MMS Opposes Ballot Question, a New Opioid Bill, and more ...

Mass. Medical Society Opposes Staffing Ballot Question

The Massachusetts Medical Society (MMS), representing more than 25,000 physicians and medical students in the commonwealth, has joined the Coalition to Protect Patient Safety in opposing the nurse staffing question on the ballot this November. MMS joins a growing contingent of healthcare leaders to oppose the proposed law.

The ballot question would require that hospitals across the state, no matter their size or specific needs of their patients, adhere to the same rigid nurse staffing ratios within all patient care areas. The petition does not make allowances for rural or small community hospitals, holding them to the same staffing ratios as major Boston teaching hospitals.

“Massachusetts’ world-class healthcare has everything to do with the team approach to patient care,” said Alain Chaoui, M.D., president of the Massachusetts Medical Society. “As a family physician, I know the value of team-based care that is focused on the needs of the patient. This law would fundamentally erode that team dynamic and replace it with a rigid system that relies on arbitrary numbers, which would put patient care at risk.”

An independent cost analysis found that the proposed ballot question – designated as Question 1 last week – would cost the state more than a billion dollars each year, and those costs will be felt across the healthcare system. The initiative would override the judgment of healthcare professionals and prevent hospitals from admitting patients if the number of nurses on duty does not comply with the rigid government mandate.

“There are no scientific studies or reports that demonstrate the effectiveness of government mandated, one-size-fits-all nurse staffing ratio for improving quality of care, patient outcomes or professional nursing practice,” said Donna Glynn, president of the American Nurses Association Massachusetts and a nurse scientist for the VA Boston Healthcare System. “In fact, no studies evaluating nurse staffing ratios reported a magic number as the single factor to affect patient outcomes or job satisfaction. This ballot question is ignoring scientific fact around what is best for nursing practice, decision making and quality patient care.”

MMS joins the American Nurses Association Massachusetts, the Organization of Nurse Leaders, the Massachusetts Association of Colleges of Nursing, the Infusion Nurse Society’s New England Chapter, Home Care Alliance, and VNA Care in protecting the state’s healthcare system and its patients from the consequences of the rigid, costly mandate scheduled to go before voters in the November 2018 election.

Vote NO On 1!

It’s official – the Secretary of State’s office has certified three questions that will appear on the November ballot and assigned numbers to them. The onerous nurse staffing ballot question will be Question 1. (Vote No on 1!) Question 2 would create a commission to consider and recommend potential amendments to the U.S. Constitution to establish that corporations do not have the same constitutional rights as human beings and that campaign contributions and expenditures may be regulated. MHA has not taken a position on Q2. A yes vote on Question 3 would keep a state law that banned discrimination against transgendered people; a no vote would overturn the protections. MHA supports the Freedom for All Massachusetts coalition, which urges a Yes vote on Q3.

House Passes Important Bill in the Fight Against Opioid Abuse

The Massachusetts House of Representatives voted unanimously last Wednesday to pass a sweeping, multi-part bill to fight the opioid crisis.

HB4725, entitled “An Act for Prevention and Access to Appropriate Care and Treatment of Addiction,” directs acute care hospitals that deliver emergency services as well as satellite emergency facilities, to have the capacity to initiate opioid treatment involving buprenorphine therapy, among other such “opioid agonists.” Such agonists have a similar effect on the body as opioids as they attach themselves to the same receptors as the addictive substance, such as heroin. Hospitals would also be required to connect patients to continuing treatment. MHA was supportive of these important parts of HB4725 and convened a workgroup earlier this year to develop recommendations for hospitals to implement the requirements.

Another critical part of the bill updates the law allowing patients to request a partial fill of prescriptions for certain narcotic drugs to enable patients to go back to the pharmacy later to seek the full prescription, if necessary. Patients would only be subject to one co-pay for such prescriptions. The bill requires electronic prescribing for all controlled substances effective January 1, 2020.

MHA worked successfully with Rep. Liz Malia (D-Boston) to amend the bill to make it easier for hospitals to more smoothly integrate MassPAT, the state’s prescription monitoring program that allows providers to quickly research a patient’s prescribing history, into hospital electronic medical record systems. Another approved amendment that Rep. Paul Brodeur (D-Melrose) and Rep. David Nangle (D-Lowell) promoted allows licensed certified social workers to perform substance use disorder evaluations in hospital emergency departments.

The bill now moves to the Senate which has a short time frame to act on it before the end of the legislative session July 31.

HPC Insight into BID-Lahey Merger Due this Week

The Health Policy Commission board is expected to vote Wednesday on the preliminary Cost & Market Impact Review (CMIR) relating to the merger that includes CareGroup, Lahey Health System, Seacoast Regional Health Systems, the Beth Israel Deaconess Care Organization (BIDCO), and Mount Auburn Cambridge Independent Practice Association (MACIPA).

Under a CMIR process, HPC staff performs a detailed investigation to determine how a proposed merger will affect healthcare costs, access, healthcare quality, and how the market functions. The HPC doesn’t have the authority to stop a proposed merger but if it finds a transaction would be detrimental to the state’s overall healthcare system it can refer its report to the Attorney General’s office, which does have the power to approve or reject a merger.

Last week, Attorney General Maura Healey wrote the HPC to share “some of our current thoughts on how, irrespective of potential positive effects on the health care system, the merger of Beth Israel Deaconess Medical Center, Lahey Health System and others, as currently proposed, might increase costs and impact access to health care in Massachusetts.”

Healey said that post-merger, the remaining independent hospitals in the state, who already receive lower reimbursement from insurers and who see large percentages of patients in public health programs (MassHealth and Medicare), could see more of their patients siphoned off into the larger system, thereby exacerbating their financial problems.

“An important aspect of how we evaluate these potential impacts is how the parties to the BI-Lahey transaction intend to operate the system going forward,” Healey wrote, adding, “We will be following up with the parties with the hope of gaining insight into that question.”

The BID system, Lahey, and others involved in the transaction have said that coordinating care between them would benefit access and lower costs.

Clinicians Concerned About Their Scores Can Get a Review

Clinicians who participated in the Merit-based Incentive Payment System (MIPS) in 2017 can now access their final MIPS score and performance feedback at the Quality Payment Program website. The scoring is important because it is the basis for the Medicare payment adjustment the clinicians will receive in 2019. That is, a positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished under the Medicare Physician Fee Schedule in 2019.

Last week, CMS announced that eligible clinicians or groups may request that CMS review their performance feedback and final score through a process called targeted review. MDs that believe an error has been made in their 2019 MIPS payment adjustment calculation, can request such a targeted review until September 30, 2018.

To request a review, go to the Quality Payment Program website, and log in using the same Enterprise Identity Management credentials used to submit MIPS data. If you have questions about your performance feedback or MIPS final score, please contact the Quality Payment Program (866) 288-8292 or QPP@cms.hhs.gov.

Free Training on Treating Pregnant Women with OUD

The Substance Abuse and Mental Health Services Administration (SAMHSA) is hosting a course designed to help physicians and healthcare professionals who care for pregnant women with opioid use disorder and substance-exposed infants make clinically appropriate and individualized treatment decisions. The information covered in this course is based on SAMHSA’s Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants guide. The free CME live training will be held on Friday, July 20 from 8 a.m. to 4:30 p.m. in Worcester. For more information or to register, please visit here. This course is approved for a maximum of 6.75 AMA PRA Category 1 credits.

CHIA Plans to Release Data Set Explaining CompareCare

On Friday, the Center for Health Information & Analysis (CHIA) will post on the CompareCare website a spreadsheet containing the data it used to populate its procedure pricing tool.

CompareCare allows individuals to search and browse insurer payment data for 295 specific services using a number of filters, and lets users select a specific insurer to see payer-specific paid amounts.

With Friday’s posting, CHIA said it is expanding its commitment to transparency. While consumers probably have little use for the data, CHIA says policymakers, insurers, providers, employers, and researchers, “and also the consultants and digital health companies that use data to serve these stakeholders” will find the massive dataset useful.

“By making this data more freely available, stakeholders can benefit both from direct access to the data and also from the products, services, and analyses that will be available from third parties who access the data. This data can also support a more informed public dialogue about health care costs,” CHIA says.

The first release will mask the payer-specific prices and instead show multi-payer weighted average prices, but CHIA will be releasing the payer-specific prices before long.

The Final 2019 Inpatient Hospital PPS Rule

Join MHA’s annual program to review the final IPPS inpatient rule. We’ll cover all of the critical changes and updates important to hospitals, including: inflation and program financial updates; changes to the value-based and quality programs; proposals on price transparency; MS-DRG grouping and significant ICD-10 changes; and other Medicare legislative and regulatory issues applicable to acute care hospitals. More information is coming soon, but mark your calendar today, register, and check back here.

John LoDico, Editor