Contraceptive Access, SUD, DSH, and more...

Health Equity in Contraceptive Access & Pregnancy Outcomes

Massachusetts birth hospitals have the opportunity to take advantage of an innovative clinical and public health program designed to promote contraceptive choice and effective contraceptive counseling.

Partners in Contraceptive Choice and Knowledge (PICCK) is a five-year grant program funded by the state and housed at Boston Medical Center/Boston University School of Medicine.

It is based on the belief that: “Every person has a right to comprehensive family planning services, including deciding when and if to parent, a right to complete and accurate information about all contraceptive methods, and access to high-quality maternity and birth services that honor individual, religious, and cultural preferences.” 

The program offers training and technical assistance in contraceptive counseling and care to hospitals and their affiliated community health centers providing OB-GYN, primary care, and adolescent care.

The specific PICCK training and technical assistance activities provided at each hospital will be tailored to meet the hospital’s needs. The PICCK program seeks to help achieve equity in contraception access and pregnancy outcomes in Massachusetts through 1) a reduction in the approximately 50,000 annual unplanned pregnancies in the state and 2) improvement in the outcomes for both mothers and infants by reducing the increased risks associated with unplanned pregnancies.

MHA was an early supporter of the PICCK concept, writing a letter in March 2018 in support of the Boston Medical Center/Boston University grant application.

Any hospital wishing to participate in PICCK, through which staff will receive contraceptive training and technical assistance to improve reproductive healthcare, may contact Boston Medical Center’s Katharine White, M.D., MPH, PICCK’s Principal Investigator, at (617) 414-3745 or Katharine.White@bmc.org.

State Government, Hospitals Address SUD Step by Step

Several new Massachusetts policies are aiding the collective fight against the opioid epidemic. In the past two weeks, the state has released guidance on how hospitals should be conducting substance use disorder evaluations and providing medication for opioid use disorders. The state also released guidance to help pharmacists and pharmacy interns that are now able to administer medications for treating mental illness and substance use disorder.

Concurrently, MHA worked with the Massachusetts College of Emergency Physicians to update joint guidelines on substance use disorder evaluations to reflect changes made by state law.

On the federal front, the Centers for Medicare and Medicaid Services has made final new policies for Medicare drug plans, including safety alerts when opioid prescriptions are dispensed at a pharmacy and drug management programs for patients determined to be at-risk for misuse of opioids or other frequently misused drugs. Last week, MHA provided its membership with a comprehensive summary of the many recent changes and evolving best practices for treating substance use disorder.

Hospital Groups Call Attention, Again, to Pending DSH Cuts

A provision of the Affordable Care Act would reduce payments to disproportionate share hospitals – facilities that serve a large percentage of the uninsured and underinsured. The thinking was that as the rates of uninsured drop due to the ACA’s coverage mandates, uncompensated care costs would also decrease.

In a letter to Congressional leadership last week, a group of hospital associations, including the American Hospital Association, noted that the ACA coverage goals have not been fully achieved – but the DSH cuts remain.

“Unfortunately, the coverage rates envisioned under the ACA have not been fully realized, and tens of millions of Americans remain uninsured. In addition, Medicaid underpayment continues to pose ongoing financial challenges for hospitals treating our nation’s most vulnerable citizens,” the letter states.

The hospitals asked Congress to delay the start of the Medicaid DSH cuts, which are scheduled to begin in fiscal year 2020, or October 1, 2019. The DSH payment reductions have been delayed a number of times to date – in a bipartisan manner. Last week’s letter asks once again for a delay.

The Don’t-Miss 2019 Patient Safety Forum – April 3

The Massachusetts Coalition for the Prevention of Medical Errors and Healthcentric Advisors have finalized the agenda for their 2019 Patient Safety Forum, Accelerating All Performance Improvement, scheduled for Wednesday, April 3 from 7:30 a.m. registration to 3 p.m. adjournment.

This year’s forum is focused on accelerating performance improvement across all organizational goals, including patient safety and initiatives to improve the diagnostic process. Session topics include: Organizational Strategies for Performance Improvement, Changing Culture, Leadership for Improvement, and Improving the Diagnostic Process. The forum includes speakers from UMass Memorial Health Care, Boston Children’s Hospital, Beverly and Addison Gilbert Hospitals, Elliot Health System, Beth Israel Deaconess Medical Center, Institute for Healthcare Improvement, Mount Auburn Hospital, Baystate Health, Brigham and Women’s Hospital, and Signature Healthcare. Presenters have achieved a 58% reduction in harm events at their facilities, changes in culture that increased event reporting 55% and more, and transformations in staff experience.

The forum is for clinical leaders and managers, including physicians, nurses, NPs, and others; quality and safety leaders and staff; C-suite leadership and board members; operations managers; risk managers and staff; patient and family advisors, and other patient/family representatives; policymakers; and anyone interested in performance improvement and patient safety. Registration is now open here.

Transitions: Wardell, DiGravio, New Partners Interim CEO, Roper

Patrick Wardell, the CEO of Cambridge Health Alliance since 2012, announced last Tuesday that he was retiring, effective June 30, 2019. Wardell, a past member of the MHA Board of Trustees, provided MHA and the entire hospital community with guidance regarding the special challenges facing disproportionate share hospitals. His steadfast pursuit of care equity for all populations and delivering safe, compassionate care are hallmarks of his tenure at Cambridge Health Alliance. MHA wishes him well in his retirement.

Vic DiGravio, the president and CEO of the Association for Behavioral Healthcare (ABH) since 2007, announced last Tuesday that he intends to resign to pursue other opportunities. MHA has worked closely with the DiGravio-led ABH on many initiatives over his 12 years of leadership, from his participation on the “Behavioral Health: Unfinished Agenda of Reform” workgroup to his efforts on the multi-stakeholder fight against substance use disorder. He has been a strong advocate for patients.

Partners HealthCare has named Anne Klibanski, M.D., the interim president and CEO to succeed Dr. David Torchiana, who will retire at the end of April. Klibanski has been Chief Academic Officer for Partners since 2012, overseeing Partners’ $1.8 billion annual research enterprise. She is also the Chief of Neuroendocrine at Massachusetts General Hospital. She is the Laurie Carrol Guthart Professor of Medicine at Harvard Medical School and an Academic Dean for Partners at Harvard Medical School. Klibanski received her B.A. in literature from Barnard College and her M.D. from New York University Medical Center. Partners said the timeline for naming a permanent CEO is expected to take up to one year.

Anne Roper, the former northeast regional vice president and controller for Alabama-based Encompass Health, has been appointed CEO of Worcester's Fairlawn Rehabilitation Hospital, effective immediately. Fairlawn is a joint venture between UMass Memorial Healthcare and Encompass Health. Roper and William Johnson had served as the hospital’s interim co-CEOs since July 2018. Roper has a BS and MBA from Auburn University at Montgomery.

WEBINAR: Health System Finance Strategy

Tuesday, March 5; 1 to 2:30 p.m.

Today’s hospital finance landscape has a number of challenges: declining government reimbursement, an unpredictable state and federal regulatory environment, shifting demographics/payer mix, and self-pay and collections issues. Hospitals and health systems are facing these and other situations that can each cause dramatic shifts in their revenue model. Such trends will increasingly require leaders to consider how they will be paid for patient care services, often by site of care. The uncertainty around these revenue drivers creates significant risks for provider organizations, but also unprecedented opportunity to redefine and shape operating, clinical care, and revenue models. Traditional hospital incremental change approaches will yield inadequate returns and only increase financial, operational, and competitive risk. Transformative change must be highly focused and sustained. A core objective for successful providers today is to develop a strategy-led transformation plan that can help navigate towards an integrated, clinical excellence model. This webinar will introduce attendees to several current, transformative adaptations that can help shift their revenues and collections in positive directions and help prepare them for the evolving revenue climate.  Visit here for more information and registration details.

John LoDico, Editor