INSIDE THE ISSUE
Congress Passes, President Signs Massive Omnibus Bill
Congress has passed the 4,100-plus-page, $1.7 trillion omnibus spending bill that not only funds the continued operation of the federal government and devotes $45 billion in additional aid to Ukraine, but also contains many healthcare-related measures.
An initial analysis of the measure shows that the omnibus bill:
- extends telehealth waivers for healthcare providers through 2024;
- extends the Acute Hospital at Home program through 2024;
- prevents the statutory Pay-As-You-Go (PAYGO) Medicare 4% sequester for two years;
- reduces the physician fee schedule cut from 4.5% to 2% for 2023 and around 3% for 2024;
- extends for two years the Low-Volume Adjustment and Medicare Dependent Hospital programs;
- extends the Alternative Payment Model bonus payment;
- provides 200 additional Graduate Medical Education (GME) slots, at least half of which would be dedicated to psychiatry and related subspecialty residencies; and
- adds marriage and family therapists to Medicare Part B coverage for behavioral health services.
MHA will be analyzing the bill closely in the coming weeks to provide its membership an in-depth analysis.
MHA’s Health Plan Report Shows Mixed Results
MHA is releasing to the membership its Semi-Annual Health Plan Performance Report that presents an analysis of the financial position of health insurance companies in Massachusetts from January 2018 through the second quarter of 2022. Financial results for the first half of 2022 were mixed, with three companies showing net losses and the remainder showing positive profit margins. The highest profit margin was 7% for United Healthcare of New England. Most plans lost members in the first half of 2022. United Healthcare of New England transferred its Medicare Advantage contract to United Healthcare of Wisconsin, resulting in a loss of more than 80,000 members.
MHA produces the report to keep member hospitals, health systems, and PHOs up to date on trends in financial performance and membership among the most prominent health plans in the market.
Secretary Sudders to Retire on January 5
The Secretary of the Executive Office of Health & Human Services, Marylou Sudders, last week announced her retirement, effective January 5. Sudders is the longest-serving EOHHS secretary, having been appointed by Governor Baker in 2015.
Sudders’ stewardship of EOHHS – encompassing the Departments of Public Health and Mental Health, the MassHealth program, and many other state agencies – occurred during a transformational time in Massachusetts healthcare. She led the COVID-19 Response Command Center, oversaw construction of a new Section 1115 Medicaid waiver, and made important inroads into strengthening the state’s behavioral health system, among many other achievements.
From MHA’s and the healthcare community’s perspective, Sudders was considered to be extraordinarily accessible and fair-minded.
“Secretary Sudders leaves a legacy on our healthcare system that is simply unmatched,” said MHA President & CEO Steve Walsh, who along with the Executive Committee on MHA’s Board of Trustees conversed almost daily with Sudders during the pandemic’s peak. “She has been the beacon leading our provider community through the most devastating time in its history, while pushing forward transformative policies that will make a difference for decades to come – such as the historic Medicaid waiver that hard-wires health equity into the way care is delivered. She is among the most meaningful advocates for patients and caregivers our commonwealth has ever seen, and we wish her all the best in what’s to come.”
Building the Behavioral Health Workforce
In an effort to build on the progress made to date in improving the state’s behavioral health system, MHA last week wrote legislative leaders of key committees outlining suggestions for appropriating existing funds in the Behavioral Health Trust Fund (BHTF).
“Given the current and unprecedented behavioral health crisis in the commonwealth and across the country that has been exacerbated by increased need for services, increased acuity of patients with behavioral health needs, and the ongoing workforce shortage, we encourage both the quick deployment of these funds to address the crisis and the use of the full amount of funds appropriated to the BHTF toward retention and expansion of the behavioral health workforce across the continuum,” MHA President & CEO Steve Walsh wrote to legislators. The letter was sent to the chairs of the Joint Committee on Mental Health, Substance Use, and Recovery, Sen. Julian Cyr (D-Truro) and Rep. Adrian Madaro (D-Boston); and the chairs of the Joint Committee on Racial Equity, Civil Rights, and Inclusion Sen. Sonia Chang-Diaz (D-Boston) and Rep. Bud Williams (D-Springfield).
MHA specifically recommended that the behavioral health loan forgiveness program be expanded so that additional behavioral health employees are eligible. These would include those that work in acute care hospitals as emergency department behavioral health staff, behavioral health consult staff in medical-surgical settings, and employees of substance use disorder programs that are affiliated with a hospital and do not require separate substance use disorder licensure.
MHA also recommends directing scholarship and grant program funds towards pipeline development scholarship and grant programs, paid internships, and college/university partnerships that mitigate the financial burden of entering and progressing up the behavioral health workforce pipeline, and that would assist in efforts to diversify the workforce. “These efforts would help support all workers,” Walsh wrote. “including those who do not require advanced degrees, including, but not limited to mental health workers, recovery coaches, peer specialists, sitters, nurses, social workers, psychologists, masters-level licensed behavioral health providers, and psychiatrists.”
An August 2022 survey of Massachusetts healthcare delivery systems that MHA and the Massachusetts Association of Behavioral Health Systems conducted reported that in the inpatient behavioral health setting alone, 568 inpatient psychiatric beds were offline solely due to staffing shortages; this was 20% of the reporting facilities’ licensed beds. Respondents commented that the largest support needed to retain staff was increasing wages and expanding loan forgiveness opportunities to additional profession types, including but not limited to grants and scholarships for applicants from historically marginalized communities pursuing bachelor’s level, master’s level, and/or certificate programs.
Dr. Richard Weiner, the president of Winchester Hospital since 2018, announced his upcoming retirement on LinkedIn last week: “January 1st begins the next chapter in my life, as I will retire at the end of the month. I’ve thoroughly enjoyed my 36 years at Winchester Hospital and all of the relationships I’ve shared. Best wishes for a wonderful holiday season and a healthy and happy 2023!”
A Holiday Message from MHA
Whew, what a year! The healthcare system in Massachusetts faced some significant challenges relating to workforce shortages, capacity constraints, behavioral health boarding, and more. Those challenges have not abated, and neither has the resolve and commitment of the Massachusetts healthcare community. We celebrate our community in this MHA holiday message entitled “We Find a Way.” Monday Report is taking a week off and will return January 9. MHA wishes you and yours a healthy and happy new year.