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MONDAY REPORT

A Behavioral Health Win for Patients and Providers

Healthcare interests last week combed through the end-of-legislative session laws and actions that emerged from a densely packed weekend of action at the State House.

MHA and its allies in the behavioral health field were buoyed by passage of what the legislature is now calling the Mental Health ABC Act – a sweeping piece of legislation that moves the commonwealth closer to the realization that mental healthcare is as important as physical healthcare.

The law enforces mental health parity laws, meaning that insurers will be held accountable for the requirements that they provide fair mental health coverage. And the law seeks to level the playing field for reimbursement to mental health providers by requiring an equitable rate floor for evaluation and management services that is consistent with primary care.

The legislation includes initiatives to address emergency department boarding, which has been a long-held priority of the hospital community and mental health advocates. It requires the Division of Insurance, in consultation with MassHealth, to promulgate regulations establishing reasonable rates at which commercial health insurers must reimburse acute care hospitals for the delivery of healthcare services for each day a MassHealth member is in an emergency department, observation unit, or inpatient floor awaiting an inpatient psychiatric placement. The law directs the Executive Office of Health and Human Services to use an online portal to facilitate timely placements for pediatric boarders and children who are boarding, and creates a statewide program to help schools implement school-based behavioral health services, among other boarding-specific measures.

“With passage of the Mental Health ABC Act, the commonwealth has taken targeted, meaningful action to address the systemic underinvestment and siloing of the behavioral health system,” said MHA’s Senior Director of Healthcare Policy Leigh Simons Youmans. “The investments the legislature made in mental healthcare and the behavioral health workforce will certainly improve care, ensure long-promised parity, and, of special importance, address the mental healthcare needs of children. MHA is grateful to the legislature, the Baker Administration, our members, and partners in the behavioral health field for their work in ensuring this act becomes law.”

Workforce: Shaping Up to Be the Greatest Healthcare Concern

What keeps healthcare executives up at night? Most will tell you it’s the workforce shortages they are facing currently, and the uncertainty about how to build up the next generation as current workers age out and younger workers choose non-healthcare fields.

MHA held its first ever Workforce Summit in July – a well-attended gathering that looked at the workforce issue from recruiting the next generation of workers, to strategies on retaining them once hired, to changing the delivery of care to account for staffing shortages.

There are currently more than 20,000 healthcare worker vacancies in Massachusetts acute care hospitals, including about 5,100 R.Ns. Some solutions floated at the MHA forum included making community college education free for unlicensed long-term care workers so that they can become licensed practical nurses and registered nurses; providing affordable and reliable transportation for workers so they can get to their jobs; and establishing a certified nursing assistant scholarship program. A CEO-led workgroup is now focusing MHA’s priorities around expanding the professional pipeline.

Last week, the state’s Betsy Lehman Center for Patient Safety released this Patient Safety Beat publication that features workforce strategies from Cambridge Health Alliance (CHA), Milford Regional Medical Center, and Massachusetts General Hospital.

“We’re looking at unique ways to recruit and focusing on what we call our employee value proposition: Believe in where you work,” said CHA’s Chief Human Resource Officer Joy Curtis. “… As a safety-net organization, our mission is clear and strong. It draws people in and helps them self-select to work here.”

Workforce Cited as Reason for Non-Transfers

Respondents to an MHA July survey say staffing constraints at post-acute facilities is the second greatest reason why more than 700 patients currently cannot be discharged from an acute care hospital to a post-acute facility. The patients are cleared medically to receive the next level of care but are stuck in the acute care hospitals for a variety of reasons. (Survey respondents say the main reason for the “throughput” issue is private insurance administrative burdens and denials.) The MHA July survey showed that in just 39 of the state’s 60-plus acute care hospitals, 744 patients are awaiting discharge to a post-acute setting, but can’t be moved.

The number of patients awaiting discharge in July compared to prior months fell, but the amount of time they are awaiting discharge increased. In July, 42% of patients awaiting to be discharged to a skilled nursing facility were waiting 30 days or more compared to 36% in June; 36% of patients awaiting discharge to an inpatient rehab facility or long-term acute care hospital were waiting at least 30 days compared to 32% in June; and 12%, as opposed to 9% in June, were waiting 30-plus days for a home health discharge.

MHA and its members continue to work closely with state officials, the Massachusetts Senior Care Association, and other post-acute partners to address these challenges.

ONL Issues Toolkit for Combatting Racism

The Organization of Nurse Leaders – MA, RI, NH, CT, VT (ONL) has produced A Tool Kit for Addressing Racism in Nursing and Healthcare to provide resources and strategies to help nurses and nurse leaders at all levels cultivate environments that are inclusive of diverse people and perspectives.

“Given our numbers, presence across healthcare settings, exposure to patients, and many roles, nurses and nurse leaders at all levels have a critical role to play; they are uniquely and strategically positioned to make an impact on reducing health disparities and achieving health equity,” ONL writes in the 20-page toolkit.

Although the Tool Kit is designed for frontline nurses, nurse managers, and nurse executives, ONL says it can assist “all healthcare providers, community members, healthcare stakeholders, and anyone interested in meaningfully improving diversity, equity, inclusivity, and belonging in their community.”

AHA Files Motions to Ensure Prompt 340B Payments

On August 3, the American Hospital Association (AHA) filed a series of motions in the United States District Court for the District of Columbia to ensure 340B hospitals are promptly paid in response to a June 15 Supreme Court decision. That decision ruled in favor of hospitals in their challenge to the U.S. Department of Health and Human Services’ (HHS) Medicare Part B payment cuts to 340B hospitals. The AHA motions seek prompt reimbursement for the cuts, but also urge that the payment remedy be done in a manner that does not negatively affect other hospitals.

PICCK Announces Fall Events

PICCK (Partners in Contraceptive Choice and Knowledge) has announced its fall 2022 webinar series and annual meeting scheduled for Saturday, September 17.

The next webinar is entitled “Tools for Patient-Centered Contraceptive Counseling” and will be held on Thursday, September 29, from noon to 1 p.m. The webinar will showcase tools PICCK created to assist contraceptive care providers in implementing the principles of patient-centered care within the realities of clinic. Presenters will discuss PICCK’s framework to assist in counseling and will explore a contraceptive decision aid and method information sheets that were designed to meet international standards, promote inclusivity, and support patient-centered care. Register here.

John LoDico, Editor