Massachusetts Health & Hospital Association The Waiver and What’s Next for HPC?
INSIDE THE ISSUE
> MassHealth Waiver
> HPC Seeks More Power
> Masking Rules
> Spaulding Rehab Hospital Cape Cod
> Dave Phelps Honored
> Biden & McGovern on Hunger
> Help Foster Digital Literacy
MONDAY REPORT
Massachusetts Medicaid Plan Hailed as Groundbreaking
The new five-year Massachusetts Medicaid waiver that the federal government approved last Wednesday will bring enhanced federal money to the state to strengthen primary and behavioral healthcare, increase support for safety-net hospitals serving low-income patients, and construct nationally groundbreaking initiatives to advance health equity and clinical quality.
The Medicaid program, known in Massachusetts as MassHealth, is funded jointly by state and federal government. A portion of the new state funding, and a key component supporting this five-year waiver, is an annual $880 million assessment from Massachusetts hospitals – more than double the annual assessment of the previous waiver time period. This funding will support the state share of numerous Medicaid payments, including health equity and clinical quality hospital incentives, safety net provider payments, delivery system investments, MassHealth hospital reimbursement, and other Medicaid waiver priorities related to health-related housing needs, nutrition, and care coordination in the community.
“This is a major victory for the patients and hospitals of Massachusetts, especially at a time when they are facing more complex challenges than ever,” said Steve Walsh, MHA’s president & CEO. “We are grateful for the leadership of Governor Baker, Secretary Sudders, and the Centers for Medicare & Medicaid Services for embracing a bold approach to how healthcare works for those most in need. This agreement will be instrumental in allowing our providers to reach their communities in new and innovative ways, and we hope it can set a model for the rest of the nation to follow.”
Aside from receiving improved reimbursement for services provided to MassHealth patients, hospitals can also earn money from meeting incentive targets related to health equity and clinical quality. While quality measures are a common feature of incentive-based payments, the Massachusetts waiver’s hospital health equity incentive program is unprecedented and will likely be a blueprint for other states to follow. U.S. Health & Human Services Secretary Xavier Becerra recognized that when announcing the Massachusetts waiver, along with approval of Oregon’s waiver proposal on the same day. He said, “This is an historic moment in our nation’s fight to end hunger and improve health equity, particularly in states like Oregon and Massachusetts. Groundbreaking action in each state will ensure children and youth remain connected to health care, and that we double down on tackling social needs impacting health, such as nutrition. Everyone should get the access to care they need to live safe and healthy lives.”
“The new waiver is a shining example of our state’s resolve to address inequities head-on and ensure everyone living in Massachusetts can access the opportunity to live a healthy life,” said Akriti Bhambi, MHA’s director of Health Equity.
The assessment and related Medicaid hospital spending plan has many parts, involving new state legislation and financing methods. MHA task forces have been working with the Executive Office of Health and Human Services (EOHHS) to construct the equity and quality incentive programs frameworks.
Of the assessment and waiver effort of hospitals and EOHHS, MHA’s Vice President of Healthcare Finance & Policy Dan McHale said, “It has demonstrated the ability of state government and the hospital community to work in true partnership. The waiver process also has shown the commitment of Massachusetts hospitals to the patients and communities they serve, through their support of the hospital assessment funding and their work towards reducing healthcare disparities and improving clinical quality in the MassHealth program. In the end, it’s all about improving care and outcomes for the 2.2 million Massachusetts residents covered by MassHealth.”
HPC Approves PIP, Calls for More Regulation; CHIA Paints Harsh Picture
The Health Policy Commission (HPC) last Wednesday approved a Performance Improvement Plan (PIP) from Mass General Brigham in which the state’s largest health system agreed to reduce its spending by $127.8 million annually.
In other meeting news, the HPC said it would need even more enforcement power going forward to rein in costs throughout the Massachusetts healthcare system. Concurrently, the group responsible for collecting the data helps drive the HPC actions – the Center for Health Information and Analysis – released figures showing that acute care hospitals statewide are more in need of financial help than further regulation. CHIA’s report showed negative margins across the board and annual losses approaching $300 million.
The Performance Improvement Plan mechanism is the HPC’s most powerful regulatory tool. Of note, $90 million of the new $128 million in targeted MGB cuts will be through commercial pricing strategies, including reducing price variation with some commercial insurance plans. Additional areas for savings involve shifting care to lower cost settings, expanding the system’s hospital-at-home program, reducing rates for telehealth specialty services, reducing skilled nursing facility admissions, and reducing use of radiology services, among other steps.
After enforcing its PIP powers for the first time, the HPC then previewed its plans to exert even more authority over the state’s healthcare system. Noting that the 2022 Cost Trend Report shows more work needs to be done to keep spending within the state’s Cost Growth Benchmark, HPC Executive Director David Seltz called for “a new, progressive blueprint to address the most important challenges facing our healthcare system today.” That blueprint calls for, among other things, “hospital price growth caps,” and more power to the HPC to allow it “to impose escalating financial penalties to deter excessive spending.” The HPC also called for greater oversight of the pharmaceutical industry and limiting insurance premium increases and cost-sharing.
Meanwhile, the Center for Health Information and Analysis released its most recent quarterly report – through June 30, 2022 – showing that the statewide median operating margin for hospitals was negative 1.4%, a decrease of 3.0 percentage points compared to the same period last year. The statewide median non-operating margin was negative 0.8 %, a decrease of 3.2 percentage points compared to the same period last year. That means that hospitals are taking in less money than they are receiving. CHIA says that through June, aggregate expenses exceeded aggregate total operating revenue by $278 million.
As has been previously reported, hospitals are at full capacity as the flu season and expected COVID-19 uptake approach. They are dramatically short of staff across all disciplines. Hospitals are paying temporary staffing agencies exorbitant amounts of money (projected to be $1 billion this year) over and above what they paid in previous years to fill the vacancies.
“We agree that the healthcare system – providers, insurers, the HPC, and others – must be more creative than in the past,” said MHA President & CEO Steve Walsh. “But that will first involve a stark recognition that hospitals are facing capacity and workforce crises that are causing them to expend money they don’t have, to contain unavoidable patient surges, and to maintain the highest quality of care possible with diminishing resources. We cannot simply upend a system that is already getting more fragile by the day. We hope these real-time issues will become a central part of the conversation.”
Brief Clarification on Masks in Healthcare Settings
The Centers for Disease Control and Prevention (CDC) on September 23 issued a directive to healthcare workers, saying among other things, that masking in healthcare facilities should be based on the Community Transmission level of COVID-19. According to the CDC, all counties in Massachusetts are at a HIGH level of transmission – except Dukes County (Martha’s Vineyard and the Elizabeth islands), which is at SUBSTANTIAL – and therefore masks should be worn. But the CDC directive is, in a sense, moot, because the state directive from the Massachusetts Department of Public Health (DPH) takes precedence. And DPH says that masks are required for anyone over age 5 in healthcare settings, including nursing homes, rest homes, emergency medical services, hospitals, physician and other medical and dental offices, urgent care settings, community health centers, vaccination sites, and behavioral health clinics. The requirement applies to patients, residents, staff, vendors and visitors. However, according to DPH, masks are optional for residents in nursing homes and rest homes.
Spaulding Rehab Cape Cod is a Magnet Hospital
Congratulations to Spaulding Rehabilitation Hospital Cape Cod, which recently received a “Magnet”-designation from The American Nurses Credentialing Center, a subsidiary of the American Nurses Association.
Only 9.4% of hospitals nationwide have received Magnet status. Spaulding Cape Cod is just the fifth rehabilitation hospital to earn the distinction, and the first in New England.
A Magnet facility is one that has great nursing outcomes, high job satisfaction, low turnover rates, and a supportive culture. The process to achieve the designation usually takes multiple years.
“To earn this distinction took the commitment by every member of Spaulding Cape Cod, with the support of the entire Spaulding Rehabilitation Network. Over the entire process our incredible team kept a focus on achieving the highest standards in patient care and quality by fostering a culture of excellence,” said Chief Nursing Officer and Operating Officer, Maureen Banks, R.N., a member of the MHA Board of Trustees. “I am so proud of Spaulding Cape Cod to be a trail blazer with this recognition by raising the appreciation of rehabilitative care.”
Of the approximately 591 Magnet hospital nationwide, 13 are in Massachusetts. In addition to Spaulding Cape Cod, the others are: Baystate Medical Center, Boston Children’s Hospital, Boston Medical Center, Brigham and Women’s Hospital, Brigham and Women’s Faulkner Hospital, Dana-Farber Cancer Institute, Lowell General Hospital, Massachusetts General Hospital, New England Baptist Hospital, South Shore Hospital, Tufts Medical Center, and Winchester Hospital.
Berkshire Cancer Center Renamed in Honor of David Phelps
Berkshire Health Systems (BHS) has announced that the BMC Cancer Center is being renamed to honor former BHS President and CEO David Phelps. The new name is the Phelps Cancer Center.
The cancer center opened under Phelps’ leadership in 2013. He then achieved a collaboration with the Dana-Farber Cancer Institute in Boston, which ultimately led to the creation of the Dana-Farber Cancer Care Collaborative, of which the then-BMC center was the first member. Phelps retired in January 2022 after nearly three decades at the helm of the system.
Barton Raser, chair of the Berkshire Health Systems Board of Trustees, commented on the incredible value of the cancer center, stating, “Dave has given our community a priceless gift. What we have right here in the Berkshires at the cancer center is hope. And the promise that no cancer patient is ever alone. On behalf of the board and leadership of BHS, we are proud to re-name the Cancer Center in Dave’s honor.”
Biden Administration and McGovern on Hunger, Nutrition, and Health
On September 28, the Biden Administration held the first White House Conference on Hunger, Nutrition, and Health in more than 50 years. During his remarks, President Biden announced a goal of ending hunger and increasing healthy eating and physical activity by 2030. The conference included panel sessions and the release of the administration’s National Strategy on Hunger, Nutrition, and Health. The strategy contains five pillars: improving food access and affordability; integrating nutrition and health; empowering all consumers to make and have access to healthy choices; supporting physical activity for all; and enhancing nutrition and food security research. Notable proposals include allowing Medicare and Medicaid to cover hospital programs that deliver medically tailored meals to patients with a diet-affected disease, and working with Congress and states to expand Medicare and Medicaid beneficiaries’ access to nutrition and obesity counseling.
Massachusetts Representative Jim McGovern (D) has been a longtime supporter of legislation to end hunger and led the effort to fund the White House conference along with regional listening sessions held in June. He is sponsoring legislation proposing a hospital pilot program to provide Medicare coverage for medically tailored meals similar to what Biden has proposed; legislative action on that topic may be forthcoming, McGovern has indicated.
Healthcare Groups Eligible for Digital Literacy Grant Program Funding
The Massachusetts Broadband Institute is looking for 10 to 15 qualified organizations to take advantage of $50 million in state appropriations to fund digital equity projects.
The Broadband Innovation Fund was included in An Act Relative to Immediate COVID-19 Recovery Needs, also known as Massachusetts “ARPA 1.0” legislation passed in 2021. The goal is to bridge the digital divide by expanding WiFi access in multi-unit buildings and low-income neighborhoods; improving digital use in public spaces; providing WiFi hot spots to people unable to have a fixed broadband internet connection; training people on how to use devices through digital literacy programs; supplying new or used devices to target populations; and engaging in education outreach to those populations.
Eligible qualified organizations include healthcare and telehealth organizations (including federally qualified community health centers), community-based organizations, municipalities, and education groups, among others.
The solicitation guidelines, including target dates, Request for Proposals, etc. are here.