The Federal Budget, ACOs, Hunger, and more...

The Trump HHS Budget for Fiscal 2019

Last Monday, the Trump Administration released its FY2019 budget proposal, which the administration says will save an estimated $637 billion over 10 years by, among other strategies, eliminating or reforming several U.S. Health & Human Services agencies.

Scheduled for elimination are the Agency for Healthcare Research and Quality (with some of its elements being absorbed into the National Institutes of Health), the Community Services Block Grant, and certain health workforce programs administered through the Health Resources & Services Administration.

The budget also puts forth several healthcare policy changes, including comprehensive Medicaid reform through legislation modeled after the Graham-Cassidy-Heller-Johnson bill, which aims at restructuring Medicaid financing through block grants.

Additionally, the bill contains provisions to cut Medicare by $554 billion, with reductions to uncompensated care, graduate medical education, post-acute care, home health, and bad debt payments. 

Several changes are proposed for the 340B drug discount program, such as a new user fee on all drugs purchased by covered entities and increased authority for CMS to apply Medicare and Medicaid 340B changes in a budget-neutral manner.

The budget would also cut the Centers for Disease Control and Prevention public health funding by 12%.

Budget proposals from the executive branch at both the federal and state levels are traditionally seen as message documents reflecting the president’s or governor’s priorities. However, in Washington’s uncertain political environment, healthcare interests are reviewing the document closely since individual elements of the Trump budget can gain traction in Congress, and several of the provisions already have been proposed in separate legislation. In addition, some of the above items could appear in regulatory reforms if statute allows.

MassHealth ACO Program Begins March 1

The MassHealth Accountable Care Organization (ACO) program begins on Thursday, March 1.  Providers and state officials have been working diligently in recent months to ensure that the more than 1 million affected MassHealth members are aware of the changes that will occur and that their continuity of care is maintained. 

Seventeen ACOs will participate in three types of ACO models and MassHealth also recently re-procured its Managed Care Organization (MCO) program with BMC HealthNet Plan and Tufts. The Primary Care Clinician (PCC) program will also continue for primary care physicians that choose not to participate in an ACO or MCO.

MassHealth members have been notified about how to choose to enroll and how they’ll be assigned an ACO/MCO if they don’t make a choice. The state also created the www.masshealthchoices.com website to help individuals determine the ACO with which their primary care physicians are affiliated. Given the various issues that patients will have to consider, including potential changes in PCPs, specialists, and MCO plans, it is important that patients are informed by those trained in these changes. MassHealth encourages enrollees to call its customer service number (800-841-2900) to learn about their options.

MassHealth has created a new website for providers related to the changes occurring with the ACO and MCO program, including how to access education materials and training webinars.

Since last year, MHA has frequently sent its members guidance documents informing them of ACO program developments, as well as notifications regarding MassHealth training and educational materials.

Report: 10% of Mass. Households Face Food Insecurity

A new study from Children’s Health Watch – a division of Boston Medical Center – shows that the cost of hunger and food insecurity in Massachusetts totals $2.4 billion a year.

Food insecurity is defined as a household’s limited or uncertain access to adequate food. Children’s Health Watch determined, based on U.S. Department of Agriculture figures, that an average of 10.3% of Massachusetts households experienced food insecurity between 2014 and 2016. Then, using existing research and studies, the researchers tracked the strong correlation between food insecurity and healthcare outcomes relating to inpatient hospital stays, depression, anemia, obesity, among many other conditions. Factoring in other costs, such as lost work time due to depression attributable to food insecurity, Children’s Health Watch reached a total cost to the state of $2.4 billion in 2016. The report’s main researchers were John T. Cook, PhD, MAEd and Ana Poblacion, PhD, MScs.

The study, which was sponsored by The Greater Boston Food Bank, was presented at a State House event last Tuesday. At that event, Kate Walsh, the CEO of Boston Medical Center and MHA’s current board chairwoman, told the State House News Service that BMC regularly asks its patients about their access to healthy food.

"We think of food as medicine," she said.

The study lays out a series of policy recommendations to alleviate the problem, from encouraging providers to regularly screen patients about food insecurity to creating a common application for MassHealth and the Supplemental Nutrition Assistance Program (SNAP) to ensure low-income individuals and families applying for health insurance also have access to food assistance.

“If we make a commitment to improving food security across our commonwealth, and follow through with sustained actions, children and their families will become healthier and perform better at school and in their workplace, seniors will be able to remain at home and maintain their well-being, the economy will experience an increase in productivity, and healthcare costs will decrease substantially,” the report concludes.

Boston Children’s Fenwick Endorses Accelerating Access Bill

Families travel from around the United States and globe to visit Boston Children’s Hospital to receive care for their children with medically complex conditions. If those families are on Medicaid, they face a series of paperwork challenges to allow them to receive care across state lines.

A bill introduced in the U.S. Senate last week by Sens. Chuck Grassley (R-Iowa) and Michael Bennet (D-Colo.) would cut through that red tape. The Accelerating Access to Kids Care Act would allow providers such as Boston Children’s to be screened and enrolled quickly in the Medicaid program of the child being treated. Once an out-of-state provider is enrolled in a state plan, that provider would not be subject to any additional screening and enrollment activities the child’s state would normally require.  The provider enrollment would last for five years before it would need to be reauthorized.

"As an institution that cares for children from almost every state each year, Boston Children's has experienced first-hand the challenges of screening and enrollment procedures that hinder access,” said Sandra Fenwick, CEO of Boston Children's Hospital. “We strongly support the Accelerating Kids' Access to Care Act and look forward to working with Senators Grassley and Bennet to make this bill law. If enacted, it will provide necessary safeguards to assure children receive timely care.”

The Healthcare Component of the Dreamer Debate

The U.S. Senate failed last week to move forward any legislation that would resolve the thorny immigration issue and the fate of “Dreamers” – the young immigrants who are in the U.S. through the Deferred Action for Childhood Arrivals (DACA) program.

Following a week-long debate, four bills came to the floor on Thursday, including one put forward by a bipartisan “Common Sense Coalition.” However, none could muster the 60 votes needed for passage.

As the Senate debated, MHA weighed in to draw attention to the importance of immigrants to the state’s vaunted healthcare sector. MHA President & CEO Steve Walsh issued a statement offering support for the Massachusetts delegation’s work to protect DACA, saying: “MHA wishes to acknowledge the impressive contributions to our healthcare system by immigrants and our strong support for DACA. National data reveals that 16% of the more than 14 million U.S. healthcare workforce – doctors, nurses, pharmacists, technicians, etc. – are foreign-born, and that number fails to include the millions of non-clinical employees who help feed our patients, maintain our buildings, and staff the wide range of jobs it takes to run our hospitals. Of particular importance are the so called Dreamers — 20% of DACA recipients work in healthcare.  We are proud that Massachusetts hospitals provide some of the best healthcare in the world, and are especially proud that foreign-born clinicians and other hospital employees are significant contributors to this excellence.

“The hospital community is also doing what it can to assure all immigrants – and anyone in need of care – that our doors are always open to them. MHA member hospitals, health systems, and affiliated caregivers work closely with populations of all types in their communities every day, and are deeply committed to providing high-quality care to each patient who comes through their doors, regardless of ability to pay or immigration status.

“We are hopeful that the efforts of Senator Warren and Senator Markey, in concert with our entire congressional delegation, will forge a meaningful and lasting solution for all Dreamers.”

The Latest Opioid Figures: A Small Glimmer of Hope

The Department of Public Health has released the latest figures on opioid-related deaths in Massachusetts throughout all of 2017, and while the data shows 1,977 casualties, that sad total is nevertheless 8.3% less than the previous year’s count of 2,155.

DPH reports that prescription opioids found in toxicology screenings of opioid deaths has trended downward since 2014, and that heroin’s presence has also decreased. However, the presence of fentanyl is still trending upward, according to DPH.

Massachusetts has made a concerted effort through legislation, increased law enforcement, and expanded treatment to curb the opioid scourge. MHA hospital members have signed on to two association-created guidelines on best-practice use of opioids in emergency departments and throughout hospital caregiving settings. The DPH report may signal that the tough, ongoing efforts may finally be showing some positive results.

Recall Notice: Phillips HeartStart MRx Defibrillator

Although the manufacturer (Phillips) has sent out recall notices for its HeartStart MRx Defibrillator, the prevalence of the device in hospitals merits a wider notice.  Philips is recalling the HeartStart MRx Defibrillator due to a defect in the device's gas discharge tube, which means the device could fail at any time.  Model numbers affected are M3535A and M3536A. An FDA notice on the recall is here.

John LoDico, Editor