State Budget, Awards to Noga/James, and more ...

MHA Offers Suggestions on FY21 State Budget Plan

Last week, MHA weighed in with the leaders of the House and Senate Committees on Ways and Means, outlining the hospital community’s thoughts on the proposed Fiscal Year 2021 state budget that Governor Baker re-submitted in mid-October.
Massachusetts has been operating on interim state budgets since the close of the fiscal year in July; the regular legislative process that should have produced a budget by July 31 was thrown into disarray by the pandemic.
In its letter to the legislators, MHA noted the unprecedented collaboration between providers, legislators, and state government in dealing with COVID-19 and the funding relief the state and federal government has provided.
“Even with the relief provided to date, healthcare providers continue to need support,” MHA wrote. “We also understand that current state budget resources are limited given the major effect this emergency has had on revenues. In that vein, we respectfully request the legislature’s consideration of modest accommodations to provide state relief to Massachusetts hospitals and healthcare providers.”
Specifically, MHA asks for the creation of a healthcare provider COVID-19 trust fund, with distributions from it determined on an application basis by the Executive Office of Health and Human Services that would take into consideration a healthcare provider’s increased expenses and lost revenues due to the COVID-19 emergency as well as state and federal relief received to date. MHA also advocates for additional funding to support safety-net hospitals in the MassHealth program, and asks that the legislature suspend the FY2021 hospital assessments that fund the administrative expenses of both the Center for Health Information and Analysis and the Health Policy Commission.
MHA told the Ways & Means leaders that it advocates for carrying over funding from the previous year’s account to fund the FY21 Sexual Assault Nurse Examiner (SANE) Program. MHA said that providers are willing to work with legislators on identifying a long-term, sustainable funding solution for SANE.
In its letter, MHA also repeated a long-standing request it has made to state government regarding the state’s share of funding the Health Safety Net over and above the $165 million hospitals contribute to the fund annually. While the state earmarks $15 million for the fund, it consistently includes language allowing it to pay “up to” that amount – and sometimes falls short of full funding. The Baker Administration is currently assuming the full $15 million state transfer for FY2021.
“MHA respectfully requests that the final budget direct the full $15 million transfer and eliminate any permissive 'up to' language to ensure the transfer is made,” MHA wrote.

Vaccine Access, Coverage, and Payment

CMS has issued an interim final rule guaranteeing that Medicare will cover the cost of any FDA-approved vaccine that is developed to fight COVID-19. The interim rule also implements provisions of the CARES Act that ensure coverage of a COVID-19 vaccine by most private health insurance plans without cost sharing from both in- and out-of-network providers during the course of the public health emergency.
Through the rule, CMS set Medicare payment rates for COVID-19 vaccine administration. The Medicare payment rates will be $28.39 to administer single-dose vaccines, but will be geographically adjusted. CMS said the rate would be further adjusted to “recognize the costs involved in administering the vaccine, including the additional resources involved with required public health reporting, conducting important outreach and patient education, and spending additional time with patients answering any questions they may have about the vaccine.”
While the state and nation lay the groundwork for a vaccine, such a vaccine is not available and won’t be until 2021 at the earliest, according to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease. He explained in an interview with JAMA that drug development companies won’t have enough necessary data until December at the earliest, which will then allow them to seek FDA emergency use authorization.
“Exactly when the EUA will be granted – could be January, could be later – we don’t know,” Fauci said

Noga Receives Prestigious ONL Award

Congratulations to MHA’s V.P. of Clinical Affairs Patricia Noga, R.N., PhD, who has been awarded the Janet Madigan Advocacy Award from the Organization of Nurse Leaders (ONL).
The award honors excellence as a community advocate or political leader committed to supporting and advocating for the nursing profession and patient care. Madigan was the well-respected, dynamic former leader of the Massachusetts Organization of Nurse Executives (MONE), which was the former name of ONL. She served in a variety of roles, including regional director, treasurer, president of MONE and chair of the Government Affairs Committee before passing away suddenly in 2013.
In addition to her many responsibilities at MHA – leading efforts in patient quality and safety, workforce development, care transitions, and disaster preparedness, among many other fields – Noga has taken a lead role in MHA’s response to COVID-19. She was also instrumental in the Question 1 ballot campaign of 2018 and in the “Caring for the Caregiver” initiative that was created in the campaign’s wake.
Noga is respected for her indefatigable work ethic, collegiality, consensus building between MHA and many groups outside of the associations, and intelligence. As the award from ONL notes, “While at MHA, Pat has established broad, collaborative, and tactical networks and relationships. Her history of respect and diplomacy allows her to tap into the expert knowledge and experience of clinicians and leaders throughout the region and nationally. She then translates that knowledge into highly regarded information for addressing complex concerns.”
ONL also honored other MHA-member nursing leaders through its annual awards and scholarship program. 
The Mary B. Concesion Award for Excellence in Nursing Leadership was presented to Terry Hudson-Jinks, R.N., Chief Nursing Officer and Senior Vice President for Patient Care Services at Tufts Medical Center.
The Marilyn Rinker Memorial Scholarship Award, which supports a qualified RN participating in an approved course of study leading to an advanced degree, was presented to Megan Seston Matson from Brigham and Women's Hospital. 
Outstanding Nurse Manager/Director Scholarships were presented to Carole Deangelis, Clinical Nurse Coordinator, Dana-Farber Cancer Institute; and Devin Lucy, Nurse Manager, Northeast Rehabilitation Hospital Network.
Sharon A. Smith Scholarship Awards were presented to Joanne Thomas, Cambridge Health Alliance, and Lillian Toomey, Boston Children's Hospital.
Read about other award recipients here. Congratulations all!

VOTE: Election Tomorrow

All elections are important. Tomorrow’s national election is especially important. The past 10 months of the pandemic have demonstrated the essential interaction between the healthcare community and local, state, and federal government. Sometimes those connections are strong and well organized for the benefit of patients, providers, and communities. Sometimes they are not. Vote wisely, but vote.
This page on the Mass. Secretary of State’s website will tell you where your voting site is.

National Group Names Care Award After BMC’s Thea James, M.D.

The national American College of Emergency Physicians (ACEP) has created the Dr. Thea James Social Emergency Medicine Lifetime Achievement Award, which recognizes a healthcare leader who incorporates social context into the structure and practice of emergency care, and who fosters high-quality research and translates the research into best practices for the application of social determinants of health at the bedside and beyond.
ACEP has presented the first award to Dr. James herself. Thea James, M.D., FACEP, is currently professor of emergency medicine at Boston Medical Center/Boston University School of Medicine. She is also the associate CMO, vice president of mission, and director of the Violence Intervention Advocacy Program at Boston Medical Center. James is also a member of the MHA Board of Trustees.
As supervising medical officer on the Boston Disaster Medical Assistance Team, James was deployed after 9/11 to New York City, after Hurricane Katrina to New Orleans in 2005, to Bam, Iran after the earthquake in 2003, and Port-Au-Prince Haiti after the earthquake of 2010. A graduate of Georgetown University School of Medicine, James completed an emergency medicine residency at Boston City Hospital. James is a nationally renowned speaker on the problem of disparities in healthcare and on how inherent racism in social structures adversely affects the health of populations.
Congratulations Dr. James!

Claims Plummet, Insurer Profits Rise, But Downturn Forecast

MHA releases its Health Plan Performance Report twice a year, and the report the association sent its members last week covering the first six months of the year paints an interesting picture of how the health insurance companies were able to weather the harsh COVID-19 storm that affected the provider community and overall economy.
From January to June, most health insurers recorded higher than usual profits and falling medical expense ratios due to significantly reduced utilization and claims payouts. The big plans were posting profit margins of between 3.9% and 5.1%. Every plan saw its medical expense ratio fall. That ratio measures how much of every premium dollar an insurer uses to pay medical claims. Some plans dropped to under 80% -- or well below what state and federal law require. The plans began to issue rebates this year as a result.
The insurers say they expect claims to rise dramatically in 2021 and they have successfully argued before the Division of Insurance for a rate increase averaging 7.9% for the first quarter 2021.

CMS Issues Price Transparency Rule

CMS issued a final rule last Thursday that requires health insurance companies and self-insured plans to disclose to their enrollees information on cost-sharing for healthcare services, and to publicly post the rates they pay healthcare providers for specific services.
Insurers are required to reveal to the public the negotiated rate between a patient’s doctor as well as an accurate out-of-pocket cost estimate for procedures, drugs, durable medical equipment, and other services.
According to the CMS media release, “The rule also allows insurers that pass on savings to consumers in plans that encourage use of services from lower-cost, higher-value providers, by allowing insurers to take credit for such ‘shared savings’ payments in their medical loss ratio (MLR) calculations beginning with the 2020 MLR reporting year.”
CMS has previously required hospitals to provide access to negotiated charges. Read a CMS fact sheet on the final rule.

Behavioral Health Comorbidities Common in Hospitalized Patients

A new report from the state’s Center for Health Information and Analysis (CHIA) shows that 45% of adults hospitalized in Massachusetts acute care hospitals had at least one comorbid behavioral health condition, and 62% of hospitalized adult Medicaid patients had a comorbid behavioral health condition.
The numbers are from state fiscal year 2018 (July 1, 2017 to June 30, 2018). The CHIA report also found that patients with any behavioral health comorbidity had inpatient stays that were, on average, 1.4 days longer than patients with no behavioral health comorbidity, and that readmission rates for behavioral health comorbidity patients were nearly double the readmission rates for patients without a comorbid behavioral health condition

Healthcare Legal Compliance Forum:
Keeping up with COVID-19 and Other 2020 Developments

Thursday, November 5, 2020 – 8:30-11:15 a.m. 

Legal healthcare compliance is an ever-changing landscape, especially in the age of COVID-19. Join us at MHA’s Compliance Forum and hear from legal and regulatory experts on today’s top issues for hospitals regarding COVID-19, the expansion of telemedicine, and other healthcare laws affecting operations. We’ll cover current enforcement issues and hear directly from the offices of the Massachusetts and U.S. Attorneys General. We’ll also review privacy issues, among other hot topics, and conclude with a riveting update on how the election will shape healthcare compliance. We hope you’ll join us for this informative virtual program. Click here to register.

John LoDico, Editor