Fighting Sepsis, Massachusetts Affordability, and more ...

A New Tool to Address Sepsis in Hospitals

Collective Medical, the company whose product is helping Massachusetts hospitals address the opioid epidemic, has announced that it is expanding its capabilities to help in the fight against sepsis in hospitals.
The Collective Medical platform (formerly known as PreManage ED) gives emergency department clinicians instant alerts about a patient’s past prescription history along with other data such as recent hospital utilization. Nearly all hospitals in the commonwealth are in the Collective network.
Now Collective is rolling out notification functionality that identifies patients with a history of sepsis so that care teams may more quickly intervene to address these patients’ unique needs. Sepsis accounts for more than one third of hospital deaths and more than $24 billion in hospital expenses. Because 42.6% of severe sepsis survivors were re-hospitalized within 90 days, it’s critical for care teams to know these patients are at high-risk and in need of special attention.
MHA is a founding member of the Massachusetts Sepsis Consortium, a partnership of more than 25 state and national health, advocacy, and government organizations that the Betsy Lehman Center for Patient Safety brought together to raise awareness and to develop protocols for rapid detection and treatment. The consortium’s April 2019 report includes 17 recommendations that hospitals and emergency departments can undertake to reduce the incidence of sepsis. Adoption and implementation of an evidence-based screening tool at initial ED evaluation tops the recommendation list.
“Massachusetts hospitals are on the front lines of dealing with sepsis and are committed to improving early diagnosis and treatment of this life-threatening condition, particularly when patients come in to an emergency department,” said Patricia Noga, R.N., PhD, MHA’s V.P of clinical affairs. “MHA is pleased to have an additional tool to help address this vital public health concern.”

Report: Massachusetts on Right Path to Lower Healthcare Costs

Altarum – a Michigan-based healthcare consulting group – has issued a scorecard that places Massachusetts first in the nation at providing affordable healthcare.
Even though the state has relatively high healthcare spending per person, a lower percentage of residents reported affordability problems than in other states. The report found that Massachusetts has great coverage, and has surpassed many states in reducing healthcare affordability burdens by, among other things, enacting measures to protect against “skimpy, confusing [Short-Term, Limited-Duration] health plans.” 
The group writes that “[Massachusetts] is the rare state that has taken initial steps to identify low-value care,” such as reducing C-sections for low-risk mothers or antibiotic prescribing, but needs to continue progress in this area. While the Bay State is still among the most expensive states in terms of private payer costs, the report notes that Massachusetts “is a leader in terms of policies to curb healthcare prices,” promote transparency, and meet spending targets. The Healthcare Affordability Scorecard is available here.

Baker’s Supplemental Budget: Funding for Safety Net Hospitals

On January 3, Governor Charlie Baker submitted to the legislature a $74.2 million supplemental budget for the current state fiscal year 2020. Included in that amount is $12.3 million for safety net provider hospitals (for a total of $16.3 million, including FY19 funding). MHA had advocated on behalf of the hospitals. 
“Last fiscal year, tax revenue collections exceeded budgeted estimates by $1.1 billion, creating an opportunity to address unmet critical needs at the end of Fiscal Year 2019,” Baker wrote in the cover letter to the supplemental bill. “Despite ample available revenue, the bill passed by the Legislature omitted certain key public spending. For that reason, I am refiling critical items that I previously proposed, in a narrower version intended to fit within currently available revenue in Fiscal Year 2020.”

ACA Proponents Ask for Quick Action; Justices Seem to Say, OK

After the Fifth Circuit Court of Appeals ruled in December that the Affordable Care Act's (ACA’s) individual mandate provision is unconstitutional, a coalition of 20 Democratic state Attorneys General, including Massachusetts AG Maura Healey, asked the U.S. Supreme Court to review the appeals court decision as expeditiously as possible.
Last Monday, the Supreme Court seemed to indicate it had heard the AGs; it gave the Trump Administration and other parties opposing the ACA to the week’s end (last Friday) to respond to the AGs’ appeal.
The Fifth Circuit determined that the ACA’s individual mandate is unconstitutional because Congress had eliminated the tax associated with it. Since the individual mandate is not coupled with a tax, it is a command for individuals to purchase health insurance and therefore unconstitutional.
The Appeals Court also directed the lower court to determine the issues surrounding severability – that is, whether the entire ACA should be ruled unconstitutional since the individual mandate is unconstitutional. The Trump Administration has argued at the district court level that only portions of the ACA are severable, while in higher courts it has e argued that the entire ACA should be unconstitutional. The Appeals Court directed the lower court to address the varying positions.
The alternative is for the U.S. Supreme Court to step in and hear the case this term, which some court observers speculate could happen given the accelerated timeline for briefs. MHA is joining with a group of allied hospital associations on an amicus brief to the court in support of the ACA and a timely review in light of the uncertainty raised by the Fifth Circuit decision.

Holidays Are Over; Timelines for (Some) Action Are Set

Hospitals don’t close for vacation, but other parts of the system slow down a bit over the holidays. Now that 2020 is here, the healthcare regulatory and legislative mechanisms are operating quickly. Governor Baker’s FY2021 state budget is due on January 22 and he is expected to lay out its priorities during his annual State of the State speech on January 21. The House Ways & Means budget is usually due mid-April, with debate probably occurring in late April. Then the Senate enters the fray during mid-May, with debate most likely occurring prior to Memorial Day.
In Washington, Congress begins the second session of the 116th Congress with a truncated 2020 calendar as impeachment proceedings and the 2020 elections will shorten the time available for Congress to legislate. The House is in session through the end of January, but the Senate legislative calendar begins in February. 
The president’s State of the Union speech is February 4, one day after the Iowa caucuses, which kicks off the 2020 presidential race. The presidential conventions are scheduled earlier than normal beginning on July 13 in Milwaukee for the Democrats, and on August 24 in Charlotte, N.C. for the Republicans. Those political dates allow little time over the next several months for reaching consensus on 2020 legislative spending and policy priorities, which means that most legislative activities will need to be completed by June. Healthcare priorities likely will include legislation to extend or delay a number of healthcare programs, as well as addressing surprise billing and prescription drug prices.

The 2019 Medicare Promoting Interoperability Program

The deadline to submit 2019 data for the Centers for Medicare & Medicaid Services’ (CMS’) Medicare Promoting Interoperability Program is March 2, 2020. The Interoperability Program (formerly known as the EHR Incentive Program) was established to encourage eligible professionals and hospitals to adopt, implement, upgrade, and demonstrate meaningful use of certified EHR technology. In 2018, CMS transitioned to the QualityNet System for hospitals that attest to the Medicare Promoting Interoperability Program. More details are available here.


Cambridge Health Alliance (CHA) on January 8 announced that Assaad Sayah, M.D. is its new chief executive officer. Sayah, the system's chief medical officer, has served as the interim CEO since June, following the retirement of CEO Patrick Wardell. Prior to joining CHA, Sayah held leadership roles at several area hospitals, including director of EMS for Brigham and Women's Hospital. He received his medical doctorate from the University of Massachusetts Medical Center and completed his residency in emergency medicine at William Beaumont Hospital in Michigan.

53rd Annual Mid-Winter Leadership Forum

Friday, February 7; 8:30 a.m. - 2:45 p.m.
Boston Marriott Newton, Newton, Mass.

MHA has a very good Mid-Winter Leadership Forum in the works for February 7. We have a series of speakers and topic-rich panels of presenters following one after the other to give attendees a wealth of topics that will engage them. We're grateful that the state’s Health & Human Services Secretary Marylou Sudders has agreed to address what is always MHA’s largest winter gathering. And Dr. Stephen Klasko, president of Jefferson Health, often cited as one of our field’s most innovative leaders, will show how to disrupt the status quo while enhancing the quality of care. WCVB-TV’s Janet Wu, who has been a fixture on the Massachusetts journalism scene for more than 30 years, will moderate a panel on the latest political developments, and a panel of ED leaders will discuss the transformative events that are shaping access to care in their environment. There are more details to come, but visit here to register for what will assuredly be a don’t-miss event.

John LoDico, Editor