Massachusetts Health & Hospital Association Maternal Equity, Insurer Fees, and more …
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MONDAY REPORT
AGO Launches a Maternal Health Equity Grant
The Massachusetts Attorney General’s Office announced the creation of a new Maternal Health Equity Grant last week, with a round of $1.5 million being distributed to healthcare providers in each region of the state. The funding is aimed at improving access to culturally competent maternal care such as prenatal services, behavioral health resources, breastfeeding support, and doula services.
A total of 11 provider organizations were awarded the initial round of grant money, each with a specified approach to reducing maternal health disparities for their patient populations.
Berkshire Medical Center, for example, will work with local organizations in Berkshire County to enhance lactation and mental health support, education for caregivers around birth inequities, and screening for partner violence among patients with substance use disorder.
The Cambridge Health Alliance Foundation will enhance its doula program through updated training on how to conduct “culturally and linguistically responsive” classes, and recruit new and diverse doulas from surrounding communities. Signature Healthcare Brockton Hospital will use the funding to recruit multilingual professionals and revamp its “Health Beginnings” program, which connects obstetricians and midwives with local patients in need.
Other participating organizations include Caring Health Center, Cape Cod Children’s Place, Community Servings, Inc., Greater Lawrence Family Health Center, Mothers’ Milk Bank Northeast, Pernet Family Health Service, Inc., Tufts University, and Whittier Street Health Center.
MHA’s Noga Running for Top Nursing Leadership Post
Patricia Noga, RN, MHA’s Vice President of Clinical Affairs, is one of four candidates named to the American Organization for Nursing Leadership (AONL)’s President-Elect slate. With more than 11,000 members, AONL is recognized as the nation’s foremost organization in advancing the needs and priories of nursing leaders. Its campaign period begins today.
Noga has held nursing leadership positions in Massachusetts hospitals over several decades, is a longtime board member of the Organization of Nurse Leaders – MA, RI, NH, CT, VT, and currently represents Region 1 (New England) on the AONL Board. She has been MHA’s go-to expert on clinical, workforce, and quality and safety issues since 2007.
“I am honored to be running for AONL President-Elect at this critical time for nursing,” said Noga. “I believe my unique background – as an accomplished nurse leader, policy expert, and highly effective consensus-builder – is the right fit for today’s nursing profession and its fast-evolving priorities.”
She launched a campaign website that includes colleague testimonials and an explanation of her platform, which centers around professional wellbeing; safe and healthy workplaces; diversity, equity, inclusion, and belonging; and supporting pathways for the next generation of nurses. Voting is open to AONL members from August 22 to September 12.
Paying Insurance Fees…to Get Paid?
In a piece that was widely circulated among the provider community last week, Propublica, an industry and government watchdog, shed light on yet another practice from national insurers that is hamstringing the ability of the system to maintain and deliver care.
At the heart of the issue are so-called electronic funds transfers (EFTs), or fees that insurers can impose on physicians when they go through the digital payment process to be compensated for their patient care services. Those kickbacks are managed through third-party “payment processors,” several of which are owned by large national insurance companies themselves. (UnitedHealthcare owns two such companies, Change Healthcare and VPay.) In other cases, the insurers and payment processers share the fees collected.
Nearly 60% of medical practices stated they were subject to EFT fees “at least some of the time,” according to the report. The charges can reportedly rise to as high as 5% per transaction, meaning substantial sums of revenue are placed into the hands of insurers that could be instead devoted to patient care. “I have to pay $1.8M in expenses that I could use on PPE for our employees, or setting up testing sites, or providing charity care, or covering other community benefits,” stated one larger medical practice.
CMS had explicitly prohibited electronic funds transfers for a time, but the practice has since been authorized following a push by national health plan interests. State and national physician groups are now compelling the agency to change course.
The EFT issue is part of a growing body of maneuvers, including arbitrary claims denials, that healthcare providers say national insurers are using to quietly generate revenue outside of traditional means. Russ Johnson, CEO of LMH Health in Kansas, recently spoke to Becker’s Hospital Review about the trend.
“The part that’s getting worse is the practices behind and underneath the contracts — the sophistication and implementation of pay practices, information systems, artificial intelligence and computer algorithms that are just denying claims by the thousands every month,” Johnson said.
A Nod to Emerging Leadership
Several local healthcare leaders were named to the Boston Business Journal’s 40 Under 40 list, including Emily Dulong, MHA’s vice president of government advocacy and public policy; Nicholas Duncan, director of emergency management at Tufts Medical Center; and Niyum Gandhi, CFO of Mass General Brigham.
Dulong helps establish MHA’s legislative priorities, leads members’ coordinated advocacy efforts on Beacon Hill, and is a sought-after expert on local healthcare policy for providers, policymakers, and advocates.
The recognitions are an embodiment of the partnership and leadership seen throughout the entire healthcare community over the course of several difficult years. MHA has repeatedly credited the collaborative spirit among all parts of the system – including providers and policymakers – as a driving factor in recent reforms to improve the workforce, expand access to behavioral health, close inequities, and beyond.
edu@MHA: A Special Preview
As the summer winds down, MHA’s education operation is gearing up for an especially busy September. Below is a rundown of some of the events coming your way next month:
Groundhog Day: Medical Staff Style (Scenarios that just seem to come up again and again and again…)
Tuesday, September 12 | 12 – 12:30 p.m.
Customer Data Protection Technology Webinar
Wednesday, September 13 | 11 – 11:45 a.m.
Community Behavioral Health Center (CBHC) & Emergency Department (ED) Care Transitions: Technical Assistance Tool Kit
Friday, September 15 | 12 – 1 p.m.
Proposed Merger Guidelines by the FTC: Impact on Mergers, Spin-off, and Joint Ventures
Friday, September 15 | 12 – 12:30 p.m.
2023 Substance Use Disorders Conference
Tuesday, September 19 | 8 a.m. – 3 p.m.
Victim Compensation and the TRACK-Kit Webinar: Part II
Friday, September 22 | 12 – 1 p.m.
Questions about these – or any – MHA education offerings can be directed to Amy Smalarz, Director of Healthcare Education and Professional Development, at asmalarz@mhalink.org.