INSIDE THE ISSUE
Series of Bills Focus on Reducing Prior Authorization First in Nation: Mass. Healthcare Community Revises Credentialing Process
In a nation-leading step for caregiver wellbeing, every Massachusetts hospital, health system, and local health plan has committed to eliminating potentially stigmatizing or invasive questions from their credentialing processes. This is part of the healthcare community’s broader strategy to support clinician wellbeing and reduce stigma within the ranks of the profession, and to help connect workers with the mental health resources they need.
Each year, thousands of local physicians and healthcare professionals go through the credentialing process to ensure they are in good standing to deliver safe patient care. However, the forms used within this process have often included outdated, unnecessary questions about clinicians’ mental health history and past drug use. Caregivers have been discouraged from seeking behavioral health services because they know they will encounter these overly broad questions and fear their livelihoods will be threatened as a result of answering honestly.
MHA’s Board of Trustees unanimously approved this effort to reform the credentialing process, and the association is working with individual members to bring their policies up to best practice. The Massachusetts Medical Society, local health plans (which have their own credentialing forms that clinicians must compete), and leading national healthcare organizations also champion the initiative. The commonwealth is the first state to mount such a comprehensive commitment across providers, insurance companies, and advocates.
In a major victory, the National Committee for Quality Assurance (NCQA), which accredits health plans nationwide, will no longer require that the plans ask clinicians about their prior drug use. The change is the result of extensive internal review, coalition building, and advocacy from MHA and its partners. The NCQA’s modification will allow the commonwealth to update its common credentialing application, known as the Integrated Massachusetts Application (IMA), with full endorsement from local health plans. This change will also affect 38 Massachusetts hospitals that use the IMA form for their own credentialing practices.
The initiative comes at an especially intense time for the healthcare system and its caregivers. As has been well documented, clinicians in every role are reporting troubling rates of stress, fatigue, and burnout. Healthcare leaders continue to prioritize new and creative ways to support their employees – including behavioral health support.
“We are proud that, once again, our provider organizations are meeting the moment and rallying around the wellbeing of their caregivers,” said Dr. Steven Defossez, vice president of clinical integration at MHA. “While we will never know which clinicians will now choose to seek support, we are confident that they and their patients will be far better off due to this united initiative. We will celebrate the impact that this effort will have, while knowing it is just one more step along the way to mitigate burnout and eliminate stigma from the healthcare profession.”
“These changes signify a major reduction of stigma-fueled barriers that render physicians reluctant to seek appropriate care for their own mental health concerns, including those commonly known to drive and exacerbate burnout like depression and anxiety,” said Massachusetts Medical Society President Dr. Barbara Spivak, whose organization in 2018 advocated successfully for the elimination and modification of intrusive and overly broad questions regarding mental health issues on physician licensure applications. “The epidemic of physician burnout remains a focus of the Medical Society, and we will continue to push for meaningful reduction of administrative burdens and improved workplace culture and flexibilities so that we can build a robust, diverse, and sustainable physician workforce capable of meeting patient needs across the commonwealth.”
“MAHP and our member plans believe that every individual should have access to high-quality, affordable, and equitable healthcare, including mental health and substance use disorder treatment,” said Liz Leahy, senior vice president of advocacy and engagement at the Massachusetts Association of Health Plans. “It is our hope that NCQA’s elimination of this outdated question, formerly required as part of health plans’ provider credentialing processes, will reduce stigma for providers and patients alike.”
Michael Caljouw, Blue Cross Blue Shield of Massachusetts’s vice president, state government and regulatory affairs, said, “We are proud of our work collaborating with our clinician partners to eliminate this particular question and will continue to review similar opportunities to remove other barriers that no longer make sense.”
The removal of potentially invasive and stigmatizing language from credentialing forms is supported by leading national healthcare organizations, including the American Medical Association (AMA), the Dr. Lorna Breen Heroes’ Foundation, The Joint Commission, the National Academy of Medicine, the U.S. Surgeon General Health Worker Burnout Advisory, the Institute for Healthcare Improvement, the Federation of State Physician Health Programs, and The Federation of State Medical Boards.
The Dr. Lorna Breen Heroes’ Foundation CEO & Co-Founder Corey Feist commended the Massachusetts decision, saying it meshes well with its ALL IN: Wellbeing First Champions Challenge. “We have seen remarkable progress across the country by licensing boards and hospitals in using our toolkit to eliminate overly invasive questions about prior mental health of clinicians, which serve to reinforce the structural stigma against getting mental health treatment as well as serve as the primary driver of suicide of health workers,” Feist said.
AMA President Jesse Ehrenfeld, M.D., praised the Massachusetts effort, adding, “We urge all other state hospital associations to make the same commitment and join a growing number of leading state and national organizations that recognize the urgent need to make these changes.”
SUPPORT Reauthorization May Advance in House & Senate This Week
The U.S. House of Representatives this week is expected to vote on legislation to reauthorize H.R. 4531, The Support for Patients and Communities Reauthorization Act (SUPPORT Act), which was originally enacted in 2018. Among other things, the act included funding for community-based mental health and substance use-disorder treatment and recovery programs, and requires state Medicaid programs to cover all three FDA-approved medications for opioid use disorder – buprenorphine, methadone, and naltrexone. At the time of its 2018 enactment, it was the nation’s largest investment in overdose prevention.
In addition to the expected House vote, the Senate Health, Education, Labor and Pensions Committee is scheduled to mark up its version, S.3393, of the SUPPORT Act today, Monday, December 11. Earlier this fall, MHA joined healthcare interests across the U.S. in signing this letter of support to Congress urging prompt action to reauthorize the SUPPORT Act.
New England Sinai Closure Adds to SE Mass. Capacity Problem
Steward Health Care, the for-profit health system based in Dallas, announced last week that it plans to close New England Sinai Hospital (NESH) in Stoughton by April 2024. The system said chronically low reimbursement rates from public payers have led to $22 million in loses at NESH. Steward owns 33 hospitals in eight states, including 10 in Massachusetts.
The closing will have a ripple effect on the Massachusetts healthcare system. NESH in Stoughton is located halfway between the Steward-owned Norwood Hospital, which has been closed since experiencing flooding in June 2020, and Signature Brockton Hospital, which has been closed for inpatient services since a fire raced through the facility in February 2023. The three facilities are located within 14 miles of each other. The closures of the Norwood and Brockton facilities, as well as the closure of Quincy-based Compass Medical in May, have put enormous pressures on surrounding hospitals that are themselves beset – as are hospitals across Massachusetts – with significant workforce shortages.
“The planned closure of New England Sinai adds yet another layer of fragility to our state’s healthcare system,” said MHA Vice President of Clinical Affairs Patricia Noga, R.N. “We know it is already a massive challenge for patients to find post-acute care services and for hospitals to discharge individuals to the next level of care.”
New England Sinai’s closure will remove 39 rehabilitation service beds, 119 chronic care service beds, and end all of the facility’s ambulatory care services, which include adult day healthcare, complex medical care, endocrinology and diabetes services, occupational and physical therapy, speech therapy services, and more.
Post-acute care hospitals such as NESH are an essential part of the care continuum. MHA’s regular monthly surveys show that there are often up to 1,000 patients who could be discharged from an acute care hospital but are stuck waiting to be discharged to a post-acute care facility, such as New England Sinai.
“While every hospital in the state is navigating severe capacity issues, those obstacles are especially pronounced in the southeast part of the state due to multiple service closures in recent years,” Noga said. “We will be working with local providers and state leaders to ensure every New England Sinai patient continues to receive appropriate care, while also striving to place as minimal added pressure as possible on area hospitals.”
Steward said it would attempt to place staff affected by the NESH closure into its other Massachusetts facilities, which currently have 820 vacant positions.
DPH Eyes Uptick in Hepatitis A Cases
In November, the state recorded six, apparently unlinked cases of Hepatitis A infection in Suffolk, Norfolk, Hampden, and Plymouth counties, and is investigating possible additional cases. “Several” of those cases, according to the Department of Public Health (DPH), involved individuals experiencing homelessness and drug use. None of the cases have a history of travel outside of Massachusetts and none appear to be linked through a common food, beverage, or drug source.
“These cases are similar to a large outbreak that began in Massachusetts in 2018 and ended in 2020, eventually involving 563 cases with 9 deaths,” DPH wrote in a clinical advisory last week. “At that time, there were additional large Hepatitis A infection clusters in California, Indiana, Kentucky, Michigan, Tennessee, Utah, and West Virginia.”
The advisory continues, “Given the pattern of significant [Hepatitis A virus] outbreaks previously seen involving similar populations, here and in other jurisdictions, there is concern that additional hepatitis A transmission and morbidity will likely occur in the commonwealth. Effective prevention and response measures include early identification of cases, vaccination, enhanced sanitation processes, and education of populations who may be at risk.”
The advisory goes on to give recommendations for healthcare providers and includes a link to educational materials in English, Spanish, and Portuguese.
Save the Date for CMS Health Equity Conference
The Centers for Medicare & Medicaid Services (CMS) has announced that its second annual Health Equity Conference will be held on May 29-30, 2024, in Bethesda, Maryland and also virtually. The free conference convenes health equity leaders from federal and local agencies, health provider organizations, academia, community-based organizations, among other groups. The Call for Proposals will open in January 2024, and conference registration will open in spring 2024.