Studies Focus on Pre-COVID; BH Funding

Explaining the Dire Need for Workforce Funding

As Massachusetts faces the persistent problem of 600-plus psychiatric patients per day boarding in hospitals as they await an inpatient psychiatric bed – and as it has become extraordinarily difficult to hire behavioral health caregivers to treat those patients – MHA last week made a distinct ask of the legislature for more behavioral health workforce funding. 
In a letter to the chairs of the House and Senate Ways & Means Committees, MHA’s Senior Director of Health Care Policy Leigh Simons Youmans wrote, “As you work to appropriate both American Rescue Plan Act (ARPA) funds and surplus funds from the fiscal year 2021 budget, in addition to prioritizing direct hospital financial relief associated with the COVID-19 pandemic, we urge you to separately consider important systemic investments to support and expand the behavioral workforce across all Massachusetts providers.” Due to restrictions on the use of ARPA funds for debt forgiveness that could affect loan forgiveness programs, MHA believes that surplus FY21 state budget revenue may be the best source for workforce funds.
Youmans noted that a February 2021 survey of 45 inpatient psychiatric units and facilities found that more than 200 already-licensed inpatient psychiatric beds could be made operational if the facilities’ staffing needs could be met. While the legislature and Baker administration have taken steps to address the crisis, including recently announced funds to address immediate inpatient psychiatric workforce needs, Youmans said additional long-term pipeline behavioral health workforce development funds are needed to ensure the long-term viability of the behavioral health system in the commonwealth.
MHA suggested to the legislative leaders the creation of a trust fund to support behavioral health workforce development initiatives; the expansion of the MassHealth 1115 waiver’s behavioral health workforce initiatives as well as expansion of the types of workers eligible for loan forgiveness/grants; training for caregivers in behavioral healthcare competencies; and reimbursement that supports staff recruitment and retention, among other suggested actions.
“While MHA and the entire commonwealth looks forward to the necessary upcoming expansion of inpatient and community-based behavioral health services through the Roadmap for Behavioral Health Reform, facilities are concerned that the need for behavioral health professionals to staff these new programs and services will exacerbate existing workforce challenges,” Youmans wrote in explaining the dire need for additional funding.

How Federal Funding Should be Distributed in Massachusetts

Tomorrow, Tuesday, September 21 at 11 a.m., the Joint Committee on Ways and Means and the House Committee on Federal Stimulus and Census Oversight will be holding a virtual hearing on the American Rescue Plan Act (ARPA), focusing on healthcare, mental health, substance use disorder, public health, and human services.
The legislature has held a series of hearings on how best to distribute the nearly $5 billion in ARPA funds that the state has on hand. 
Last week, House Speaker Ron Mariano (D-Quincy) said he expects that by Thanksgiving, Massachusetts should have legislation outlining how the federal money should be spent. A state report to the federal government outlines how federal relief funding the state has received has been distributed, and plans for future projects.
Since the ARPA dollars were released to the state earlier this year, MHA has advocated strongly for the state to use part of the funding to provide additional and much-needed relief to healthcare organizations, which continue to navigate precarious financial circumstances as they recover from the initial surges of COVID-19 and endure costly new challenges in caring for patients. 

Brown-bagging, White-bagging Legislation

Tomorrow the Joint Committee on Financial Services will hear testimony on An Act Relative to Specialty Medications and Patient Safety (S.695/H.1199), from Sen. Jason Lewis (D-Winchester) and Rep. Jon Santiago (D-Boston), which, if it becomes law, will finally seek to prohibit the use of “brown bagging” and put guardrails around insurer-compelled "white bagging." 
Brown bagging is when a third-party specialty pharmacy dispenses a drug directly to a patient, who then transports the medication to a healthcare provider for administration. White bagging is when a third-party specialty pharmacy dispenses a drug and sends the drug directly to the hospital pharmacy or physician’s office. The provider stores the drug, and a clinician administers the drug to a patient.
What concerns patients and the hospitals that care for them about brown bagging is that there is strong clinical consensus that requiring patients to properly store and then transport a drug to their clinician for administration jeopardizes patient safety. 
Under the white bagging model, when an insurer mandates that a drug be delivered, there are a number of concerns that may affect patient safety, including the drug chain of custody, timeliness of delivery in urgent situations, processes for storing and dispensing medications, and waste when there are unexpected changes in patients’ health status. 
Insurers use white bagging because they can contract with third-party specialty pharmacies to purchase pharmaceuticals, removing the provider from the drug acquisition process. The insurers then reimburse the third-party specialty pharmacy for the drug and pay the provider only for the drug’s administration – even though the HPC found that third-party specialty pharmacy treatment methods have costs and cost-sharing amounts for patients that can vary widely. 
S.695/H.1199 incorporates the recommendations of the HPC that insurers should not require brown bagging for any drug; that payers should offer home infusion as an optional benefit, not as a requirement; that insurance companies that require white bagging should ensure their third-party specialty pharmacies are using patient safety best practices and that they should offer site neutral payments, which can lower drug prices and reduce provider administrative expenses. 

The State's Tier 3 Designation

The Department of Public Health (DPH) has issued updated COVID-19 Resurgence Planning and Response Guidance for Acute Care Hospitals, effective today, to re-establish the regional COVID-19 hospital preparation and response planning process that was initially implemented in November 2020. The regional process is intended to assist the healthcare system address capacity constraints, maintain patient safety, and avoid mandatory service reductions or closures wherever possible. The DPH guidance applies to all hospital-licensed services – except for community health centers under the hospital license – and does not apply to emergency care. All Massachusetts Regions will be designated as Tier 3 beginning today, requiring twice weekly meetings.
The guidance acknowledges that hospitals are facing capacity constraints because of both COVID-19 and non-COVID-19 care (including patients whose conditions have been exacerbated by the pandemic) while managing significant staffing constraints.

FDA Panel Votes for Limited Use of Booster Shots

The Food and Drug Administration's (FDA's) Vaccines and Related Biological Products Advisory Committee voted on Friday that the benefits of a Pfizer booster shot outweigh the risks for individuals age 65-plus and for those of all ages who are at high risk of severe COVID-19. The panel rejected the initial question that would have provided boosters to all those age 16 and over. The FDA panel's vote supports boosters to be administered "at least six months after completion of the primary series" of vaccines. The vote was 18 to 0 (and 16-2 to reject boosters for all those 16-plus years of age). After the vote, members of the advisory committee were polled -- but did not formally vote -- on the question of whether the FDA should expand the use of boosters to also include "healthcare workers or others at high risk for occupational exposure." The panel agreed unanimously to pass that expanded recommendation to the FDA.
The FDA is not bound by the advisory committee's vote; the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices will vote on the booster issue this month. 

Large Healthcare Study Does Not Include Pandemic Elements

The Massachusetts healthcare system – and all of society – experienced a dramatic shift beginning in March 2020 when, among other transformational acts, the governor declared a state of emergency, and hospitals ended elective procedures, searched frantically for personnel protective equipment, and cared not only for an influx of COVID-19 patients but also for a stressed workforce. In the ensuing months, billions of dollars would be sapped out of the system, trillions of federal dollars would be appropriated, and today, 19 months later, the reverberations continue.
Last week, the state’s Health Policy Commission issued its 2021 Health Care Cost Trends Report that examines healthcare spending and the state’s performance against the healthcare cost growth benchmark. The latest data in the 2021 report is from 2018-2019 – or before COVID-19. Therefore, its corresponding policy recommendations may not reflect the realities healthcare providers are facing in the midst of a generational health crisis.
MHA released a statement thanking the HPC for its pre-pandemic assessment and said it is looking forward to an “informed and collaborative conversation” with the agency in the future about the policies floated in the report. But, MHA added, as of now, “MHA and our members remain singularly focused on the immediate challenges that healthcare organizations are experiencing today. Providers are working day and night to address the ongoing pandemic, staffing shortages, serious capacity challenges, and an exhausted workforce.”

CHIA Report Looks at How EDs Used to Be Years Ago

As has been reported extensively, Massachusetts emergency departments are facing a steadily rising count of COVID-19 patients, and a large influx of patients who for the past 19 months have deferred their care and are now surging into EDs as opposed to seeing providers in urgent care centers and physician offices.
The state’s Center for Health Information and Analysis (CHIA) last Thursday published its first report on ED utilization patterns. The report’s data is from 2016 to 2019, and does not address how COVID-19 disrupted the healthcare system and continues to affect ED use.

Supply of Sexual Assault Evidence Collection Kits Runs Low

Because of national supply chain issues, the state’s supply of Sexual Assault Evidence Collection Kits (SAECKs) is running low. Staff from the Massachusetts Department of Public Health’s Sexual Assault Nurse Examiner (SANE) Program announced last week that they may be visiting individual hospitals to manually inventory the SAECKs on-site. And they may take available SAECKs to redistribute to other hospitals to meet patient need until new SAECKS arrives. The SANE program is communicating with hospital contacts on record to arrange the visits.

MHA Executive Insights Webinar Series: Leading an Alliance

Thursday, September 30; 8-8:30 a.m.

Join MHA's Executive Insights Series, which features candid interviews of Massachusetts healthcare leaders. We welcome you to pour a cup of coffee and start your day with us as we hear directly from the CEOs who help power our world-class healthcare community. 
Assaad Sayah, M.D., CEO of Cambridge Health Alliance (CHA), will join us on Thursday, September 30 to discuss his role in advancing community health and CHA’s service to one of the most diverse populations of the state.
Click here to register.

John LoDico, Editor