INSIDE THE ISSUE

> Relief for Hospitals
> Local Reproductive Protections
> A Change at the HPC
> Adverse Events Decline
> Federal PHE Extended
> HHS’ Primary Care Initiative

MONDAY REPORT

Economic Development Bill Includes Hospital Relief

The Massachusetts House last Thursday passed a sweeping $4.2 billion economic development bill that includes $350 million in hospital relief funding. The relief dollars are drawn from the state’s American Rescue Plan Act (ARPA) funds and would be the first major source of relief for Massachusetts healthcare organizations since last December.

The support comes at a particularly tenuous point for hospitals, whose financial losses have been compounded by rising inflation and travel labor costs.

“MHA and our members are deeply grateful for the much-needed relief passed by the House,” said MHA President & CEO Steve Walsh. “This historic funding will help our hospitals and health systems take a significant step on the road to economic recovery. After 27 months of battling a relentless public health crisis, they want nothing more than to be able to be there for patients and caregivers. We look forward to working with both branches of the legislature and the Baker Administration as this bill moves forward.”

The House bill also incorporates several measures that can help support health equity. $50 million was set aside for broadband projects that promote digital equity and inclusion, with priority given to projects benefiting communities of color. Public housing units, libraries, and schools are among the targets for such broadband expansion initiatives. Sections to increase the child/dependent care credit, eliminate the child/dependent care credit cap, and increase the state earned income tax credit also made the final cut.

Legislature Weighs Reproductive Health Protections

The Massachusetts House and Senate have now both passed bills to bolster protections for patients and providers involved with reproductive and gender-affirming care in the commonwealth. Both proposals affirm that those services are secured under the state’s constitution. Thus, local courts and authorities would be prevented from cooperating with out-of-state investigations or legal action relating to the delivery of reproductive services within Massachusetts borders.

Those measures, currently in place through an Executive Order signed by Governor Baker, were an immediate priority for the provider community following the overturning of Roe v. Wade. MHA and other healthcare advocates have been highly engaged with lawmakers over the past weeks to support and inform the permanent protections as they were drafted. The Senate version of the bill includes an MHA-supported provision that extends protections to genetic counselors, who help coordinate abortion care and related resources for patients.

In addition to the legal protections, both pieces of legislation require health plans to cover abortions without any form of cost-sharing and create a DPH standing order authorizing pharmacists to dispense emergency contraceptives. The chambers will work to reconcile differences, including whether or not to allow late-term abortions due to lethal fetal anomalies, and send a final proposal to the Governor’s desk before the legislative session ends on July 31.

At the national level, the U.S. Department of Health and Human Services issued a memo last week compelling all healthcare providers to deliver “stabilizing medical treatment” to pregnant patients who come into their care – even if that means performing an abortion. HHS says the mandate supersedes individual state laws, as it falls under the Emergency Medical Treatment and Active Labor Act (EMTALA).

“As frontline health care providers, the federal EMTALA statute protects your clinical judgment and the action that you take to provide stabilizing medical treatment to your pregnant patients, regardless of the restrictions in the state where you practice,” said HHS Secretary Xavier Beccera in a letter to providers. In separate guidance, HHS reminded retail pharmacies that they cannot deny or dissuade patients from receiving drugs that may assist in early-term abortions.

HPC Changes Leadership, Discusses Policy Priorities

The Health Policy Commission (HPC) board meeting last Wednesday began with news that Dr. Stuart Altman would be stepping down after ten years as lead commissioner. Altman was the inaugural HPC chair, overseeing the group’s work to address healthcare costs since 2012.

“MHA and our members are grateful for Dr. Altman’s years of committed work as the Chair of the Health Policy Commission,” read MHA’s message following the announcement. “It is fitting that the commonwealth ranks as the number one state for healthcare access and affordability as his tenure comes to a close.”

The Baker Administration named Deborah Devaux, a former executive at Beth Israel Lahey Health and Blue Cross Blue Shield of Massachusetts, as the new HPC Chair. MHA applauded the selection, stating that Devaux’s “deep experience across the healthcare continuum and focus on putting patients first will make her an excellent choice to succeed Dr. Altman and lead the commission from day one.”

The HPC Board devoted the bulk of its meeting to a discussion on its five policy focuses: strengthening accountability, constraining excessive prices, making health plans accountable, advancing health equity, and implementing targeted strategies and policies. The hospital community has urged the commission to account for the present-day, on-the-ground pressures providers are facing – including staggering financial losses, pervasive inflation, and worsening workforce shortages – as it discusses long-term policies that could shape the way the system operates.

Adverse Events in Hospitals Have Declined

Research published last week in the Journal of the American Medical Association shows adverse events in U.S. hospitals dropped significantly between 2010 and 2019. Adverse events occur when harm is brought upon a patient due to medical practice rather that the patient’s condition itself. The study of 244,542 adult patients across 3,156 acute care hospitals examined outcomes in four specific clinical areas, as well as a grouping of all other conditions.

According to the research, the rate of adverse events decreased significantly among patients presenting with acute myocardial infarction, heart failure, pneumonia, and major surgical procedures. Those incidents include drug-related events, hospital-acquired infections, procedural complications, pressure ulcers, and falls; all of which are regarded as indicative of overall hospital safety and quality. A similar decline was also observed within the adjusted rates of “all other conditions” for the years that grouping was studied (2012-2019).

“There has been an improvement in patient safety in U.S. hospitals during the 10 years we studied. Our data shows that the major safety improvement efforts made by our country and our hospitals seems to be paying off,” said co-author Dr. Mark Matersky of the UConn School of Medicine and UConn Health.

Healthcare safety is a core part of MHA’s mission and the work of its various councils, which help contribute to MHA’s PatientCareLink, where up-to-date guidance and best practices are shared. This work is bolstered through partnerships with the Massachusetts Coalition for the Prevention of Medical Errors, Organization of Nurse Leaders, and Betsy Lehman Center for Patient Safety.

The U.S. is Still in a Public Health Emergency

U.S. HHS Secretary Xavier Becerra signed a renewal of the federal Public Health Emergency (PHE) last Friday. The COVID-19 PHE was first established in January of 2020 and has been extended nine times since. It will now likely remain active for at least the next three months. The American Hospital Association remains vocal in advocating for the extensions, which preserve flexibilities and waivers that have helped healthcare providers respond to the crisis.

How Can the Country Better Address Primary Care?

The U.S. Department of Health and Human Services is seeking insights on how the federal government can improve its approach to primary care. HHS established its Initiative to Strengthen Primary Health Care last September and will establish a federal foundation to support primary care through sustained partnerships with patients and communities, equitable care using interprofessional teams, and the coordination of care across providers and community-based organizations.

The first order of business for the initiative is to develop an action plan that will dictate specific actions that the agency can take to achieve these goals. HHS is asking for input from providers on successful models or innovations that improve primary healthcare, existing barriers to implementing those models and innovations, successful strategies for engaging communities, and specific suggested HHS actions. Each organization can submit one response to OASHPrimaryHealthCare@hhs.gov. Additional instructions and information are available here.

John LoDico, Editor