INSIDE THE ISSUE

> Telehealth Parity
> SCOTUS Decision on Roe v Wade
> CHA and the Boarding Crisis
> A Roadmap to Equity
> Waiver Extension
> Transition

MONDAY REPORT

Telehealth Parity: Ensuring Fair Payment

The Health Policy Commission’s (HPC’s) Advisory Council met last Wednesday to discuss the role of telehealth in the state’s healthcare system.

Telehealth use spiked during the pandemic as patients stayed away from physician offices and hospitals, getting their care instead through virtual visits with the caregivers. The state recognized the importance of telemedicine at the outset of COVID-19, mandating that insurers cover it. In 2020, the legislature passed, and the governor signed into law, Chapter 260, which decreed that behavioral health visits via telehealth must be covered in perpetuity on par with in-person visits. Coverage and reimbursement parity was also extended to primary care and chronic disease management services, but only through January 1, 2023. Any requirement for parity for all other services delivered via telehealth ended on September 13, 2021; only one insurer has subsequently reduced reimbursement for those services as the healthcare sector awaits the final Division of Insurance regulation on telehealth coverage and reimbursement. Chapter 260 also directed the HPC to assess the state of telehealth in the commonwealth and deliver a report and recommendations on its use going forward. Last week’s Advisory Council meeting was a part of the HPC’s fact-gathering process for that report.

Christine Schuster, R.N., the president & CEO of Emerson Hospital and Chair-Elect of MHA’s Board of Trustees, told the council (of which she is a member) that when the pandemic hit at the start of 2020, Emerson’s medical staff got on the telemedicine platforms quickly to the great benefit of patients, especially those with chronic diseases, who often have mobility and transportation issues, making it difficult to get to in-person medical visits.

“When we saw that telehealth was working for general, med/surg type visits, we added telestroke, teleneurology and, most recently, pediatric telehealth with Mass General Hospital,” Schuster said, adding that the service helped alleviate the boarding crisis in her facility’s emergency department, particularly for children.

“The doctors providing these visits spend the same amount of time even though the patient is not physically in front of them, so we would advocate for payment parity,” Schuster said.

While some health insurance companies offered parity reimbursement for telehealth before the state compelled them to as the pandemic began, others only relented after directives from the Division of Insurance. Some insurers told the HPC last week that while they support parity for behavioral health telehealth, they favor “freedom of contract” between parties for other services as opposed to a requirement that doctors treating patients virtually should be reimbursed the same as clinicians treating patients in person.

Steven Strongwater, the president & CEO of Atrius Health, told the HPC that contrary to insurer arguments that telehealth has not resulted in the promised lowering of healthcare costs, it eventually will. He said his physicians operating under a capitated system have an incentive to keep costs down, and that telehealth visits often result in less ancillary tests. That, in combination with the fact that telehealth makes it easier for people to get care, thereby avoiding deferred care or visits to the ED, will keep overall healthcare costs down, he said.

MHA as a convenor of tMED – the Massachusetts Telemedicine Coalition – is urging the legislature to support an extension of reimbursement parity for chronic disease management and primary care services for an additional two years. Under the framework of Ch. 260, the state operated with the assumption that primary and chronic disease services would be clearly defined and reimbursed for a period of two years – during calendar years 2021 and 2022. However, the rise of the COVID-19 Delta and Omicron variants threw a wrench into the plans to give providers the reliability that parity in reimbursement would allow as the health system returned to the “new normal.” Without the extension of reimbursement parity, providers are facing a “reimbursement cliff” for telehealth parity for primary care and chronic disease management services as of December 31, 2022. Providing this period of parity will also allow for the collection of data to understand telehealth utilization, its effect on access to care, and inform the foundation of a long-term telehealth payment framework.

MHA’s Statement on Roe v. Wade Decision

Last Friday, the Supreme Court of the United States, in a 6-3 decision, eliminated the constitutional protections for abortion. The decision will result in nearly half of the states banning the procedure. Following the ruling, MHA released the following statement:

“The Supreme Court’s decision to overturn Roe v. Wade is harmful, callous, and completely detached from the necessary reproductive care that is delivered in our country every day.

“This ruling does more than just erode essential personal freedoms for vulnerable individuals; it is a tremendous blow to public health in our nation.

“We echo the serious concerns of our colleagues across the country about what this will mean for the safety and wellbeing of patients in states that are stripping these fundamental rights away. This much we do know: no law can prevent someone from terminating a pregnancy. It can only prevent them from doing so safely with the consult of experienced, compassionate clinicians.

“To the women and birthing people across the United States: the hospitals and health systems of Massachusetts have your back. We are committed to advocating for reproductive rights until the day we are assured that every American has access to the services they need.

“Here in Massachusetts, we are proud of the state’s long history as a leader in reproductive rights. Along with our elected officials and local patient advocates, we look forward to not just maintaining – but building upon – the strong infrastructure that healthcare providers have established for individuals seeking safe, accessible reproductive care.

“But there is no question that great uncertainty remains. It is not yet clear what effect this ruling will have on care demand in states like Massachusetts, nor on the liability of local healthcare providers who perform abortions. MHA and our members will continue to fight for patients and clinicians every step of the way.”

The Baker Administration took a step to help mitigate some of that uncertainty last Friday, issuing an executive order aimed at protecting healthcare providers from legal liability premised on, and professional sanctions issued under, the laws of other States when those services are lawful in the commonwealth and meet the commonwealth’s standards for good professional practice. Among other steps, the order prevents state agencies from assisting “any investigation or proceeding initiated in or by another State that seeks to impose civil or criminal liability or professional sanction” upon individuals who receive or deliver legal reproductive services in Massachusetts. prevents state agencies from assisting “any investigation or proceeding initiated in or by another State that seeks to impose civil or criminal liability or professional sanction” upon individuals who receive or deliver legal reproductive services in Massachusetts.

Cambridge Health Alliance Helps Ease Boarding Crisis

The Center for Inpatient Child & Adolescent Psychiatry includes a 24-bed child psychiatry unit for children ages 3-12 (11 new beds); a 21-bed adolescent psychiatry unit for youth ages 13-17 (opened in June 2021 to expedite 7 new beds); and a new 24-bed neurodevelopmental unit that will provide multidisciplinary and specialized care to children and adolescents with a variety of clinical needs.

The Somerville facility will allow CHA to expand services previously offered at its Cambridge campus and integrate them into Somerville’s operations. CHA will convert two units at its Cambridge Hospital campus to adult inpatient psychiatry units. In total, CHA will add 64-66 inpatient psychiatry beds to meet regional and state needs, adding to its current 89-bed inpatient behavioral health services, for a total of 155 inpatient beds for patients of all ages.

“We are in the midst of a challenging and complex mental health crisis, which has only been intensified by the COVID-19 pandemic,” said Assaad Sayah, M.D., CEO of Cambridge Health Alliance. “As a leader in behavioral health services, we want to be part of the solution.”

Said Marylou Sudders, secretary of the Executive Office of Health and Human Services, “Seeing the intense demand for inpatient psychiatric beds, in 2021 EOHHS put out a call with incentives to our hospital colleagues to respond to the demand. And without missing a beat, CHA was first to answer that call. CHA has stepped up, particularly for children with complex behavioral health challenges, and understands the youth-centered and trauma-informed environment that children need to heal along with their families.”

BMC’s Accelerator Article Lays Out Roadmap for Equity Improvement

It’s a given that the hospital and healthcare community as a whole is re-focusing its attention on the need to embrace diversity, health equity, and inclusion in all aspects of healthcare delivery and operations. But what exactly does that mean in practice?

Boston Medical Center’s Health Equity Accelerator, launched mid-pandemic in 2021, offers a good roadmap to transforming healthcare to deliver health justice. The team at BMC’s Accelerator drafted an article for NEJM Catalyst to describe the organization’s novel approach of “achieving health equity through intentionality, innovation, and sustained commitment.” What that means, in part, is that healthcare organizations must accept accountability for poor outcomes in certain populations as opposed to just attributing those outcomes on patient factors. “The advances of the last few decades have not translated into materially closing gaps and, in some instances, gaps have widened,” the BMC team wrote. “Instead, we have come to believe that intentionality to address inequities will in fact improve outcomes for all.” Doing that requires health systems to explore their role in creating and perpetuating health inequities, through such actions as recognizing and addressing barriers to economic mobility that lead to poor outcomes, becoming more approachable or relatable by improving the diversity of care providers, recognizing that “the national health system has a long history of medical practices that have directly or indirectly had negative impacts on marginalized groups,” and eliminating bias in individual interactions.

“We started this journey by looking internally: we needed to determine which of these health inequities are present within our patient population, understand their drivers and our contributions, and take accountability for them,” the researchers wrote. The paper also covers ways that statistical analysis can skew perceptions, how an Accelerator team works, and how the concept was applied to help achieve equity in care for those who are pregnant.

More Time to Negotiate the Waiver

Last week, the federal government granted Massachusetts an extension – through September 30, 2022 – on the current Section 1115 Waiver that was set to expire on June 30. The five-year waiver is the main agreement between the Centers for Medicare and Medicaid Services (CMS) and the commonwealth, determining how the state’s MassHealth program will operate. The extension is needed as negotiations are currently underway on the new five-year waiver that is precedent-setting for, among other items, tying MassHealth reimbursements to the ability of providers to meet new clinical quality and health equity measures.

Transition

Kate Walsh, the president and CEO of the Boston Medical Center (BMC) health system, has been elected to the American Hospital Association (AHA) Board of Trustees, for a term effective immediately and running through December 31, 2024. Walsh is also a member and former Chair of the MHA Board of Trustees. Walsh praised the AHA for its leadership during the pandemic, and added that the national association representing nearly 5,000 hospitals and health systems is “focused on two of the central challenges facing the entire healthcare community – reducing the health sector’s carbon footprint for a healthy climate, and achieving true health equity for all of our patients.” Douglas Brown, UMass Memorial Health’s president of Community Hospitals and chief administrative officer, also sits on the AHA Board.

John LoDico, Editor