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> Beds Needed to Add Capacity
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> Transition

MONDAY REPORT

House Budget Debate Begins Wednesday

This Wednesday, the Massachusetts House of Representatives begins deliberations on the fiscal year 2025 budget that the House Ways & Means Committee released on April 10.

There are 1,495 proposed amendments to the budget, including nine MHA priority amendments.

Among the nine are five filed by Rep. Marjorie Decker (D-Cambridge) that specifically address behavioral healthcare. Decker co-chairs the Joint Committee on Public Health along with Senator Julian Cyr (D-Truro).

One of Decker’s amendments (1225) would ensure the viability of services required by the Mental Health ABC Act by aligning behavioral health crisis services to how these services are delivered under the reforms made through the Roadmap for Behavioral Health Reform. The amendment would also ensure commercial coverage of these services. Another one of Decker’s amendments (1222) would establish a special commission to study alternative models to care for state-agency-involved children who are ready for discharge and who require behavioral healthcare outside of the inpatient or emergency department. Her companion amendment (1242) requires the Department of Children & Families to escalate cases of “stuck” state-involved kids, including convening an emergency team to coordinate care for the child and determine an appropriate setting. Another Decker amendment (1227) would require MassHealth, the Group Insurance Commission, and commercial health plans to cover services provided by peer support specialists, regardless of where those services are provided, including coverage of services delivered in emergency departments, acute care hospitals, freestanding psychiatric hospitals, and substance use disorder facilities.

As the 2025 budget discussions get underway, a conference committee continues to meet on a fiscal year 2024 supplemental budget. Both the House and Senate versions of that budget contain a provision to extend the authority of hospitals to allow graduate nurses and nursing students in their final semesters to work at the bedside with supervision, but before they are fully licensed by the state. Those added nurses have been critical during a period when the entire healthcare system is facing severe shortages of workers. But the graduate nurses were removed from the bedside on March 31 when the pandemic-era authority expired. The conference committee, meeting since April 1, needs to resolve the other big items in the supplemental budget – funding for migrant housing and regulating to-go drinks from restaurants – before the supplemental budget containing the nursing provision moves to Governor Healey’s desk.

Mass. Rates Near Top in Equity Ratings, But More Work Needed

Massachusetts is at the top, or near the top, of all states in addressing racial equity in healthcare, according to the Commonwealth Fund’s 2024 State Health Disparities Report.

But even though the Bay State scored well against all other states, the report found that healthcare disparities between different racial and ethnic groups within the state were significant.

“Profound racial and ethnic disparities in health, well-being, and life expectancy have long been the norm in the United States,” the report notes. “These disparities are especially stark for Black and [American Indian and Alaska Native] people, who live fewer years, on average, than white and Hispanic people and are more likely to die from treatable conditions, more likely to die during or after pregnancy and suffer serious pregnancy-related complications, more likely to lose children in infancy, and are at higher risk for many chronic health conditions, from diabetes to hypertension.”

The Commonwealth Fund looked at how well a state’s health system works for people from different racial and ethnic groups, and across different dimensions of care. Massachusetts ranked first among states when comparing health outcomes, healthcare access, and healthcare quality provided to the Asian American, Native Hawaiian, and Pacific Islander (AANHPI) population. For the Black population, Massachusetts ranked second overall for outcomes, access, and quality, and first for Hispanic individuals. For White individuals, the state’s overall ranking was third in the nation.

But when comparing the care provided to White people as opposed to other groups, Massachusetts showed disparities. For example, in the category “Deaths before age 75 from healthcare-treatable causes,” White individuals in Massachusetts experienced 58 such deaths per 100,000 population, which is far below the national average of 83 per 100,000. However, in the Bay State, Black people experienced almost twice as many deaths (100 per 100,000) as White people, while the Hispanic population experienced 61 deaths per 100,000. Similar disparities exist between many, but not all, of the total 25 categories the Commonwealth Fund used in making its rankings.

In Massachusetts, hospitals are centering many of their equity-related efforts through a nation-leading 1115 Medicaid waiver program. Within the five-year commitment, hospitals will be undertaking comprehensive data collection to better identify care disparities, screening for the supports patients may need in their everyday life, improving access for patients with disability and/or translation needs, and building new partnerships across the care continuum.

The Hard Numbers Demonstrating the Capacity Crisis

The Massachusetts Public Health Council last Wednesday voted to approve two hospitals’ requests to expand their bed counts, and in doing so clearly showed how the capacity crisis is affecting the healthcare system.

Cape Cod Healthcare (CCH) won approval to add 32 medical surgical beds, all in private rooms, increasing its licensed bed capacity at its Hyannis facility to 229 beds. CCH is currently building a four-story addition to its main campus, which includes space for expanded oncology and cardiac units, as well as “shell space” for future projects. The additional 32 beds that the council approved last Wednesday will go into that shell space. CCH told the council that its average medical/surgical occupancy rate over the past two years was 91% and that it is treating higher acuity patients and an aging population. The number of patients boarding in the Cape Cod Hospital ED for 12 hours or more increased from 1,490 to 2,403 between 2021 and 2022.

Massachusetts General Hospital also won approval from the council to add 94 beds, raising its total to 994. The council’s vote amends its previous approval of MGH’s $1.9 billion expansion project. In making its argument for the new beds, MGH noted that in fiscal year 2023, 24,388 patients boarded in the MGH ED while waiting for an inpatient bed. MGH uses a “Code Help” or “Capacity Disaster” status when patient volume increases to help it maintain patient safety. In FY23, either status was invoked on 93% of the days. The hospital estimates that more than 500 patients who presented in the ED and would have been admitted, voluntarily left without being seen because of the severe capacity crisis it – and hospitals across the state – is facing.

Transitioning Nursing Home Residents to Community Care

Massachusetts has reached agreement to settle a case that will allow current nursing home residents with disabilities to transition to community settings. The agreement still must be approved by a U.S. District Court judge overseeing the case against the state, Marsters v. Healey.

Under the agreement the state will send liaisons to nursing homes to inform affected residents of their options and provide assistance to help them find housing and care. Among other actions, the state will provide rental vouchers and create new residential settings. Through its services, the state expects to transition 2,400 people out of nursing facilities over the next eight years. Massachusetts estimates it will spend $1 billion over that period to fulfill its obligations to the residents.

“The Executive Office of Health and Human Services understands how important it is for people in nursing facilities who are interested in returning to their communities get the support they need to be able to do so,” said Secretary of Health and Human Services Kate Walsh. “Whether that means helping people find and access appropriate community-based care or housing opportunities, we want everyone to feel empowered in making their own most informed decision.”

Transition

Kevin Giordano has been named president of Brigham and Women’s Faulkner Hospital, Chief Operating Officer of Brigham and Women’s Hospital and the Brigham and Women’s Hospital Physicians Organization, and Senior Vice President, Operations at Mass General Brigham. He has served in those roles on an interim basis since August 2023. Giordano earned his bachelor’s degree in finance and information systems from the Carroll School of Management at Boston College and his master’s in business administration from the Yale School of Management.

John LoDico, Editor