State Budget, Patient Experience, and more...

MassHealth Reform Revisited in Governor’s State Budget Proposal

Last Wednesday, Governor Charlie Baker released a $40.9 billion FY19 state budget proposal, which, among other items, contains a 1.3% increase to the MassHealth budget based on the assumption that there will be a 1.2% increase in MassHealth enrollment.

Also included in the budget is Baker’s re-introduction of his earlier proposal to move 140,000 non-disabled adults with incomes above 100% of the federal poverty level (FPL) out of MassHealth and into subsidized insurance through the Health Connector exchange. The administration is seeking federal approval of the proposal through a recently filed MassHealth waiver.

According to EOHHS, the proposal assumes that a Connector plan will expand to include those up to 138% of the FPL, thereby allowing the affected individuals to maintain MassHealth-like out-of-pocket expenses. The proposal also assumes a MassHealth dental benefit for those in the plan – which currently is not available in the Connector. The change in Connector income eligibility and dental coverage would be achieved through the Connector’s rulemaking process. The FY2019 budget assumes this change will yield $60 million in net state savings given the effective date of January 1, 2019; factoring the federal share of the Medicaid program results in a $120 million benefit to the state.

While the Legislature chose not to enact this proposal last summer, MHA has noted to both the House and Senate its continuing support of the MassHealth-to-commercial-insurance shift. As part of its support, MHA has recommended added protections for enrollees’ out-of-pocket expenses and readily available access to coverage.

The governor’s budget would increase funding for opioid treatment and prevention and affects a number of other hospital-centric measures, ranging from  MassHealth prescription drug financing and coverage proposals, to a new $168 million “Safety Net Provider Trust Fund” for hospitals that qualify for safety net provider payments under the terms of the current MassHealth waiver.

MHA’s budget focus now turns to the House Ways & Means Committee, which is expected to release its FY2019 budget proposal in mid-April.

Patient Experience with Primary Providers: Good and Getting Better

The Massachusetts Health Quality Partners (MHQP) last Wednesday released its 13th statewide patient experience survey, which showed that primary care experiences for Massachusetts commercially insured patients continue to improve. MHQP said that the good results come despite the backdrop of increased out-of-pocket expenses and significant uncertainty in the healthcare system.

The results show increases over the past three years across all of the survey’s topic areas, including communication, integration of care, knowledge of patient, adult behavioral health, organizational access, self-management support, office staff, pediatric preventive care, child development, and willingness to recommend.

MHQP said the good reports from patients “come at a time of shifting policy and health benefits in healthcare, including the uncertainty about the future of the Affordable Care Act and the proliferation of high-deductible plans which have shifted out-of-pocket expenses to consumers.”

The strongest steady gains in recent years have been made in how often primary care providers ask adult patients questions related to behavioral health. MHQP added behavioral health to the patient experience survey in 2013, with questions about whether or not primary care providers asked their patients about feeling depressed, feeling stressed, or if they are experiencing problems with alcohol, drugs, or a mental or emotional illness. The mean composite score in this category for all adult practices increased from 50.8% in 2013 to 61.7% in 2017.

The survey was fielded in the spring of 2017 and sampled patients from 866 adult and 321 pediatric primary care practices statewide, representing more than 4,000 primary care providers. The 2017 survey was fielded with commercially-insured patients. In 2018, MHQP will also be surveying patients enrolled in MassHealth as part of a new contract MHQP signed with the Executive Office of Health and Human Services.

Hospital CEO and Sheriff Join Arms in Opioid Battle

Kate Walsh, the president and CEO of Boston Medical Center and MHA’s current Board Chair, co-authored an op-ed in the Boston Herald last week with Suffolk County Sheriff Steven Tompkins about the need to address addiction through clinical treatment and improved diversion programs.

“That’s why, together as public health and public safety professionals, we’re urging the Massachusetts Legislature to take important steps forward in criminal law reform,” Walsh and Tompkins wrote.

Specifically, the two called on the conference committee now debating a compromise reform bill to “make sure that the final legislation provides diversion away from the criminal legal system, when appropriate, instead of mandatory sentencing; provides evidence-based treatment for those who are incarcerated; supports clear re-entry pathways to treatment and overdose prevention; avoids imposing criminal penalties when a drug user overdoses; and diminishes the barriers that a criminal record can play in people securing employment and housing.”

MHA has consistently endorsed the use of medication-assisted treatment (MAT) in hospital ERs as part of the total “toolbox” of strategies to address substance use disorder.

Don’t Throw Away that IV Pouch Yet

After the state experienced a small dip in the flu during the first two weeks of January, last week flu cases spiked upward. All seven regions of the state are reporting increased flu cases and influenza-associated hospitalizations are far above previous year’s reports for the same time.

Hospitals are still struggling to ration IV fluid bags, the supply of which has only recently begun to increase as the main production facilities affected by hurricanes in Puerto Rico come back online.

Last week the FDA sent notices to hospitals informing them that they are allowed to extend the shelf life of certain supplies manufactured by Baxter Healthcare Corporation, a big supplier with operations in Puerto Rico. For example, the shelf life of “10% Osmitrol (Mannitol) in Water in 500 mL Viaflex Container with 4.5 mil HDPE Overpouch” is 15 months; but due to the shortage, the FDA said the shelf life can be extended another three months.  The extension applies only to select supplies listed here.

AHA’s M.D. Outreach Resonates With MHA

The American Hospital Association announced last week that it was launching the AHA Physician Alliance to strengthen its outreach to physicians. Noting that physician/hospital relationships have never been more important, the AHA said the Alliance was formed to include “the clinical voice” in the AHA’s work.  It will focus on three strategies: 1) Lead Well, to develop collaborative teams to move organizations forward; 2) Be Well, to improve the health of clinicians; and 3) Care Well to focus on better health for patients and communities.

MHA’s Steven Defossez, M.D., VP for Clinical Integration, applauded AHA’s effort and noted how it mirrors what MHA has accomplished through its Physician/Hospital Integration Collaborative (PHIC) and Physician Leadership Council (PLC).
“In today’s accountable care environment, physicians must be at the table in any discussion about how to move the healthcare system forward as a whole,” Defossez said. “MHA has been able to do this through PHIC and PLC and we applaud AHA for creating the Physician Alliance.”

Defossez said he was especially interested in tracking the progress of the AHA Alliance’s “Be Well” initiative now that MHA and the Mass. Medical Society have begun a task force on the important issue of physician burnout.

Partners Deal in Rhode Island Takes Next Step

Partners HealthCare and Care New England (CNE) Health System of Providence, R.I. announced last Friday that they have entered into a “definitive agreement” to have CNE become part of Partners. In April, the two systems signed a “letter of intent” through which CNE agreed to negotiate exclusively with Partners. The definitive agreement represents a more formal document that will outline the details and plans for the actual transaction. After that document is made final, the systems will seek state and federal approval for the deal. The parts of Care New England covered under the definitive agreement are: Kent Hospital in Warwick; Women & Infants Hospital of Rhode Island in Providence; the VNA of Care New England, based in Warwick; Butler Hospital in Providence; and The Providence Center (mental health and addiction treatment services) in several Rhode Island locations. The media release announcing the agreement also noted: “Under the proposal, the strong educational and research relationship that CNE has fostered with Brown University will continue to play a critical role in the healthcare landscape and its future development.”

CHIP and the Short-Lived Shutdown

The three-day government shutdown came to an end last Monday when the Senate voted 81 to 18, and the House 266 to 150, for a continuing resolution federal spending package.

The agreement includes funds for a six-year reauthorization of the Children’s Health Insurance Program, as well as a delay of two years on the tax of high cost insurance plans, health insurers, and medical devices.  The continuing resolution package did not include reauthorization for community health centers, a delay in the scheduled Medicaid DSH cuts, nor extension of several expired Medicare small and rural payment programs like the ground ambulance add-on, Medicare Dependent Hospital, and Low-Volume adjustment.

The federal spending component of the resolution is only extended through February 8 when Congress will need to take up a fifth spending package for the remainder of FY18. Senators Elizabeth Warren and Ed Markey voted no; Representative Bill Keating and Stephen Lynch voted yes, while Reps. Mike Capuano, Katherine Clark, Joe Kennedy, Jim McGovern, Seth Moulton, Richard Neal, and Niki Tsongas voted no.


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John LoDico, Editor