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> MOLST-to-POLST Transition
> Hearing Tomorrow on Key Bills
> Workforce Forum
> Digital Access
> Transitions

MONDAY REPORT

State Seeks Consumer Help with Serious Illness Form & Website

The way in which patients facing serious medical events inform their clinicians about their care decisions continues to evolve.

Massachusetts is switching from the Medical Orders for Life-Sustaining Treatment (MOLST) form to the Portable Orders for Life Sustaining Treatment (POLST) form. The main difference is that the MOLST form is printed on pink paper, while the POLST form contains updated information and can be submitted and accessed electronically. The forms detail whether a patient wants CPR to resuscitate them and whether they are accepting or refusing medical treatments, including those that might extend life. A POLST form is a medical order, like a prescription.

The transition has been ongoing since 2023, with facilities across the state first participating in a POLST pilot program in 2024, with full implementation planned for 2026. MHA has been involved in the MOLST-to-POLST process throughout the transition.

Last week, the Massachusetts Executive Office of Aging & Independence (AGE) announced that it is developing a new website and materials to educate patients and caregivers about POLST and is seeking consumers to assess its outreach. Specifically, the state is looking to speak to adults 18 and over, who are living with serious illness or declining health, or caregivers of people with serious illness.

Participants will be invited to take part in either a 60-to-90-minute one-on-one interview if they are living with a serious illness or declining health, or a 60-to-90-minute focus group if they are a caregiver. Participants will be paid $150.

These online sessions will be held in late October. During the sessions, participants will review the state’s draft educational materials and a website about POLST. The state is asking the caregiver community to help identify people who can participate and has produced this brief flyer for distribution or posting.

If interested, individuals can complete this initial screening to see if they are a match for Cambridge Focus, the research firm assisting Mass POLST. Interested parties can also call (857) 331-1357 and ask for Janice Rosenblum.

Financial Services to Hear a Host of Health Bills Tomorrow

The Legislature’s Joint Committee on Financial Services holds a hearing tomorrow on a large slate of healthcare-related bills, including MHA priority bills relating to telehealth, hospital at home, and unilateral insurance practices.

H.1130/S.763, An Act Relative to Telehealth and Digital Equity for Patients, sponsored by Rep. Marjorie Decker (D-Cambridge) and Sen. Adam Gómez (D-Springfield), would require insurers to reimburse providers for all telehealth services on par with what they would receive for delivering similar services in-person. Currently, reimbursement parity is only required for behavioral health services offered via telehealth. Notably, the bill prohibits insurers from imposing prior authorization requirements on medically necessary telehealth visits that would not apply to in-person visits. H.1130/S.763 also requires all commercial payers and the Group Insurance Commission to cover and reimburse for e-consults, e-visits, remote patient monitoring, and remote therapeutic monitoring services and devices. It would also require health plans to identify and offer digital health education to their members with low digital health literacy to assist them in accessing medically necessary covered telehealth benefits; this mirrors language that the Centers for Medicare and Medicaid Services has adopted for Medicare Advantage plans. The legislation also establishes a special commission to make recommendations on how to address health outcomes and digital access inequities through the recruitment and implementation of digital health navigators.

“Since the pandemic, healthcare providers have been providing care to patients via telehealth and the results have been clear; it has proven to be convenient for patients, cutting wait times and transportation costs, as well as helping to resolve ED capacity issues, while improving the efficiency of healthcare delivery,” said MHA’s Senior Director of Virtual Care & Clinical Affairs Adam Delmolino. “Without reimbursement parity, telehealth services won’t be able to be deployed to their full potential, thereby compelling patients to seek in-person services or forgo necessary treatment.”

Many patients face transportation challenges, difficulty taking time off from work or school, child-care access issues, or are immunocompromised and at higher risk of infection, serious illness, or hospitalization – so they seek care through the ease and safety of telehealth. To compel in-person services for such patients could amplify existing systemic disparities in healthcare access, thereby undoing the significant equity benefits of telemedicine.

A study in Jama Internal Medicine earlier this year found that telemedicine may reduce low-value care – that is, medical tests and procedures that provide little to no benefit to patients and which contribute to excess medical spending.

Also before the Financial Services tomorrow is H.1141/S.806, An Act Increasing Access to Acute Hospital-at-Home Services, sponsored by Rep. Daniel Donahue (D-Worcester) and Sen. Patrick O’Connor (R-Weymouth). Through hospital-at-home programs, hospitals provide advanced inpatient care outside of a facility’s walls and within a patient’s home. During the pandemic, the Centers for Medicare and Medicaid Services (CMS) provided a waiver that allowed hospital-at-home programs to be reimbursed by Medicare at the same rate as inpatient care. Hospitals took advantage of the waiver as a way of freeing up beds in over-capacity facilities while bringing care closer to people in their homes, which benefited both patients and their families. However, the programs still only enjoy predictable reimbursement parity from Medicare and MassHealth – making them unsustainable for many provider organizations, especially at a large scale. The bills before the legislature tomorrow would require hospital-at-home coverage from commercial insurers as well as the Group Insurance Commission. (MassHealth already covers such programs.)

Hospital-at-home programs have the support from both Democrats and Republicans in Congress. The continuing resolution packages from both parties in D.C. include an extension of the Medicare hospital-at-home waiver. Since the shutdown, and the subsequent temporary elimination of the waiver, hospitals have been forced to transfer patients from beds in their homes back into the hospital.

“We’re hopeful that when the shutdown is resolved and a continuing resolution is passed, it will contain an extension of the hospital-at-home waiver and we may eventually have a permanent authorization in place,” MHA’s Delmolino said. “But, in order for our hospital members to have the predictability and support that they need to grow these programs, we need for them to be reimbursed properly by various payers. The bills before the legislature correct this inadequacy.”

Among the other health bills before the committee tomorrow is H.1267/S.699, An Act Relative to Unilateral Contract Changes, sponsored by Rep. Frank Moran (D-Lawrence) and Sen. Brendan Crighton (D-Lynn). This bill prohibits the Group Insurance Commission and commercial carriers from entering into contracts with healthcare providers that allow them to make unilateral changes to the contracts. Currently, carriers may unilaterally change the terms of the contract while it is in force, potentially causing operational, financial, and medical consequences for both patients and providers. For example, several insurers have announced they will begin automatically “downcoding” the billing level for certain office visits based on the information contained on the claim form, as opposed to the information in the medical record. Another insurer announced it will automatically reduce payment for inpatient stays unless they meet the insurer’s specific guidelines for inpatient admissions that appear to run counter to federal rules.

Policymakers Talk Workforce Challenges, Priorities

Last Monday, MASSterList and the State House News Service convened a policy forum to discuss the persistent workforce challenges impeding care delivery in Massachusetts.

“Workforce dynamics can have profound impacts on care delivery patterns, health outcomes, and ultimately healthcare costs,” said Health Policy Commission executive director David Seltz as he summarized the growing list of pressures on clinicians and other members of the care team.

Much of the morning’s conversation revolved around two worrisome trends that healthcare professionals are enduring on a daily basis: workplace violence and excessive administrative burdens.

“We need to send a message to our healthcare workers, like going to a TSA agent, that you do not put your hands ever on a healthcare worker,” said Rep. John Lawn (D-Watertown). A hospital employee is victim to a violent act every 36 minutes in Massachusetts, a trend that MHA and its members have been addressing through enhanced prevention measures, training, and other collaborative actions over the past decade. Lawn is a lead sponsor of legislation supported by MHA, the Massachusetts Nurses Association, and 1199SEIU Massachusetts that would create comprehensive protections and supports for workers who are victims of violent acts while serving on the job. He stated that “we are very close to having [the bill] done.”

Clinical leaders – including Dr. Elisa Choi (representing the Massachusetts Medical Society) and Hiyam Nadel of Massachusetts General Hospital – shared their on-the-ground struggles with a rising volume of paperwork and administrative tasks that drive provider burnout and create care obstacles for patients.

“This is like if you never once in your entire life cleaned out your closet. It would be pretty difficult; you’d be on an episode of Hoarders,” said MHA President and CEO Steve Walsh, reflecting on the administrative requirements that are adding $1.75 billion in cost waste to the Massachusetts healthcare system annually. “We don’t clean out our closet in healthcare. So the regulatory burdens we had in the 1950s are still there on top of the regulatory burdens that were passed last year and the ones we passed this year.”

“We’ve tried to work with the different entities and now it’s just time, I believe, for the state to say ‘stop’,” said Sen. Cindy Friedman (D-Arlington) on the topic of excessive prior authorization practices. Friedman is the lead sponsor of a bill supported by MHA, the Medical Society, and Health Care For All that would streamline the prior authorization process with the aim of freeing up caregivers and opening up care access for patients.

Walsh also highlighted the success of MHA’s new Healthy Work Environment Academy, an intensive 18-month program for frontline nursing teams to address a specific on-the-job issue and devise a solution that will be implemented within their facility. The initial cohort of 10 hospitals is sponsored by Johnson & Johnson, which also underwrote last week’s event and which was represented on the panel by Aisha Williams, global lead of healthcare workforce strategy & programs.

MBI’s Connected & Online Program Supports Telehealth

Hospitals and healthcare providers, along with a host of other groups, are eligible to receive “internet-enabled devices” from the state to help expand digital access across the commonwealth.

More than $23 million from the U.S. Treasury’s Capital Projects Fund was distributed to the state’s Executive Office of Economic Development. Using that funding, the state’s Connected & Online program will be implemented through the Massachusetts Broadband Institute, which is a division of MassTech.

The program plans to distribute 27,000 devices (laptops, tablets, etc.), along with assistive technology and supportive equipment, to organizations across the state. The program only funds projects that enable public access to devices that expand access to 1) workforce training, 2) education, and 3) health monitoring and access (telehealth). To qualify, proposed projects must demonstrate how they will help individuals across all three domains. Projects in Gateway Cities and rural communities will be given priority.

“From rural towns to our largest cities, residents deserve the chance to log on and connect with opportunity,” said Lieutenant Governor Kim Driscoll. “These devices will help families access telehealth, students complete their homework, and job seekers apply for new opportunities. This investment is about removing barriers so that everyone in Massachusetts can fully participate in our economy.”

To see a list of FAQs, as well as an application form, visit the Connected & Online Program webpage. Applications close on November 7 and award notifications will be made in early December.

Transitions

Diana Richardson, who has led Merrimack Health since April in an interim role, has been named to the permanent position of president and CEO, effective immediately. Merrimack Health consists of Merrimack Health Lawrence Hospital, Merrimack Health Haverhill Hospital, and Merrimack Health Methuen Hospital, as well as the Merrimack Health Community Medical Associates physician practice.

Prior to joining Merrimack Health, Richardson was a senior transition liaison with the Massachusetts Department of Public Health, where she helped address the Steward Health Care bankruptcy crisis. Before her time at DPH, Richardson served as executive vice president of Tufts Medicine and president of Tufts Medical Center in Boston, after previously holding the role of senior vice president and chief operating officer. Richardson is a graduate of Boston University and holds an MBA from Bentley University.

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Susan Szulewski, M.D., has been named president and chief operating officer of McLean Hospital, effective November 1. Szulewski will also continue in her role as vice president of clinical operations for Mass General Brigham Behavioral and Mental Health. At McLean, she will work in partnership with Maurizio Fava, M.D., who will become chair of psychiatry for Mass General Brigham.

Szulewski joined McLean in 2015, most recently serving as chief medical officer. She earned her medical degree from the University of Medical Sciences in Poznan, Poland, completed her psychiatry residency at the Warren Alpert Medical School of Brown University, and received her MBA in healthcare management from the Heller School at Brandeis University.

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The American Hospital Association has named Joanne Cunningham as AHA Regional Executive for Region 1, which includes Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont, effective immediately. Cunningham’s prior roles include CEO of the Partnership for Quality Home Healthcare and CEO of the Home Care Association of New York State. Prior to those positions, she spent 10 years in executive and senior leadership positions at the Healthcare Association of New York State and Healthcare Trustees of New York State. In the early part of her career, she worked as chief healthcare advisor to then-Congressman Edward J. Markey (D-Mass.), former Senator Max Baucus (D-Mont.), and former Maryland Governor William Donald Schaefer (D). Cunningham holds a bachelor’s degree from State University of New York at Potsdam and a Master of Health Science degree from the Johns Hopkins University Bloomberg School of Hygiene and Public Health.

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Michael Treash has been named president of Health New England, the health plan of Baystate Health, effective immediately. Treash will report to Baystate Health President and CEO Peter Banko. Treash most recently served as chief operating officer and senior vice president at Health Alliance Plan in Detroit. His previous leadership roles include vice president of enterprise operations at Priority Health in Grand Rapids, interim CEO of Missouri Health Care Cooperative, COO of The Outsource Group, and executive vice president and COO at Mercy Health Plans in Chesterfield, Missouri. He holds a bachelor’s degree in political science from Western Michigan University and a Master of Public Administration from Arizona State University.

John LoDico, Editor