INSIDE THE ISSUE
House Ways & Means Releases 2023 Budget Proposal
The House Ways and Means (HWM) Committee, chaired by Rep. Aaron Michlewitz (D-Boston), released its $49.6 billion FY2023 state budget proposal last Wednesday, and the House is expected to take up debate on it next week.
From the healthcare point of view, the Ways & Means budget proposal carries forward the elements from Governor Baker’s budget plan relating to the hospital assessment and associated Medicaid spending, which are subject to approval by the Centers for Medicare and Medicaid Services. The assessment and the related spending provisions in the both the HWM and Baker budgets bring substantial new hospital funding to support health equity, clinical quality outcomes, safety net providers, delivery system reforms, and chronic underpayment of services provided to MassHealth patients. They also support health-related housing needs, nutrition, and care coordination in communities.
House Ways & Means’ proposal also calls for a Connector Care expansion initiative that establishes a two-year pilot program extending Connector Care eligibility for applicants between 300% to 500% of the federal poverty guidelines.
One persistent problem MHA has noted with previous budget proposals, as well as this one, is that they contain permissive language allowing the state to transfer “up to $15,000,000” to the Health Safety Net Trust Fund, which allows the state to override the statutorily required $30 million transfer amount. Last year, the Health Safety Net experienced a $62 million funding shortfall that hospitals financed entirely. MHA is filing an amendment to the budget to mandate the full transfer given the continuing financial pressures on hospitals.
The HWM budget makes several investments in behavioral healthcare across the Departments of Mental Health and Public Health. Of note, outside section 54 tasks the Health Policy Commission with conducting an analysis of the effects of the pandemic on behavioral health-related emergency department boarding. The HPC must file its report with the legislature by July 1, 2023. HWM is proposing a new loan forgiveness program for clinical behavioral health workers employed by the Department of Mental Health (DMH), and the proposed budget funds many DPH behavioral health programs, including a mental health telehealth pilot in schools, a mental health workforce pipeline program, a public awareness campaign to promote awareness and use of available behavioral health services, and a loan forgiveness program for mental health professionals.
Last Friday, a series of amendments filed on MHA’s behalf included ones relating to coverage for care delivered by certified community health workers, ensuring resources for behavioral health patients while they board, supporting a telehealth digital navigator program, and as mentioned above, protecting the Health Safety Net.
HPC Sets Benchmark and Hopes it Does No Harm
The Health Policy Commission (HPC) has set the state’s cost growth benchmark at 3.6%, up from the 3.1% that the healthcare system had been operating under since 2018.
The benchmark has come under increased scrutiny this year given the fact that healthcare providers have been financially destabilized by two years of pandemic pressures, the current workforce shortage, and operating margins that have plummeted during the first quarter of this calendar year.
Commissioners in setting the benchmark conceded that healthcare spending, which was below the benchmark pre-pandemic, will certainly exceed it dramatically as providers recover from the pandemic during a high-inflation economy.
“I think all of us understand that these last two years … is anything but normal for all aspects of our society, particularly the healthcare system, whether it is their need to take on added responsibilities due to COVID, or to bring on added expenses that are needed to keep their hospitals high quality,” said HPC Chair Stuart Altman. But he added that the state “cannot take our foot off the brake” in slowing healthcare costs. Altman said that a 3.6% benchmark would not “shortchange our healthcare system as it copes with these problems” while again conceding, along with HPC Executive Director David Seltz, that healthcare cost growth nationwide post-pandemic will inevitably be “significant.”
HPC Commissioner David Cutler noted that the current 7-8% high inflation rate is far above the 2% rate that was built into the forecasting equation the HPC uses to set the benchmark. He noted that when costs go up prices usually go up. But since many hospital prices are fixed through contracts with insurers, those prices can’t rise. Cutler said he expects during the next round of negotiations, providers will demand price increases, and added that for some organizations – those with lower prices – that ask “is probably justified.”
“We should be very clear that it is not our intention to force organizations to go bankrupt because their costs have risen in the pandemic and that some leniency in some circumstances should be appropriate,” Cutler said, adding again that he envisions leniency only for lower-paid facilities.
MHA President & CEO Steve Walsh said after the HPC hearing last Wednesday, “As the HPC acknowledged in its discussion, our healthcare organizations are still operating under extraordinary circumstances. This reality must remain front-and-center whenever we evaluate the performance of the system or make decisions that influence how hospitals operate. MHA and our members have made it clear: we strongly support a cost growth benchmark. But it is a critical tool in critical need of evolution. We will continue to advocate for a modernized approach to the benchmark, using the wisdom of state legislators to ensure the tool can keep up with the times and succeed in the years ahead.”
DOI Issues Regulations on Provider Directories, Telehealth
The Division of Insurance (DOI) last week released proposed regulations that address some concerns MHA and its membership have raised about health insurance company polices relating to provider directories and coverage for telehealth.
Providers have long attempted to ensure that health insurance companies present families and individuals seeking care in Massachusetts with accurate provider directories to reduce the difficulty people face in finding clinicians. Through Chapter 124 of the Acts of 2019, the legislature created a Provider Directory Task Force. Many of the recommendations that task force made were included in the DOI proposed regulations released last week.
As reported in the April 4 Monday Report, MHA expressed concern to DOI that the lag in issuing regulations to implement Chapter 260 provisions relating to payment parity for telehealth services left health insurance companies to devise their own rules that were often disadvantageous to patients. The Boston Globe on April 11 ran a story noting the one-year lag in issuing Chapter 260 regulations, and DOI issued its proposed telehealth regulations on Tuesday.
While MHA expressed thanks that the telehealth regulations were released, the association’s Director of Virtual Care & Clinical Affairs Adam Delmolino said, “As we take a deeper look and gather feedback from our coalition partners, we will continue to flag concerns about where these regulations need to be improved – particularly when it comes to definitions around chronic disease management and primary care services, and how they can help improve health equity.”
The tMED Coalition, of which MHA is a founding partner will submit detailed feedback to DOI at a public hearing scheduled for both the telehealth and provider directory rules on May 11 at 11 a.m.
BORIM to Require Implicit Bias Training
New physicians in Massachusetts, and doctors seeking license renewal, must now complete a 2-credit continuing medical education requirement on the topic of implicit bias in healthcare, according to a directive last week from the state’s Board of Registration in Medicine (BORIM). The new rule is effective June 1, 2022. BORIM said the requirement is needed, “In order to promote awareness of implicit bias by physicians and to provide resources for moderating the negative effects of implicit bias on patient care.”
Hospitals Lauded for Their LGBTQ+ Policies
The Human Rights Campaign’s Healthcare Equality Index released recently shows a number of Massachusetts hospitals received a 100% score in an evaluation of their policies and practices related to the equity and inclusion of their LGBTQ+ patients, visitors, and employees.
The Massachusetts hospitals receiving the Campaign’s “Equality Leader” rating are Cooley Dickinson Hospital, Mount Auburn Hospital, Tufts Medical Center, Boston Medical Center, Beth Israel Deaconess Medical Center, Dana-Farber Cancer Institute, Boston Children’s Hospital, and Cambridge Health Alliance’s Everett Hospital, Somerville Campus, and Cambridge Hospital.
Berkshire Medical Center, Brigham and Women’s Faulkner Hospital, Brigham and Women’s Hospital, the VA Hospitals in Boston and Central Western Massachusetts, and Fairview Hospital were rated as “Top Performers.”
Note that only 906 healthcare facilities nationwide participated in the survey, so other Massachusetts facilities with strong inclusive policies may not be included in the lists above.
Congratulations to ONL
The American Organization for Nursing Leadership (AONL), the national affiliate of the American Hospital Association that represents more than 10,000 nurse leaders, has presented the Organization of Nurse Leaders – Mass., R.I., N.H., Conn., Vt. with its AONL Affiliate Achievement Award. The award recognizes an AONL affiliate promoting nursing leadership and its influence in advancing nursing practice, patient safety, quality, recruitment, and retention and serves as a model for other states or regions with similar interests. ONL was cited for “exhibiting exemplary leadership in responding to challenges posed by the COVID-19 pandemic through advocacy, diversity, and member service.”
AHRQ Releases New Toolkit to Help Fight CLABSI & CAUTI
The Agency for Healthcare Research and Quality (AHRQ) has released a new toolkit to assist clinicians in reducing the rates of central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) in intensive care units.
AHRQ, a division of the U.S. Department of Health and Human Services, said the toolkit was developed over five years and focuses on three components; assessing the current situation in a facility and creating a plan to move forward; implementing a series of strategies that incorporate the CUSP (Comprehensive Unit-based Safety Program) concept as well as a new, tiered interventional approach; and overcoming common challenges that ICU teams face when attempting to decrease the rate of their CLABSI and CAUTI.