Joint Committee on Health Care Financing
The Massachusetts Health & Hospital Association (MHA), on behalf of our member hospitals, health systems, physician organizations, and allied healthcare providers, appreciates the opportunity to submit comments on a number of bills regarding health agency operations and oversight.
MHA supports SB692, which extends to MassHealth members the consumer protection rights under the Office of Patient Protection at the Health Policy Commission. The right to a timely internal appeal process with an insurer as well as the right to file an independent external review following an adverse determination by an insurer should be extended to all patients in the commonwealth. The current protections only apply to payers in commercial health insurance plans.
HB1175/SB685 introduces reporting requirements for MassHealth accountable care organizations (ACOs) regarding services provided both before and after the implementation of the ACO program, as well as for services provided by community partners. The information that HB1175/SB685 seeks is data that MassHealth is better able to evaluate and report, as it has the claims data used to compare actual reimbursement versus benchmark spending, as well as any comparison to the general MassHealth program. ACOs are not an appropriate source for gathering information on services provided prior to the formation of the ACO program. MHA also has concerns with putting into statute additional reporting requirements for MassHealth ACOs as existing contract arrangements between ACOs and the MassHealth program are already significant. For example, the ACO contract reporting requirements contain at least 120 reports related to finances, contract management, quality, behavioral health, operations, and pharmacy services. Each report varies in length and detail, and the reports range from being required on a monthly, quarterly, annually, or ad-hoc basis.
MHA specifically wishes to highlight its concerns with HB1127/SB669. Massachusetts hospitals place the highest priority on patient safety, transparency of safety data, and the ongoing work to improve safety in all healthcare settings. MHA supports the purpose of the Betsy Lehman Center to serve as a clearing house for the development, evaluation, and dissemination, of best practices for patient safety and medical error reduction. MHA supports the portion of HB1127/SB669 that would allow the Betsy Lehman Center and any agency that collects patient safety information to transmit the data to each other under a specific interagency agreement; we also support the requirement that the agreement would include the provision to protect the privacy and security of the information and to conform with federal law.
However, MHA notes that expanding the definition of “adverse event” in HB1127/SB669 to cover “harm” rather than “injury” requires clarification. That is, what is the intention of this change? MHA recommends that the legislature consider how the proposed change to the “adverse event” definition compares to the definition that the Department of Public Health (DPH) uses. Additionally, MHA requests that DPH’s definition of a “healthcare associated infection” (HAI) be used as opposed to HB1127/SB669’s definition of a HAI to be one that is acquired “during the course of receiving treatment for other conditions within a healthcare setting.” Lastly, MHA is concerned with section (g) in HB1127/SB669 that allows the Lehman Center to “adopt rules and regulations necessary to carry out the purpose and provisions of this section.” MHA recommends that the legislature continues to support the Center’s current mission of coordinating safety efforts while convening and assisting healthcare entities and consumers, but that the Center is not transformed into a regulatory entity, which is what this legislation would initiate, as currently drafted.
MHA is opposed to HB1136, as drafted, which seeks to establish a statewide commission to review provider billing practices. Every hospital and healthcare provider has adopted a series of internal practices to ensure correct coding standards that follow federal and state compliance program requirements. In addition, substantial audits are conducted by both federal and state authorities (such as CMS auditors, MassHealth auditors, the State Auditor, and Attorney General Medicaid Fraud Control Unit) on Medicaid program expenditures. It is difficult to understand what value would be added by the additional reviews called for in HB1136. MHA is concerned with any proposal that would add unnecessary and duplicative requirements on the system while offering no perceived benefit.
MHA supports transparency for patients and healthcare stakeholders surrounding the cost and quality of healthcare providers and services. However, we do not believe the report called for under HB1176, as written, would benefit this effort. The patient care services offered by the outpatient providers listed in the legislation vary extensively; urgent care centers are primarily used for immediate preventative care and diverting patients from higher-cost settings or hospital emergency departments, and outpatient surgery centers treat patients that have been referred for planned surgical procedures. The study does not seek to examine the payment factors that are an important consideration when looking at healthcare providers and the services they deliver; such factors include the insurance networks in which providers participate, and whether or not they treat patients on MassHealth and Medicare. HB1176 also does not consider the increasing number of patients enrolled in alternative payment methods, such as ACOs, and whether or not outpatient providers participate in these plans. As hospitals and health systems strengthen integrated care delivery, as evidenced by the MassHealth ACO program, new, mandated studies must recognize how insurance networks and the ability to refer patients to participating providers affects care access. This proposed report does not.
A more pertinent and useful study on outpatient providers would be an analysis of the recent proliferation of urgent and retail care centers and how access for lower-income patients is affected. Such an evaluation would focus on: whether or not these providers are affiliated with an existing health system; if these providers accept MassHealth and MassHealth ACO patients; if they are using electronic health records as mandated by Chapter 224 of the Acts of 2012; and whether or not the establishment of a retail or urgent care clinic in a community hospital service area has affected the patient mix and payer mix of the hospital.
MHA opposes SB719, which would amend health insurance statutes to specify which metrics may and may not be used in determining alternative payment arrangements. It additionally permits the use of age, acuity, social determinants of health, and behavioral health needs – while prohibiting the use of historic price trends – when assessing the users of a particular provider. It would also require the disclosure of data used in pricing determinations. And finally, it establishes that use of prohibited data or failure to disclose data to the Center for Health Information and Analysis is to be considered an unfair business practice under GL 93A. MHA opposes this legislation since it would be administratively complex to administer and does not take into account numerous nuances in provider prices. Such a proposal would need to be modeled and tested significantly before being considered and implemented.
MHA opposes HB1138 as it is administratively burdensome and will not add value to the healthcare system. this legislation: 1) amends the Health Policy Commission (HPC) statute to require that all ACOs publish the standards they use to determine which providers of healthcare services (not just free-standing ancillary services) shall be approved to provide services to ACO patients; 2) mandates that all providers of healthcare services must be informed in writing by the ACO of the standards by which they were accepted or rejected as an approved provider of healthcare services for ACO patients; and 3) requires the HPC to annually review the standards published by each certified ACO and issue a report of its findings. The review is directed to include whether the ACO’s standards ensure consideration and participation by providers sufficient to ensure the goals of the HPC and maximize value to patients by minimizing price and health status adjusted total medical expenses and maximizing quality and access. It is important to remember that ACOs are certified by the HPC and, therefore, must already meet rigorous standards. Requiring an outside government agency to assess whether the ACO is choosing appropriate clinicians to provide care to its patients is an unnecessary overreach and will reduce or eliminate the flexibility that ACOs have to select the caregivers most appropriate for the populations they treat.
Thank you for the opportunity to offer testimony on this matter. If you have any questions regarding this testimony, or require further information, please contact Michael Sroczynski, MHA’s Senior Vice President of Government Advocacy, at (781) 262-6055 ormsroczynski@mhalink.org