Conversion Therapy, Tobacco, the Waiver, and more...

Group Providing Care to Older Adults Raps Ratio Ballot Question

The Massachusetts Senior Care Association (MSCA) – the group that represents more than 400 facilities providing healthcare services to more than 120,000 older adults and people with disabilities – has joined the Coalition to Protect Patient Safety in opposition to the proposed nurse staffing ballot question.

Like many other non-hospital healthcare organizations, MSCA is gravely concerned that the ballot question would pull nurses from its facilities.

“Direct care nursing staff are the vital backbone of our long-term care system, and even today we are in urgent need of additional nurses to ensure and meet the care needs of our seniors,” said Massachusetts Senior Care President Tara Gregorio. “We are extremely concerned that the proposed nurse staffing ballot question will decimate our already fragile long-term care system by recruiting away long-term care clinicians to meet the potential new hospital staffing mandates.”

The Massachusetts Senior Care Association represents nursing and rehabilitation facilities, assisted living residences, residential care facilities, and continuing care retirement communities, all of which employ more than 77,000 staff members and contribute more than $4 billion annually to the Massachusetts economy.

The ballot question being proposed by the Massachusetts nurses’ union, which represents less than a quarter of nurses in the commonwealth, would require that hospitals across the state, no matter their size or specific needs of their patients, adhere to the same rigid nurse staffing ratios within all patient care areas at all times. The petition does not make allowances for rural or small community hospitals, holding them to the same staffing ratios as major Boston teaching hospitals.

The measure would cost more than $1.3 billion dollars in the first year, and $900 million each year thereafter, according to an independent study by MassInsight and BW Research Partners.

Senate Votes to Up Legal Age for Tobacco; MHA Agrees

The Massachusetts Senate last Thursday voted 33 to 3 to pass SB 2571, which would raise the legal age for tobacco use from 18 to 21 years. MHA was a strong supporter of the bill, arguing in its advocacy to the Senate that tobacco and nicotine use is the leading cause of preventable illness and premature death in Massachusetts.

Noting a U.S. Surgeon General report that said almost 95% of tobacco users become addicted to nicotine before age 21, MHA has argued that raising the legal age to 21 for tobacco products makes sense.

In addition to raising the smoking age, and banning the sale of e-cigarettes to those under 21, SB2571 also forbids the sale of tobacco products at healthcare facilities. In its ongoing efforts to reduce tobacco use in the commonwealth, MHA has long argued that it is counterproductive to the collective mission of hospitals and healthcare providers – including pharmacies – to sell tobacco products where healthcare treatment is offered. Almost 90% of MHA hospital members have established completely tobacco-free campuses prohibiting any use on site, and several hospitals have joined MHA in establishing employment practices that screen for tobacco use. The Senate tobacco bill was championed by Sen. Jason Lewis (D-Winchester) and Senate President Harriette Chandler.

House Passes Bill Banning Conversion Therapy

The Massachusetts House last Wednesday passed a bill (H4664) that would prevent licensed healthcare providers from engaging in “conversion therapy” – that is, attempting to change an individual’s sexual orientation or gender identity – with anyone under age 18.

Such conversion therapy has been medically debunked and is based on the theory that individuals that don’t conform to heterosexuality or specific genders need to be “cured.” Advocates of the bill, which passed 137 to 14, said it is needed to protect vulnerable youth grappling with their sexuality and gender identity. MHA supported the efforts to ban conversion therapy.

“When you boil it down to its essence, this bill is about helping kids here in the Commonwealth of Massachusetts, doing right by our kids here in the Commonwealth of Massachusetts, and ending fraudulent, debunked and out-of-date medical practices,” said Rep. Sarah Peake (D-Provincetown).

CMS Responds to Massachusetts Medicaid Waiver Requests

Last week, the Centers for Medicare and Medicaid Services (CMS) responded to the state’s 1115 Medicaid Waiver request that had been filed last September. As part of that filing, the Executive Office of Health and Human Services (EOHHS) had requested authority to permit non-disabled adults with incomes above 100% of the federal poverty level to be only eligible for subsidized insurance in the Connector exchange rather than through MassHealth. MHA had supported the proposal in conjunction with steps to ensure appropriate affordability standards and to guard against any loss of coverage. However, last week CMS rejected the request.
Also of note and garnering national attention was the EOHHS proposal to institute a “closed formulary” in the MassHealth program that, among other things, would enhance the agency’s ability to negotiate supplemental rebates with drug manufacturers. Currently, Medicaid programs participating in the federal Medicaid drug rebate program must include on their list of offered drugs nearly all FDA-approved drugs from a pharmaceutical company. This “open formulary” requirement often makes it challenging for states in negotiating additional rebates from drug manufacturers, which is one of the reasons EOHHS had made this proposal. CMS did not approve this request but indicated support for the state’s overall goal to lower drug costs.  In its letter, CMS stated it would be willing to consider an alternative proposal that would allow the state to exclude certain Medicaid-covered outpatient drugs from Medicaid coverage if the state were to negotiate directly with manufacturers and forgo all rebates available under the federal drug rebate program. 
CMS also did not approve proposals to implement narrower networks in MassHealth's Primary Care Clinician (PCC) program to encourage enrollment in Accountable Care Organizations and Managed Care Organizations.

In a positive development, CMS did approve the EOHHS request to waive state veteran annuities when determining income for MassHealth coverage. Massachusetts currently provides a $2,000 annual payment to disabled veterans and Gold Star parents and Gold Star spouses, which in some cases may have prevented the person or family from qualifying for Medicaid coverage.

Staffing & Quality Data at Your Local Hospital & Home Health Agency

Interested to see how your hospital staffs each of its units? Want to see how the federal government, using evidence-based data, rates your hospital’s quality of care? For well over a decade this information has been easily accessible at PatientCareLink – the website MHA and the Organization of Nurse Leaders created in 2006. With the addition of the Home Care Alliance of Massachusetts, the public can assess reports about home healthcare agencies in the state.

It’s all transparent, verified data. Data from Medicare’s Hospital Compare and Home Health Compare are now available on PatientCareLink for 63 Massachusetts acute care hospitals, nine rehabilitation hospitals, and 87 home health agencies.

To view the latest updated reports, click here and then choose from the left-hand column either Massachusetts hospitals, or Home Care Alliance. Also available from the left-hand column is staffing data from facilities represented by the Hospital Association of Rhode Island.

Happy July 4 (and a Little Health Advice from Gen. Washington)

MHA will be closed on Wednesday, July 4 in observance of Independence Day.  As the healthcare system struggles with rising pharmaceutical prices, perhaps now is a good time to reflect on some advice from Founding Father George Washington, who in September 1785, before he became president, wrote to his old friend and fellow Revolutionary War veteran Richard Varick, urging preventative healthcare over the excessive use of medicines: “I am sorry to hear of your long indispositions, and repeated attacks—It may be well to nurse yourself a little,” Washington wrote. “Disorders, oftentimes, are easier prevented than cured. And while you are in the way to re-establish your health (on which I heartily congratulate you) it is better to use preventatives than alternatives &ca &ca of which the [Apothecary shops] are replete.”

The Final 2019 Inpatient Hospital PPS Rule

Thursday, August 16; 9 a.m. – 12 p.m.
MHA Conference Center, Burlington, Mass.

Join MHA’s annual program to review the final IPPS inpatient rule. We’ll cover all of the critical changes and updates important to hospitals, including: inflation and program financial updates; changes to the value-based and quality programs; proposals on price transparency; MS-DRG grouping and significant ICD-10 changes; and other Medicare legislative and regulatory issues applicable to acute care hospitals. More information is coming soon, but mark your calendar today, register, and check back here.

John LoDico, Editor