Benchmark, Federal Budget, Guns, and more ...

Hospitals on Board With 3.1% Benchmark – With Caveats

The Health Policy Commission in coming months is scheduled to decide on whether the state’s healthcare cost growth benchmark – currently set at 3.1% – should remain at that level. Last Wednesday, the HPC held a hearing to begin the process of reviewing the benchmark.
The current 3.1% standard was determined by taking the 3.6% potential gross state product (PGSP) that is set annually by the administration and the legislature’s Ways & Means Committees, and then subtracting 0.5% as the law mandates. The PGSP for next fiscal year already has been set to remain at 3.6%, so the benchmark will stay at 3.1% – although the HPC can modify it by a 2/3 vote to anywhere between 3.1% and 3.6% subject to legislative review. (It can’t be lowered below 3.1%.)
The healthcare system is meeting the benchmark and total healthcare spending growth in Massachusetts is consistently below the national rate. But healthcare costs continue to be of concern, so there is little appetite for the HPC to raise the benchmark.
In its testimony to the HPC last week, MHA said it supports the 3.1% benchmark but asked the state to recognize “several critically important caveats” that could destabilize the state’s success to date.
First, MHA noted that “pharmaceutical pricing is largely outside of healthcare provider control,” and pharmaceuticals continue to be a significant driver of total healthcare expenditure growth.
MHA also noted that labor accounts for close to 70% of a hospital’s operating costs, and the demand for healthcare workers is exceeding the supply, especially for behavioral health caregivers. The aging healthcare workforce, especially RNs, is putting price pressure on hospitals as nurses retire from the market and replacements are in short supply.
Behavioral health is further at risk, MHA wrote, due to the nature of how such care is financed. “Currently, providers cross-subsidize underpaid behavioral health services by relying on revenue from those services that are reimbursed at a higher level. Targeting cuts for higher-margin services in an effort to reduce the cost growth benchmark has the potential to result in fewer resources to support underfunded services, and could potentially result in unintended consequences for expanding behavioral healthcare,” MHA wrote.
Another unknown, according to MHA’s testimony, is the federal landscape – especially repeated legal, regulatory, and political challenges to the Affordable Care Act.
In its testimony, MHA also noted the ongoing concern of its members regarding commercial insurers using the 3.1% benchmark as a cap on any rate increases to providers, adding, “This is particularly problematic when used against lower-paid community hospitals and was never intended to be used in this manner.”
“While we support the aggressive 3.1% benchmark, it is critical to recognize that there are factors – many of which are outside of the direct control of providers – that could make meeting this target difficult to attain,” MHA said.

HPC IDs Insulin Costs as Cost Driver

What are the healthcare cost concerns in the state, according to the above-mentioned HPC hearing? There’s responsibility to be shared across the system, from consumers who need further education on what is the right place to receive non-urgent and emergency care, to Massachusetts readmission numbers continuing to lag the national rate.
But one item that stood out in the HPC’s meeting last week was the ever-increasing price of insulin. The agency found that for Massachusetts residents with diabetes, annual spending on insulin products increased by 50% from 2013 to 2016. Insulin spending was the largest contributor to their healthcare spending growth, accounting for 27% of total spending in 2016.

Trump Budget Puts Medicare/Medicaid in Crosshairs

The Trump Administration released its budget blueprint for federal fiscal year 2020 last week and, by any measure, it does not contain good news for Medicaid, Medicare, hospitals, or coverage expansion.
A president’s budget – any president’s – is merely a statement of priorities. Congress will draft the main budget document and, with Democrats in control of the U.S. House, the likelihood of sweeping Medicare and Medicaid cuts as the administration proposed is slim.
The administration proposes about $575 billion in Medicare reimbursement reductions over 10 years, with most of the money coming from provider cuts and targeting “wasteful spending.” (The Obama Administration proposed about $400 billion in similar cuts.)
For Medicaid, the president proposes repealing Medicaid expansion funding, requiring able-bodied Medicaid recipients to work, and creating a block grant system for states. The cuts total about $1.5 trillion over a decade but observers say savings from the block grants and other provisions work out to about a $777 billion overall cut over 10 years.
Many members of the Massachusetts congressional delegation slammed the president’s budget proposal. Rep. Richard Neal, who chairs the House Ways & Means Committee that has oversight over Medicare and the budget, was especially critical, saying, "The president’s budget is filled with recommendations that would hurt American families, and his half-trillion-dollar cut to Medicare is one of the most egregious." 
AHA President and CEO Rick Pollack said, "Patients should be confident in knowing that their hospital is their lifeline to access care in their community. The cuts proposed today raise serious concerns about how hospitals and health systems can ensure they serve as the safety net for their patients."

CHA: The First Step in Helping is Learning How to Help

Cambridge Health Alliance (CHA) is using a federal grant to allow its health personnel to go into communities and train individuals on how to assist someone facing a mental health crisis.
While much attention has been paid to the shortcomings of the behavioral health system in dealing with those seeking care, studies show that only 2 in 5 people needing help actually seek treatment. Friends and family members of the potential patient may not know what to do to help.
Through a program funded by U.S. Health & Human Service’s Substance Abuse and Mental Health Services Administration (SAMHSA), CHA is offering free “Mental Health First Aid” training in community settings in Cambridge, Chelsea, Everett, Malden, Medford, Revere, Somerville and Winthrop.
CHA’s Community Health Improvement Department is partnering with community organizations to ensure broad reach and access for adults, children and veterans.
Mental Health First Aid is an eight-hour certification training that provides individuals with the skills to assist someone facing a mental health crisis, just as CPR helps those having a heart attack. Trainees will learn a five-step action plan that guides them through the process of reaching out and offering support.
“When we observe someone having a health crisis like a heart attack, or car accident, we don’t hesitate to offer some sort of aid,” noted Jaime Lederer, MSW, MPH, who directs the grant program at CHA. “People are sometimes less comfortable responding to a mental health crisis – someone experiencing anxiety, severe depression or substance misuse. Mental Health First Aid gives laypeople the knowledge and skills they need to provide assistance and refer people for further help.”
To learn more about CHA’s mental health & substance use services, including Mental Health First Aid training, click here.

M.D.s Were Part of Last Week’s Big Gun Ruling

Last Thursday’s ruling from the Connecticut Supreme Court, allowing relatives of those killed in the tragic shooting at Sandy Hook Elementary School to proceed with their suit against the manufacturer of the gun used in the killings, garnered national attention for the suit’s potential to assign some responsibility for the shooting to the gun company.
Twenty-six people were killed in the shooting, including 20 first graders, by a gunman wielding an “AR-15 Bushmaster” type of weapon. 
The suit is also noteworthy due to the participation of 10 emergency physicians and trauma surgeons from around the U.S. who filed a friend of the court brief in support of the suit. Some of the doctors treated the victims of infamous mass shootings, including those in Sandy Hook, Aurora, and Columbine. They detailed their experiences treating the victims, discussed how such shootings have caused healthcare facilities to craft “active shooter” strategies, and how, as one doctor wrote, “being shot by a military assault rifle is carnage in the truest sense of the word.”
The doctors wrote that they “believe that with the freedom to make and sell these intrinsically dangerous military weapons to a civilian population should come the responsibility to bear the heavy costs of the foreseeable harm they cause.”

First Annual Diversity and Inclusion Leadership Award

ACHE of Massachusetts will present its First Annual Diversity and Inclusion Leadership Award at its spring conference on Friday, May 17, 2019. Nominations for the award must be submitted by an ACHE of MA member no later than Friday, April 5. Please use this nomination form and submit it to info@massache.org
The award will recognize an organization’s commitment to promoting diversity and inclusion initiatives and programs. Recipients of the award are evaluated based on the American Hospital Association and Institute for Diversity in Health Management #123Pledge principles demonstrating their dedication to improving the collection and use of race, ethnicity, GLBTQ, and language preference data; supporting cultural competency training; increasing diversity in governance and leadership; and engaging and strengthening community partnerships.

WEBINAR: Confronting the Opioid Crisis in America

Tuesday, April 9, 1 to 2:30 p.m.

The alarmingly high death rate from the opioid epidemic in Massachusetts has become our state’s number one public health crisis. In this webinar, you'll learn what Massachusetts has been doing to combat both the spigot problem and the treatment challenges of the opioid epidemic. We'll discuss the root causes of our current predicament; the first step in getting out of a hole is to stop digging. Next, we'll discuss addiction physiology and opioid substance use disorder treatment. Lastly, we'll cover concrete best practices, tools, and guidelines which you can take back to share with your colleagues. MHA’s VP of Clinical Integration Steven Defossez, M.D., will lead the discussion. He spearheaded physician engagement on MHA’s Substance Use Disorder Prevention and Treatment Task Force, and co-chairs the Massachusetts Medical Society-MHA Joint Task Force on Physician Burnout. Registration details are here.

John LoDico, Editor