are making outsize contributions to the national fight against COVID-19, in terms of early recognition of the problem, contact tracing, vaccine development, and more.
  
Frank Cutitta spent more than 100 days in the COVID ICU at Mass. General Hospital and then undertook intensive rehabilitation from the virus at Spaulding Hospital Cambridge. Now recovered, he spoke to the Leadership Forum attendees about the caregivers who refused to give up on him and his long struggle. One takeaway: being in isolation for so long and encountering only caregivers who wore safety masks, Cutitta missed the connection one gets from seeing a person’s face. (Some hospitals now have digital boards that display a photo of the caregiver entering a room.)
  
In closing the event, MHA president & CEO Steve Walsh reminded attendees that the time for innovative action is now.
  
“From health equity to innovation, the issues discussed today can’t wait any longer,” Walsh said.
  

In the recent past the Massachusetts Department of Public Health (DPH) has strengthened its ability to investigate and combat sexually transmitted diseases by gaining confidential access to hospital electronic health records (EHRs). Now DPH wants to create a pilot program that would allow state epidemiologists remote access to hospital EHRs so that the department can have timely and complete information about cases of COVID-19 and their close contacts for the express purpose of performing its public health duties. Case investigations in the past about STDs or vaping product use, among other public health issues, require hospital staff to provide DPH with a large volume of data. Recent COVID-19 investigations require hospitals to provide DPH with patient contact information, length of stay, level of respiratory support, occupation, race/ethnicity, and exposure history – all of which requires many work hours. By allowing remote access to EHRs through the pilot, DPH wants to investigate if its epidemiologists can get the data they need and, at the same time, reduce the administrative burden on hospitals. Last week, MHA put out a call to its membership to get volunteers for the pilot program.

The U.S. Health & Human Services General Counsel issued a strongly worded letter to the large drug manufacturer Eli Lilly last week, telling the company that its actions relating to the 340B drug program were out of line.
  
The 340B program allows certain provider organizations to get discounts on pharmaceuticals from manufacturers participating in the Medicaid program. Eli Lilly had written to HHS asking if the drug company’s plan to unilaterally alter its 340B pricing agreement with certain pharmacies would result in sanctions. Unwisely, the drug company set its own deadline for HHS to respond.
  
HHS responded that in the midst of a pandemic, the government is under no obligation to meet Lilly’s arbitrary deadline and that the company’s pricing decision during an unprecedented economic downturn “is, at the very least, insensitive.”
  
Noting that Eli Lilly “seems to be enjoying an outstanding year” financially, HHS Counsel Robert Charrow, writes, “In contrast, during this same period, most healthcare providers, many of which are covered entities under section 340B, were struggling financially and requiring federal assistance from the Provider Relief Fund established by the CARES Act.”
  

Harrington HealthCare System has voted to enter into a letter of intent with UMass Memorial Health Care to pursue an acquisition agreement. According to a media release, “The agreement would allow Harrington HealthCare System [HHCS] and Harrington Hospital to maintain their local community boards with reserved powers held by a UMass Memorial subsidiary, which will become the sole member of HHCS. Further, HHCS Board will have representation on both the parent and community hospital boards of UMass Memorial." The Harrington system consists of Harrington Hospital in Southbridge, Harrington HealthCare at Webster, and three additional medical office buildings. The acquisition is expected to take six to nine months.

President Trump issued an executive order last Thursday that, among other things, focused on the issue of surprise billing and reaffirmed the right of patients with pre-existing conditions to get health insurance.
  
The order says that if Congress does not address the issue by year’s end, U.S. Health & Human Services will update the Hospital Compare website to inform Medicare recipients of hospital billing practices, including whether the hospital: is in compliance with the Hospital Price Transparency Final Rule (that is, the public posting of charges); provides patients upon discharge with a receipt that includes a list of itemized services received during a hospital stay; and reports how often it pursues legal action against patients over payments.
  
Hospitals agree that no patient should be caught in the middle when it comes to out-of-network billing. The main issue, however, is how to resolve such billing disputes between provider and insurer. MHA has strongly opposed setting fixed benchmark rates, opting instead to allow health insurance companies and providers to negotiate out-of-network reimbursement. If those negotiations fail, hospitals support mediated dispute resolution.
  
The executive order also reaffirms the right of Americans with pre-existing conditions to get health insurance coverage, adding that “the [Affordable Care Act] is neither the best nor the only way to ensure that Americans who suffer from pre-existing conditions have access to health-insurance coverage.”
  
Incredulous Democrats, including U.S. Ways and Means Chair Richard Neal (D-Mass.), criticized the president’s new-found commitment to protecting those with pre-existing conditions, calling it “a shameless election year stunt.”
  
“If President Trump and his Republican allies were serious about protecting the more than 130 million people with pre-existing conditions, then they would drop their ongoing lawsuit to overturn the ACA and its consumer protections,” Neal wrote, along with Energy and Commerce Chairman Frank Pallone, Jr. (D-N.J.) and Education and Labor Chairman Robert C. Scott (D-Vir.).
  

The Quality and Patient Safety Division of the Massachusetts Board of Registration in Medicine has released a collection of stories from Massachusetts hospitals and other providers detailing how they have been dealing with COVID-19, and how they’ve protected staff and patients during the pandemic.
  
Among many other narratives, the document contains stories of how Emerson Hospital dealt with PPE shortages and instituted programs to ease the burden on its workforce; how Milford Regional Medical Center created a “Quick Guide for Approach to Patients with Suspected/Confirmed Covid-19 Disease,” and how Spaulding Hospital Cambridge converted four LTAC units to treat patients with COVID-19.

CMS released a "snapshot" slide deck last Wednesday that showed primary, preventive, and mental health services have declined among children during the pandemic. The federal Medicaid and Children’s Health Insurance Program (CHIP) data also shows that service delivery via telehealth for children has increased dramatically, but not enough to offset the overall decline in services.

Preliminary data show vaccinations among Medicaid/CHIP beneficiaries up to age 2 declined through April, started to level in May, but are still substantially lower than prior years’ rates. Child screening services and dental services followed similar trends. CMS reported outpatient mental health services for children declined through May; telehealth for children’s mental health services increased starting in March but, again, it was not enough to offset the decline.

Preliminary data show nationwide delivery of any services via telehealth to children increased by over 2,500% from February to April 2020; Massachusetts was among the states providing the most telehealth services to children.