Community Benefits, Mental Health Bill, and more ...

Hospitals Saving Lives Inside and Outside of Their Walls

Cape Cod Healthcare pays commercial fishermen to provide fresh, local fish to community food pantries. Brigham and Women’s Hospital reaches out to local school systems to increase education and employment opportunities for young people and to create pathways for careers in healthcare and the life sciences. At Beth Israel Lahey Health’s Anna Jaques Hospital, a dedicated patient care navigator champions women throughout their pregnancies, supporting those with substance use disorder and/or neonatal abstinence syndrome. And Holyoke Medical Center has contracted with a local partner providing passenger shuttles to ensure that folks in its service area can get to their medical appointments, or just visit a friend or relative in the hospital.
Every hospital in Massachusetts has such community benefit programs that are provided at no cost to those being served, and that are not reimbursed by state or federal governments, health insurance companies, or any public subsidies. According to the Massachusetts Attorney General’s Office, Massachusetts hospitals in FY18 provided nearly $650 million in community benefits for Massachusetts residents. The IRS – allowing hospitals to count financial losses related to care provided to Medicaid recipients and medical education costs, among other metrics – totals hospital community benefits in Massachusetts at $2.7 billion annually.
MHA has produced a publication – A Commitment to Community: Massachusetts Hospitals’ Community Benefit Initiatives – that details stories from each of its acute care hospital members throughout the commonwealth, showing how they are improving the health of individuals and communities.
A special section highlights the intersection between housing and health – that is, how housing instability directly contributes to poor health outcomes. The development and maintenance of safe, affordable living accommodations is one of the six social determinants of health that the Massachusetts Department of Public Health has identified in its Determination of Need guidelines, and housing is one of the four community benefits areas on which the state encourages hospitals to focus.
“These are stories that need to be heard, because they tell how hospitals each day are working outside of their walls to empower the disadvantaged and strengthen the links between us all,” said MHA President & CEO Steve Walsh. “Our members’ work ranges from providing healthy food programs for kids in schools and seniors, to integrating housing assistance into a patent’s care plan, to training EMS responders, and running substance use disorder recovery programs. All of it is noble and it’s all worthy of attention.”

State Senate Releases Proposed Mental Health Bill

The Massachusetts Senate this week is expected to begin debate on a comprehensive mental health bill.
The measure, drafted by Senators Julian Cyr (D-Truro) and Cindy Friedman (D-Arlington), in collaboration with the offices of Senate President Karen Spilka (D-Ashland) and Michael Rodrigues (D-Westport), was reported out from Senate Ways & Means last Thursday and is scheduled for debate by the full Senate this Thursday.
A main goal of the legislation is to ensure mental health parity – that is, mandating that insurance coverage for mental healthcare should be equal to coverage for any other medical condition. Last week, Senate President Spilka was quoted as saying, “we all know in fact, it [parity] does not exist.”
According to a Senate fact sheet on the bill, it would provide the state with “better tools to implement and enforce our parity laws, including quicker evaluation and resolution of parity complaints, greater reporting and oversight of insurance carriers’ processes and policies related to mental health care coverage, and reasonable penalties and alternative remedies for when an insurance company does not comply with the law.” The bill would also eliminate insurance company prior authorization for mental health acute treatment, placing clinical determinations back into the hands of providers. 
In addition to supporting workforce development, telehealth, and the establishment of study groups, the bill would require commercial insurance carriers to cover community-based services for individuals experiencing a psychiatric emergency. Currently, these services are only paid for by MassHealth.
The proposal also calls for emergency departments “to have the capacity to evaluate and stabilize a person admitted with a mental health presentation at all times, and to refer them to appropriate treatment or inpatient admission.”
"Massachusetts hospitals have long sought true parity in coverage between behavioral health and medical/surgical care," said MHA's President & CEO Steve Walsh. "While we are still reviewing the details of the Senate proposal, we commend Senate President Spilka and Chairs Cyr, Friedman, and Rodrigues for their thoughtful proposal to bridge a bifurcated healthcare system and make concrete changes to patient access and coverage of mental health services. True implementation of parity rules will result in meaningful improvements to the health and wellbeing of our most at-risk patients. Our hospitals, health systems and other care providers look forward to working with the legislature on the passage of this important effort.”

MHA’s Mid-Winter Leadership Forum:
Politics, Transformation & a Tragedy that Led to Meaningful Change

Approximately 350 people attended MHA’s Mid-Winter Leadership Forum last Friday – the 53rd such gathering in MHA’s 84-year history.
Attendees were treated to a thought-provoking address from Stephen Klasko, M.D., president and CEO of Thomas Jefferson University and Jefferson Health in Philadelphia, who spoke about healthcare in the age of artificial intelligence. Massachusetts Health & Human Services Secretary Marylou Sudders addressed the gathering, and two nationally recognized political figures – Democratic consultant Maryanne Marsh and Republican Ginny Buckingham, the former head of MassPort – held forth on the fractious political environment both in the Bay State and in Washington. Longtime WCVB-TV reporter Janet Wu moderated that panel.
But the most heartfelt presentation involved Boston Globe journalist Peter DeMarco, whose wife, Laura Levis, died from an asthma attack after having difficulty accessing the Somerville Hospital emergency department. He shared the stage with Assaad Sayah, M.D., the newly appointed president of Cambridge Health Alliance, which is the parent system of Somerville Hospital, and the CMO of the system since 2013.
DeMarco told the audience that he was standing on the stage with Sayah “as a partner in this endeavor, not as an opponent. You will not hear me cast blame or point fingers. Dr. Sayah and I are here together as a team to teach and share. I am grateful that he and Cambridge Health Alliance are trying very hard to see that Laura's death will have real meaning.”
Sayah added, “So many factors come into play in matters of life and death, many of which are unpredictable. This event revealed gaps we did not realize we had, and, from the moment it occurred, we have worked extremely hard to look at what happened, how it happened, and how we can do better.”
The two then followed nearly step by step the route Levis took, and how the lack of lighting, insufficient signage, and faulty communication, including an inadequate 911 response, all seemed to conspire against her and ultimately led to her death just outside the ED. Levis' death, DeMarco’s persistence in seeking answers, and CHA’s response have all led to changes throughout the state. Recognizing the importance of the issue, MHA formed an ED Access Workgroup (see story below) to create best practices around “wayfinding,” exterior signage, and staff training.
“I think the first lesson we learned from this is that you can't wait to implement security measures if there are deficiencies,” Sayah said.
Said DeMarco, “Ask yourself, what do I habitually ignore that could be important? How would this – whatever this is – look to a patient who's never been to my hospital before? How can I be proactive, not reactive? How can I encourage my staff members to think the same way? How can I learn from others' mistakes so that they don't happen here? If you and your staffs can do that, then you will truly honor my wife's memory.”

MHA’s ED Access Work Group Issues Recommendations

Recognizing that all hospitals could be susceptible to an incident such as the one that took Laura Levis’ life, MHA assembled an ED Access Working Group composed of ED chiefs, chief nursing officers, and facilities experts, among others. The goal was to create best practice recommendations to ensure optimal access to all Massachusetts EDs. The group focused on external wayfinding, including signage and lighting as well as security, staff education, coordination with local safety officials, and local 911 systems. 
Cambridge Health Alliance, which undertook a sweeping review of its system and implemented changes, was instrumental in helping create the MHA guidance. MHA last Friday sent these recommendations to its membership, and will share them with the Department of Public Health and select legislators.

State of the Union Speech Includes Healthcare Priorities


President Donald Trump delivered his State of the Union address last Tuesday, in which he pledged to guarantee coverage for patients with pre-existing conditions, protect Medicare, and sign legislation to dramatically “lower prescription prices” if Congress would “get a bill on my desk.” 
He announced $50 million in new funding for neonatal research and noted his administration’s initiatives on fighting Alzheimer’s, kidney disease, and HIV. While not included in the President’s remarks, U.S. Department of Health and Human Services Secretary Alex Azar released a statement saying the administration would also focus on issues such “improving maternal health and transforming health in rural America.” 
The president is expected to submit his annual budget to Congress for Fiscal Year 2021 this week and many of the proposals he mentioned are expected to be included in it.
Democrats responded to the prescription drug comments in the speech by chanting “H.R. 3”—the drug price bill the House passed last year. And Massachusetts Representative Jim McGovern (D) tweeted during the speech that by attempting to defeat the Affordable Care Act in federal court, the Trump Administration is actually seeking to eliminate, not guarantee, coverage for patients with pre-existing conditions.

State Meets Cost Growth Benchmark

The Massachusetts Health Policy Commission (HPC) last Wednesday released its 2019 healthcare cost trend report last week, showing that from 2017 to 2018, the state’s healthcare spending growth was 3.1% percent, precisely matching the 3.1% benchmark set in 2018. It is the ninth consecutive year that healthcare spending growth in Massachusetts is below the national trend.

More Details of Neal-Brady Surprise Billing Legislation

U.S. House of Representative’s Ways & Means Committee Chairman Richard Neal (D-Mass.) and Ranking Minority Member Kevin Brady (R-Tex.) have proposed legislation to resolve the “surprise billing” issue that could finally put the issue to rest.
Neal and Brady first released a rough outline of their proposal in December 2019, but last week full details of the plan emerged. Most importantly, the plan calls for patients to be protected from surprise medical bills for out-of-network services. The bill would also afford patients greater transparency about these potential situations by requiring insurers to provide accurate and up-to-date information regarding provider networks and an Advance Explanation of Benefits for services scheduled schedule at least three days in advance. 
In resolving payment disputes for such out-of-network occurrences, the bill fosters open-negotiation between providers and insurers. If the requested or proposed payment amount is unsatisfactory, either side can initiate a “baseball style” mediation process administered by independent third parties without any affiliation to providers or payers. Under this model of arbitration, both sides will come to the table with their best offers and an arbitrator will choose one over the other following guidelines that will be determined through a rulemaking process.
MHA President & CEO Steve Walsh said “The hospital community is grateful for Chairman Neal’s extraordinary leadership on the issue of surprise billing. The bipartisan Ways & Means proposal provides important protections and transparency for patients while bringing insurers and care providers together to negotiate without undue government interference in private contracts. It correctly takes patients out of the middle of surprise billing disputes and holds insurers accountable for their responsibilities in these situations. This approach is the first fair and balanced solution we have seen emanate from Congress.”

JAMA Study: MOUD Works

Medication for opioid use disorder (MOUD) that employs buprenorphine or methadone to treat people with opioid use disorder has the best chance of preventing individuals from overdosing again, according to a February 5 JAMA Network Open study, whose authors include Sarah E. Wakeman, M.D., of Massachusetts General Hospital, and Marc R. Larochelle, M.D., of Boston Medical Center.
The study tracked 41,000 patients with OUD, who received a variety of interventions ranging from MOUD with buprenorphine or methadone, MOUD with naltrexone, intensive and non-intensive behavioral healthcare, or inpatient detoxification or residential services. During 3-month follow-up, 707 participants (1.7%) experienced an overdose, and 773 (1.9%) had serious opioid-related acute care use. Only treatment with buprenorphine or methadone was associated with a reduced risk of overdose during the 3-month period.
Chapter 208 of the Acts of 2018 requires acute care hospitals that provide emergency services within an emergency department (ED) and satellite emergency facilities to have the capacity to initiate opioid agonist therapy, including buprenorphine, to patients that present after an opioid-related overdose. The patient must also be directly connected to continuing treatment prior to discharge. MHA convened a member workgroup composed of ED clinicians, addiction specialists, psychiatrists, nurses, social workers, and others, and in 2019 issued comprehensive guidelines to assist acute care hospitals implement MOUD programs.


Lawrence General Hospital has named Deborah J. Wilson as its next president and CEO. She had been serving as interim CEO since former President and CEO Dianne Anderson, R.N., left the post in November 2019. In a media release announcing the appointment, Wilson left no doubt about her key priorities. She said, “This hospital is an extraordinary community resource, and, in the face of diminishing reimbursement, I am committed to protecting and defending our region’s right to high-quality care … We need more equitable and fair reimbursement from both commercial insurers and governmental payers if we are going maintain the essential services that we provide to the Merrimack Valley.” 
Heather Thiltgen has been named president of Boston Medical Center (BMC) HealthNet Plan and Well Sense Health Plan, which have a combined membership of approximately 400,000. Most recently Thiltgen served as senior vice president of strategic markets for Medical Mutual of Ohio, the state’s largest health insurer.

2020 Design, Operation & Construction Conference

Friday, May 15; 7:30 a.m. - 1:30 p.m.
MHA Conference Center, Burlington, Mass.

Registration is open for MHA’s Annual Design, Operation & Construction Conference, always a timely and relevant program for facilities leaders, architects, builders, and those doing business in the healthcare design and construction business. Reminder: This conference is FREE for MHFPS, NEHES or other facility professionals working for a hospital or system. Through generous sponsorship and registrations, this event is made available to all facility professionals at all levels. Please encourage your staff to attend. Register early as this event fills up quickly! 2020 Featured Sessions include: Advanced Project Management Strategies; How Technology Supports Patient Experience; Energy Management; Key Regulatory Issues and Updates; and Hospital Evacuation: It Could Happen to You. There will be an optional legal briefing after lunch entitled: Top 10 Risk Areas for Construction Deals. This conference is Co-Sponsored by Massachusetts Healthcare Facility Professionals Society. Click here for more info, including registration.

John LoDico, Editor