Community Benefits. Caregiver Burnout. Telehealth.

MassHealth Extends Telehealth Past COVID-19 Emergency

One of the most noteworthy care delivery changes that has occurred during the COVID-19 public health emergency is the increased, and successful, use of telehealth.
Last week, MassHealth issued an all-provider bulletin that maintains the telehealth policies that have been in effect in the state during the pandemic, and that extends them for 90 days after the end of the Massachusetts-declared public health emergency. Under the state policy, the rates of payment for telehealth services are the same as the rates of payment for traditional, in-person visits. Notably, the bulletin continues to maintain coverage and reimbursement for the use of audio-only telephone services as well. The bulletin applies to MassHealth fee-for-service, primary care clinician, and primary care ACO arrangements. Additionally, MassHealth managed care organizations will be required to maintain telehealth flexibility to the same extent as MassHealth until 90 days after the end of the Massachusetts-declared public health emergency. The bulletin continues to permit qualified MassHealth providers to prescribe controlled substances (schedule II-IV) to members using telehealth modalities without an in-person visit and in compliance with all applicable state and federal laws, regulations, and guidance.
As for what will happen to telehealth post-COVID-19 emergency, MassHealth has indicated it will issue additional guidance to describe its successor telehealth policy. MassHealth has been participating in listening sessions along with the Division of Insurance to hear from healthcare providers and others regarding the successor policy that will hew to the state’s new telehealth law, Ch. 260 of the Acts of 2020. How to address telehealth going forward in the “new normal” will also be a topic of discussion for the MHA MassHealth Hospital Workgroup.

Massachusetts Hospitals’ Community Benefit Initiatives

MHA’s new Saving Lives. Serving Communities. publication, created with the assistance of its membership, describes the community benefit process in Massachusetts and provides examples of programs from hospitals across the state. Community benefits are an essential – but not always visible – role that hospitals play outside of their walls in improving the health of their patients. 
FY2019 is the most recent available year of community benefits reporting to the Attorney General’s office. The $753 million in aggregate funding represents a $112 million increase from FY18. The IRS – which views community benefits more expansively by allowing hospitals to count financial losses related to care provided to Medicaid recipients and medical education costs, among other metrics – totals hospital community benefits in Massachusetts at $2.7 billion for the same period. The pdf of the report contains this link directing people to the Attorney General’s database on all community benefit programs offered throughout Massachusetts.
The report notes that the robust outreach to communities before the pandemic hit surely had a positive effect in minimizing in some way the devastation from COVID-19 that followed in the successive year.

Hospitals, Physicians, Healthcare Leaders Address Clinician Burnout

As the COVID-19 pandemic continues to place tremendous strain on the resiliency and wellbeing of caregivers, 120 Massachusetts hospitals, physician organizations, and healthcare leaders have signed on to a Massachusetts Medical Society-MHA initiative that commits the groups to continue their efforts in addressing clinician burnout. 
The MMS-MHA Joint Task Force on Physician Burnout, in collaboration with local and national organizations, has analyzed the causes of physician and clinician burnout and identified and shared effective burnout reduction strategies. The to-date 120 groups will select a measure of clinician wellness or burnout, measure its prevalence in their organization over time, and include improving that measure as an institutional goal.
“Our caregivers are often called heroes, but they are still very much human and are subject to more stress and strain than ever before,” said Steve Walsh, MHA president and CEO. “Hospitals and healthcare leaders are focused on ensuring that our most valuable resource – our clinicians – get the support they need. This latest commitment has the flexibility to allow organizations to focus on specific areas tailored to their individual needs, which ultimately helps us address burnout on a united front.” 
“The issue of clinician burnout was at an alarming level long before COVID-19. We are fortunate that healthcare leaders and systems came together to acknowledge and begin to address the issue,” said Dr. David A. Rosman, MMS president. “During the pandemic, members of the health team demonstrated their unwavering commitment to their patients, no matter the risk. It turned out that the risk was more than COVID-19 – working to the brink of exhaustion and despair, their mental health has been pushed to and in some cases over the edge. This commitment to addressing burnout and deploying institutional improvements is a critical step in assuring that clinicians and all healthcare teams are able to deliver care to our patients through the pandemic and beyond.”
The MMS-MHA task force has outlined some its findings in its publications Changing the EHR from a Liability to an Asset to Reduce Physician Burnout and A Crisis in Health Care: A Call to Action on Physician Burnout. The group’s work also aligns closely with the work of MHA’s Caring for the Caregiver Task Force, which focuses on challenges relating to worker safety, wellbeing, engagement, and development and deployment of staff. A recently released Caring for the Caregiver Task Force Report, which includes information about clinician burnout, is available on MHA’s PatientCareLink site. 

AHA's People Matter, Words Matter Posters 

The American Hospital Association has launched its new People Matter, Words Matter poster series to help combat behavioral health stigma in healthcare settings by encouraging providers to adopt respectful, patient-centered language. In the first poster, Linden Oaks Behavioral Health provided information on using people-first language, which primarily acknowledges the person rather than the illness or disability. The AHA, along with behavioral health and language experts from member hospitals and partner organizations, will continue this series of downloadable posters in the coming months for hospitals to distribute and display in clinical settings.

President Biden Releases Jobs Plan

On Wednesday, President Joe Biden announced his $2.5 trillion American Jobs Plan, an initiative primarily focused on infrastructure, domestic manufacturing, and taxes. The jobs plan is considered part two of the President’s January stimulus outline, with part one being the COVID pandemic aid package (the American Rescue Plan) enacted two weeks ago. 
The plan includes $18 billion to modernize Veterans Administration hospitals and clinics and $400 billion to expand long-term care services under Medicaid. The long-term care services would be addressed through two provisions:
Expanding Medicaid access to home and community-based services (HCBS) for seniors and people with disabilities.
Making permanent the Medicaid Money Follows the Person program to further support long-term care.

In addition to its infrastructure components, the plan includes corporate tax changes to discourage offshoring by U.S. manufacturing corporations and offshore corporate investments and tax havens. It would also establish a global minimum corporate tax. Moving this proposal through Congress is expected to be challenging, with Republicans and a growing number of Democrats worried about the cost of the package. 

CMS Temporarily Holds Claims to Wait for Final Sequester Legislation

Congress departed last Friday for a two-week “district work period” recess, leaving an important piece of legislation unfinished. The Senate has passed legislation to extend through December 31, 2021, the moratorium on the 2% Medicare sequester payment cut. The House passed similar legislation several weeks ago, but since the Senate amended the House bill, it must receive another House vote to achieve congressional passage. 
The current moratorium on the sequester cut expired on Wednesday, March 31. While the House is expected to pass the bill the week of April 12, the lag between the end of the moratorium and its expected extension required the Centers for Medicare and Medicaid Services (CMS) to take action. CMS released a notice last Tuesday saying it has instructed Medicare Administrative Contractors to hold claims dated April 1 or later, to allow Congress time to complete action on the moratorium.

Fallon Shifts Focus to Government Programs

The health insurance company Fallon Health, which serves about 169,000 Massachusetts residents, announced last week that effective April 1 it is shifting away from most of its commercial products to focus “on programs that serve older adults and lower-income individuals” – that is, on its Medicare and Medicaid products.
Specifically, Fallon said its product focus will be on Medicare Advantage, Senior Care Options Program, MassHealth Accountable Care Organization Partnership Plans, Program of All-Inclusive Care for the Elderly, and a limited number of products on the Massachusetts Health Connector, including ConnectorCare. The insurer said its transition “runway” for its commercial clients will extend for 18 months to help ease the transition.

South Shore Health to Remain Independent

South Shore Health President and CEO Dr. Allen Smith announced on March 31 that his system will remain independent after being wooed by a number of other health systems.
South Shore’s Board Chair Ken Kirkland said, “We extend our sincere thanks to the organizations that responded to the RFP process with proposals that were detailed, thoughtful, and creative. Our decision-making was defined less by eliminating certain organizations than it was by recognizing that we have the talent and infrastructure to be successful. We will continue to evolve, innovate, and form clinical affiliations to meet the needs of our community, and are confident that remaining independent is the best way for us to do that at this time.”
While it will not be part of a larger system, South Shore Health lists its clinical partners as Boston Children’s Hospital, Brigham and Women’s Hospital, and Dana-Farber Cancer Institute.

Vulnerable Patient Populations Webinar Series
Part 1: Vaccine Hesitancy

Tuesday, April 6; 11 - 11:30 a.m.

MHA is hosting a free webinar series on the unique health considerations for vulnerable patient populations. In this first session, expert faculty will discuss how to define vulnerable populations and the reasons behind and implications of vaccine hesitancy in these populations. Faculty will examine demographic data, discuss a case study to provide context, stimulate thought about effects to the patient and the institution, briefly discuss the role that intersectionality plays in the treatment of vulnerable populations, and wrap-up with approaches to engaging and communicating with patients. Register today!

John LoDico, Editor