INSIDE THE ISSUE
Red Cross: Shortage of Blood Donors Threatens Supply
The American Red Cross announced last week that it is experiencing the lowest number of people donating blood in 20 years. Overall, blood donors have declined by 40% over the past 20 years, according to the Red Cross. It attributes part of the problem to the remote work people embraced during the pandemic, which cut into employer-sponsored blood drives.
“Prior to the pandemic, some eligibility changes were implemented to safeguard donors, such as raising the minimum hemoglobin thresholds, resulting in an increase in donor deferrals especially among young donors (16–18-year-olds),” Red Cross wrote. “More than a decade ago, there were also changes in blood transfusion protocols at hospitals that impacted the demand for blood. These changes illustrate the convergence of several factors that has made it challenging to keep and grow a motivated donor base to meet patient needs over the past two decades.”
To give blood, or to volunteer as an “ambassador” assisting those who are donating, or to sign up to help transport blood, visit redcross.org.
Hospitals, Insurers, Nursing Homes, Regulators Unite on Capacity Crunch
The state’s healthcare system represented by hospitals, health insurers, nursing homes, and state regulators joined together last week to release a revamped voluntary plan addressing the persistent problem of patients backing up in hospitals as they await a transfer to a nursing home or other post-acute care setting. These transitions are especially vital because hospitals are still facing severe capacity constraints and often have a hard time finding beds for patients in need of acute care.
The well-documented patient “throughput” problem is the result of many issues, from workforce shortages that have taken available beds offline, to the difficulty in transporting patients, to delays in getting the proper authorizations for the transfers.
Last Wednesday, Health & Human Services Secretary Kate Walsh outlined the new agreement in a memo to MHA, the Massachusetts Association of Health Plans (MAHP), Blue Cross Blue Shield of Massachusetts (BCBSMA), the Massachusetts Senior Care Association, LeadingAge Massachusetts, and Steward Health Care.
Over the next 80 days, until April 1, BCBSMA and MAHP member insurers voluntarily agree to waive prior authorizations for admissions from acute care hospitals to post-acute care facilities across commercial, Medicaid, Medicare, and Medicare Advantage lines of business. “Plans will encourage self-insured plan sponsors to adopt the waiver,” the memo reads. The waiver does not apply to long-term care or custodial admissions. The plans will still be allowed to conduct retrospective reviews to determine the appropriateness of the care, and the providers will be expected to work closely with the plans, giving them appropriate notice about expected transfers and offering periodic updates.
Nursing facilities have agreed to extend their admission hours and hospitals agree to commence their discharge planning as early in the day as possible to assist the transfer process. Hospitals also commit to “seek innovative ways” to improve their staffing plans to staff all their licensed medical/surgical beds.
“The Massachusetts healthcare community has proven time and again that it can and will come together cooperatively to benefit the patients who rely on it,” said Steve Walsh, MHA president & CEO. “This recent voluntary agreement, which comes at the busiest time of year for healthcare providers, is yet another example of that cooperation. The easing of prior authorization requirements can be an especially powerful tool for hospitals to keep patients moving along their care journey. We applaud the steps that MAHP, Blue Cross, and our post-acute partners are taking to ease patient transitions, and we are grateful for Secretary Walsh’s leadership on the issue.”
Budget Showdown in Washington
The budget/continuing resolution drama continues to play out in Washington, D.C. with many of the players entrenched in their familiar roles.
Unless a deal has been reached since Monday Report went to press, a partial shutdown of the government begins Friday, January 19, with full shutdown occurring on February 2.
Senate Majority Leader Chuck Schumer (D-N.Y.) and House Speaker Mike Johnson (R-La.) had reached an agreement last week but, as in the past, hardline House Republicans attempted to scuttle the deal. They argue it does not go far enough in reducing spending or addressing border issues.
The Schumer-Johnson deal was based on an agreement that President Joe Biden and former House Speaker Kevin McCarthy had reached early in 2023 to limit discretionary spending. The same hard-right faction opposed the agreement when it was used to keep the government running in October, and they forced McCarthy out. Now Johnson faces the same pressures.
The headline disputes between Democrats and Republicans focus on funding for the wars in Ukraine and the Middle East and cutting funding for IRS enforcement. Caught in the middle are certain health programs. For example, the Schumer-Johnson preliminary deal rescinded $6.1 billion in COVID-19 emergency spending.
Budget Shortfall Leads to MassHealth Cuts
The lower-than-expected tax revenues in Massachusetts throughout Fiscal Year 2024 hit home last week when Governor Maura Healey announced her plan to cover a $1 billion shortfall.
The governor will use $625 million in non-tax revenue, including money from interest on investments, along with $375 million in spending cuts to cover the billion-dollar gap. The largest component of the $375 million in cuts is a reduction of $294 million in the MassHealth line item.
“MassHealth spending will be $294 million lower, but the reduction is not due to a decrease in enrollment as a result of the redeterminations process,” a spokesperson from the Executive Office of Health & Human Services told the State House News Service last week. “Savings are primarily due to members using fewer services than we had originally budgeted. The remainder, a smaller part, is from modest, targeted adjustments to what is paid to managed care plans. Again, no savings are due to reduced caseload, eligibility changes, member benefits, or provider payments.”
Most of the spending reductions are attributed to an updated forecast of utilization for certain programs, including the Medicare Savings Program, which had anticipated a considerable increase in enrollment due to eligibility expansions. Of note, the managed care plan rate cuts will affect payments to accountable care organizations, many of which are part of hospital health systems.
The governor’s FY2025 budget is due next week. The new revenue assumptions for the coming fiscal year will undoubtedly affect spending assumptions for FY25.
New Directive Makes it Easier to Get Contraceptives
Last October, the Public Health Council approved an emergency amendment to state regulation, creating an expedited process for people seeking hormonal contraceptives. Last week, after the required public comment period on the emergency ruling had passed, the council formerly promulgated the regulation, which is now in effect.
Under the new rules, pharmacists can prescribe and dispense hormonal contraceptive patches and self-administered oral hormonal contraceptives to patients of any age without the requirement of evidence of a previous prescription. Such contraceptives include but are not limited to “the pill,” skin patches, and hormone-releasing contraceptive coils.
A pharmacist is not required to obtain a Massachusetts Controlled Substance Registration to prescribe these medications. But they do have to follow a set of directives as outlined in a Circular Letter from the Bureau of Professions Licensure. Requirements include having the pharmacist complete an approved training program, having the patient receiving the medicine complete a self-screening tool, and advising the patient to consult with a primary care physician or reproductive health practitioner, among others. A scheduled appointment with a pharmacist is not required, and a pharmacist may choose not to prescribe contraceptive products.
People Are Signing Up for ACA Plans
While the Affordable Care Act continues to be controversial in some parts of the country and replacing it with an as-yet-undefined alternative is central to the platforms of many Republicans running for president, the law appears to remain popular with the many who rely on it.
Last week, U.S. Heath & Human Services announced that since the 2024 open enrollment period began on November 1, 2023, more than 20 million have selected an ACA plan.
That includes 16.6 million people who had a plan in 2023 and were automatically re-enrolled, and 3.7 million who are new to enrollment in 2024. The enrollment period runs through January 16. (People can sign up through the Massachusetts Health Connector through January 23.) People in 32 states signed up through HealthCare.gov, while those in 18 states and D.C. signed up through state-based exchanges. HHS says that in Massachusetts, 285,034 have signed up or were re-enrolled since November 1.