Massachusetts Health & Hospital Association 
INSIDE THE ISSUE
> A Harmful Healthcare Bill
> The FY26 State Budget
> LGBTQIA+ Care
> Streamlining Accreditation Processes
> CDH/Quinnipiac Affiliation
> Transition
> Lucian Leape (1930 – 2025)
> July 4
MONDAY REPORT
Congress Passes Bill with Staggering Healthcare Implications
The U.S. House of Representatives on Thursday, after a marathon session, voted to approve the Senate version of the “One Big Beautiful Bill.” The president signed the bill on July 4.
If the previously passed House version of the bill was the jab that rocked the U.S. healthcare system back on its heels, the U.S. Senate’s version was the roundabout punch on the chin that would lead to millions of uninsured people seeking care at underfunded hospitals that most likely would be forced to eventually reduce services, close outright, or negotiate much higher rates from commercial insurers.
The Republican-backed bill that passed will result in 11.8 million Americans becoming uninsured, according to the Congressional Budget Office. Cuts to Medicaid would reach $1 trillion by 2034. Enhanced premium tax credits under the Affordable Care Act are set to expire later this year, which would result in another 5.1 million losing coverage, according to the CBO, which also projected the bill adding $3.9 trillion to the national debt.
Of the 16.9 million people that will lose coverage, more than 300,000 will be from Massachusetts, according to various estimates. The uninsured, when ill, would then seek care through hospital emergency departments as they do now. Their care would be paid for by the state’s Health Safety Net, which this year – in a state that currently leads the nation in the lowest number of uninsured – is already in arrears (see related story below). That is, there is not enough funding to care for the current number of uninsured and underinsured Massachusetts residents, never mind another 300,000 or more people without coverage.
The bill’s Medicaid work requirements will require new hospital and state administrative structures to track who is and who is not eligible for coverage, which will further increase healthcare costs.
“Despite the relentless advocacy of our congressional delegation, Massachusetts will now brace for yet another major disruption to its already fragile healthcare system,” said MHA’s Executive Vice President & General Counsel Mike Sroczynski. “All of the concerns conveyed over the past several months – about patients’ access to coverage, the status of essential funding streams, and providers’ ability to maintain services – are now part of a new reality that healthcare organizations and local leaders must navigate. We will be working closely with our federal delegation to address each of these challenges and explore every avenue to mitigate their impact on Massachusetts. Meanwhile, local policymaking will be more consequential than ever. This is a time for us to listen carefully to the voices of hospitals and health systems, rally around the solutions within our control, and prioritize reforms that support the needs of patients and their dedicated providers.”
Legislature Sends State Budget to Governor
The Massachusetts legislature passed a $61 billion FY2026 state budget last Monday and sent it to Governor Healey, who signed it on July 4.
The budget sent to Healey contains $471 million less in MassHealth funding than the governor proposed in her original H.1 proposal. It also does not contain any relief for the Health Safety Net (HSN) that will experience a $280 million shortfall this year and an even larger shortfall in FY26. MHA continues to work with policymakers in an attempt to craft some form of HSN relief, especially in light of the expected devastating cuts to Medicaid expected from the federal government (see related story above).
The budget did include funding to maintain operations at both Pappas Rehabilitation Hospital for Children and Pocasset Mental Health Center. And on the mental health front, the budget increases funding for Department of Mental Health child and adolescent programs, and adult mental health and support services.
The final budget also included language establishing a task force to study and address barriers to practicing telehealth across state lines, including exploring appropriate options for interstate medical practice – a plan that MHA has long supported.
New Training Available for LGBTQIA+ Care
The Massachusetts Department of Public Health (DPH) and The Fenway Institute at Fenway Health are offering anyone licensed by the Board of Registration in Medicine access to training materials to help provide improved care to the LGBTQIA+ community.
In a letter to all BORIM licensees, DPH Commissioner Robbie Goldstein, M.D. wrote, “DPH believes that all LGBTQIA+ individuals in the commonwealth should be able to access necessary, knowledgeable, and respectful health services. This initiative will make it easier for you to be a part of achieving that goal by giving you access to highly engaging and innovative training materials. We will provide training on key topics, including, but not limited to, creating an inclusive and welcoming environment, collecting sexual orientation and gender identity (SOGI) data, primary care for transgender and gender diverse patients, affirming care for transgender and gender diverse children and adolescents, and telehealth for LGBTQIA+ patients, among others.”
Healthcare professionals can sign up for the DPH/Fenway Health Training Initiative here.
The commonwealth’s commitment to LGBTQIA+ care comes at a time when such targeted care is under attack nationally. Executive Orders and other actions from the White House since January have rescinded previous administrations’ orders calling for health equity and non-discrimination protections for LGBTQIA+ people; have removed federal recognition of the concept of gender identity; and have attempted to make radical reductions to the provision of gender-affirming care for young people, among other actions.
Joint Commission is Streamlining its Accreditation Process
A Joint Commission (JC) accreditation process at a hospital is a grueling, all-hands-on-deck process that can take the better part of a year to complete. Last week, the JC, conceding that its process can drain already stressed healthcare workforces, announced a new, streamlined Accreditation 360.
Under the new program, the JC is removing 714 of its more than 1,500 hospital accreditation program requirements and is simplifying the language of the remaining elements. Its updated Accreditation Manual will more clearly identify Centers for Medicare and Medicaid Services-directed Conditions of Participation; the remaining requirements and National Patient Safety Goals will be merged into the JC’s 14 new National Performance Goals. The new standards are online and are available to the public (as opposed to earlier years) and become effective January 1, 2026.
The other major change under Accreditation 360 is the JC’s optional “Continuous Engagement” process through which hospitals can work with the commission on ongoing improvement processes between the triennial accreditations. The JC is making additional best-practice resources available to assist in this area
The National Quality Forum, which is an affiliate of the JC, announced as part of Accreditation 360 new outcome measures for certifications, focusing on what the JC calls “high-priority clinical areas” identified by clinicians, health systems, payers, and purchasers; they are maternity care, hip and knee procedural care, spine procedural care, and cardiovascular procedural care.
“Healthcare organizations today are navigating historic complexity, and the pressures are enormous,” said Jonathan Perlin, M.D., the JC’s president and CEO. “…Designed by a team of operationally experienced healthcare leaders, this new model removes standards whose time has passed, and we are introducing a suite of novel tools for benchmarking and performance support. Reducing burden helps busy clinicians and healthcare organizations focus on what matters most: delivering the safest, highest-quality and most compassionate healthcare possible.”
Cooley Dickinson and Quinnipiac University Ink Academic Affiliation
Cooley Dickinson Hospital (CDH), a member of the Mass General Brigham system, has formed an academic affiliation with the Frank H. Netter MD School of Medicine at Quinnipiac University, located in North Haven, Connecticut.
Under the agreement, third-year medical students from “QU Netter” will have clinical rotations at the hospital. It is the first time CDH will host medical students. Quinnipiac will assist with housing logistics for the students, and clinical faculty and advanced practice providers will receive academic appointments.
Dr. Sundeep “Sunny” Shukla, vice president of medical affairs and associate chief medical officer at CDH, as well as assistant professor in the department of emergency medicine of QU Netter was instrumental in launching the affiliation, which will begin in September.
Transition
Charles Cavagnaro, III, M.D., has been named president of UMass Memorial Health – Marlborough Hospital and UMass Memorial Health – HealthAlliance-Clinton Hospital. He has been serving as interim president at both facilities since June 2024. Cavagnaro is well known in the Massachusetts healthcare arena, having served as president and CEO of Wing Memorial Hospital and Medical Center for nearly 15 years, as Eastern Region President of Baystate Health, and most recently as Corporate Vice President for UMass Memorial Community Hospitals and Chief Medical Officer for HealthAlliance-Clinton and Marlborough before moving into the interim role last year. He is a graduate of Cornell University and Cornell University Medical College.
In Memoriam: Lucian Leape, Patient Safety Pioneer
Dr. Lucian Leape, whose pioneering work on medical errors led to the creation of the entire field of assessing patient safety by focusing on systems of care, passed away on June 30 at his home in Lexington, Mass. at the age of 94. Leape, a pediatric surgeon, began tracking medical errors and their causes, which led in 1999 to the landmark Institute of Medicine report, “To Err is Human: Building a Better Health System.” It determined that up to 98,000 deaths per year were attributable to medical errors that were not primarily due to just human error, but to the flawed systems of care. That report and his work led to hospitals and the healthcare sector both in the U.S. and across much of the globe refocusing to ensure that safety was a system-wide, not individual concern. Are there safeguards in place to ensure medications are stored and dispensed in the correct amounts? Are there systems to assuredly confirm verbal orders between clinicians? In short, are there measures in place to prevent serious adverse events to patients along each step of care? Today all hospitals have patient safety officers and protocols – all due to Leape’s work.
“Every best-practice seminar, harm-reduction program, or continuous-improvement initiative undertaken by a hospital – and such work occurs almost every day – is largely attributable to the system improvements that Dr. Leape identified and championed,” said Patricia Noga, R.N. PhD, MHA’s vice president of clinical affairs. “The importance of his work cannot be overemphasized. It changed how care is delivered and, in doing so, has saved thousands of lives.”
While he was born in Pennsylvania, Leape was closely tied to Massachusetts, graduating from Harvard Medical School, and training at Massachusetts General Hospital and Boston Children’s Hospital. He became professor of surgery at Tufts Medical School and chief of pediatric surgery at New England Medical Center, and later a professor at the Harvard School of Public Health.
Happy Belated Independence Day!
The Declaration of Independence had five signatories from Massachusetts: John Hancock, Sam Adams, John Adams, Robert Trent Paine, and Elbridge Gerry.
In addition to serving as a member of the U.S. House of Representatives, the ninth governor of Massachusetts (where his redistricting attempts led to the term “gerrymandering”), and the fifth Vice President of the U.S. under President James Madison, Gerry was also a hospital executive of sorts.
During the great Marblehead smallpox epidemic of 1773, Gerry joined with three other leaders of the town to build Essex Hospital on what was then known as Cat Island and is now known as Children’s Island off the coast of Salem. The inoculation hospital successfully treated hundreds of patients under strict guidelines; guards were posted, travel was limited to and from the island, cleanliness was maintained, and a physician’s okay was needed before a patient was cleared for re-entrance into the population. But within four months, the vaccine skeptics of the day stormed the island and burned Essex Hospital to the ground. A “smallpox war” then raged for weeks between those who wanted the arsonists prosecuted, and those that broke them out of jail and vowed resistance. Peace was maintained when Gerry and the three owners dropped the charges. He then turned his full attention towards independence from Great Britain.