New MHA MAT Guidelines, a New Congress, and more...

MHA Releases Medication for Addiction Treatment Guidelines

MHA has released these guidelines to assist hospitals develop appropriate programs to administer and/or prescribe Medication for Addiction Treatment (MAT) in their emergency departments or satellite emergency facilities. A new state law (Chapter 208) requires acute care hospitals that provide emergency services to have the capacity to initiate opioid agonist therapy to patients after an opioid-related overdose, and to directly connect the patients to continuing treatment prior to discharge.

“MAT is a very effective treatment option, and emergency departments offer a real opportunity to reach patients in that critical moment following an overdose,” said Ali Raja, M.D., the executive vice chair of Massachusetts General Hospital’s Department of Emergency Medicine, who chaired the MHA workgroup on MAT. “These guidelines share best practices for adoption of MAT in emergency departments, facilitate training and credentialing for ED clinicians, and identify ways to ensure continuity of care after patients are discharged. It’s all designed to give the clinicians the tools they need to accomplish the ultimate goal of supporting patients as quickly as possible and help them get their lives back.”

MHA President & CEO Steve Walsh said, “While recent statewide data has shown improvements, our nation’s opioid epidemic continues to ravage our communities and take far too many lives. How we manage this crisis in our hospitals is of utmost importance. These MHA guidelines are designed to provide a practical resource for hospitals and clinical staff to help fulfill the requirements in the commonwealth’s latest opioid law, championed by Governor Baker and the legislature. The procedures aim to ensure that patients with opioid use disorders can start their treatment and get on the road to recovery before they leave the hospital.”

The new MHA guidance document provides general recommendations for development of an in-hospital MAT program, using best practices from several Massachusetts hospitals as well as facilities in other states that have or are considering MAT adoption. Each hospital is encouraged to consider and implement recommendations that are appropriate for their facility.

The guidelines also include an explanation of the requirements for clinicians to obtain a federal “X Waiver” to prescribe MAT, information on the laws and regulations currently in place to allow hospitals to discharge patients with a take-home kit of buprenorphine, a general Q&A section for clinicians, and template fact sheets to educate patients on the use of buprenorphine.

MHA developed the recommendations in collaboration with the Massachusetts College of Emergency Physicians and with practitioners from member hospitals, including specialists in emergency medicine, addiction medicine, behavioral health, and nursing. MHA has hosted two X-Waiver trainings and is coordinating additional trainings in January.

The guidelines for MAT in Massachusetts hospital emergency settings further advance the ongoing efforts of MHA and the Massachusetts hospital community to curb the opioid crisis. Earlier this year, MHA and Tufts Medical Center, working with hospital clinicians and operational staff in Massachusetts and other states, developed two documents to help hospitals develop internal policies to prevent opioid misuse by patients admitted as inpatients for care and treatment. Caregivers across the state now also have access to Prescription Monitoring Program (PMP) information through MassPAT, and MHA is working with providers to enable even faster access to this information.

Previously, MHA convened a task force that included a multi-disciplinary group of clinicians and operational staff to create and issue an array of guidance and informational sheets to improve opioid prescribing practices and screening for OUD within hospitals, as well as to enhance patient education concerning the potential risk and harm of opioid use and possible alternative treatments. All of these guidance and educational materials are available on MHA’s PatientCareLink website.

In November 2018, DPH’s most recent report on the opioid epidemic showed prescribing of opioids in the state had fallen by 35% from the first quarter of 2015 to the third quarter of 2018.

Judge Halts Drastic Cut to 340B Drug Discount Program

The U.S. District Court for the District of Columbia on December 27 issued a permanent injunction to the Centers for Medicare and Medicaid Services (CMS), halting the federal government’s nearly 30% reduction in reimbursements to certain hospital outpatient departments purchasing drugs through the 340B program.

CMS’ 2018 outpatient prospective payment system (OPPS) rule issued in November 2017 contained the 340B reduction. Specifically, it reduced 340B drug payments from the average sales price (ASP) of the drug plus 6%, to ASP minus 22.5%. Affected hospitals – mainly disproportionate share hospitals – estimated the payment policy would cost them more than $1.6 billion annually. The American Hospital Association and other hospital groups then brought suit.

In the recent ruling, the District Court judge essentially ruled that by imposing a nearly 30% payment cut, CMS “fundamentally altered the statutory scheme established by Congress” to set reimbursement rates, and exceeded its authority.

But the judge stopped there. He did not rule in favor of reimbursing hospitals for the money lost during 2018 due to the reimbursement cut, nor did he halt 340B payment reductions that went into effect on January 1, 2019.  He did request briefs from the parties on an appropriate remedy.  Observers expect CMS to appeal the ruling on the 2018 OPPS, and the hospital groups to bring suit to halt the 2019 OPPS 340B payment reductions.

Governor Baker’s Second Term and a New Legislative Session

Governor Charlie Baker and Lieutenant Governor Karyn Polito were sworn into their second terms last Thursday. And the day before, the Massachusetts legislature began a new two-year session (the 191st), with the House once again electing Robert DeLeo (D-Winthrop) as speaker and the Senate voting in Karen Spilka (D-Ashland) as president. DeLeo is serving his sixth term as speaker and Spilka is serving her first full term after taking over the presidency for five months last term.

In her inaugural speech, Spilka alluded to controlling spiraling pharmaceutical prices and reining in healthcare costs.  However, in a December 31 opinion piece in the Boston Herald, Spilka said one of her “personal priorities” is a “commitment to achieving true mental health parity, and finding creative ways to integrate preventative mental health care into our healthcare system, so that treatment is as routine as that which we expect for heart disease or diabetes. We must also commit ourselves to ending the stigma surrounding mental illness. When mental health touches so many of our lives—from those struggling with addiction, chronic homelessness or recurring incarceration, to veterans fighting PTSD and families trying to break the cycle of child abuse and neglect—advocating for routine, preventative mental health care is a challenge that we must take on.”

Governor Baker devoted much of his speech to education and transportation issues, but regarding healthcare, he said he would file legislation to expand telemedicine, “rethink scope of practice,” and address parity issues affecting mental health.

Budget Leaders Set Limit that Influences Healthcare Benchmark

Each year the leaders of the Massachusetts House and Senate Ways and Means Committees meet with the Administration and Finance Secretary to come up with their assumption of how much state revenues will increase in the coming year. From this they base their fiscal year budget plans.

The three budget leaders, with input from outside economists, also come up with the Potential Gross State Product (PGSP), which is the long-run average growth rate of the commonwealth’s economy, excluding fluctuations due to the business cycle. The PGSP is important because the Health Policy Commission uses it to set the state’s healthcare cost growth benchmark.

Last week outgoing House Ways & Means Chairman Jeffrey Sanchez, Acting Senate Chair Joan Lovely, and Administration and Finance Secretary Michael Heffernan set the revenue assumption at 2.7% and the PGSP at 3.6%.

Chapter 224, which created the cost growth benchmark concept, mandates that for calendar years 2018 to 2022, the benchmark must be the PGSP minus 0.5% – or in this case 3.1%.  The HPC, however, can vote to modify the benchmark between 3.1% and 3.6%.  The HPC usually sets the benchmark in March.

A New Congress with Massachusetts Muscle

The new 116th Congress was sworn in last Thursday and its leadership contains some Massachusetts members.

Massachusetts Rep. Richard Neal (D) will become chairman of the powerful Ways & Means Committee through which all legislation dealing with taxes, trade, healthcare, and Social Security, among other topics, flows.  Last November after Democrats regained control of the House, Neal said healthcare would be his priority.

Rep. James McGovern (D) will be chairman of the House Rules Committee, which decides how or if legislation can be debated or changed when it comes to the House floor.

Rep. Katherine Clark was elected as the vice chair of the House Democratic caucus, making her the sixth highest ranking member. Clark also serves on the House Appropriations Committee, and its Labor, Health and Human Services, Education, and Related Agencies subcommittee.

Newly elected Rep. Ayanna Pressley (D) is one of 102 female House members (the most ever) and she is the first African-American from Massachusetts to serve in the House.  Another Massachusetts newcomer is Democrat Lori Trahan who won the 3rd Congressional District seat that was left vacant by retiring U.S. Rep. Niki Tsongas.

The state’s entire Congressional delegation is Democratic.  Also of note, Massachusetts Senior Senator Elizabeth Warren announced last week she was setting up a committee to explore a presidential run in 2020.

House First Order of Business: Defend ACA

The new Democratic House was expected to pass a rules package that includes a provision allowing it to intervene in a federal lawsuit that is challenging the constitutionality of the Affordable Care Act.

In mid-December a U.S. District Court Judge in Texas ruled the ACA unconstitutional, triggering an immediate response by a group of Democratic state Attorneys General, including Mass. AG Maura Healey, which filed a brief against the ruling. On December 30, the judge ruled that the ACA can stand while his original ruling is being appealed. Last Thursday, the group of AGs filed that appeal.

The House rule directs the House’s Office of General Counsel to represent lawmakers in any court action defending the ACA and allows the hiring of outside counsel.

52nd Annual Mid-Winter Leadership Forum

Thursday, February 7, 2019; 8:30 a.m. – 2:30 p.m.
Sheraton Hotel, Framingham, Mass.

This is the MHA event of the winter and the Mid-Winter Leadership Forum planned for February promises to be a good one. The confirmed keynote speaker is David Gergen, director of the Center for Public Leadership at Harvard Kennedy School, and senior political analyst for CNN.  Gergen has served as a White House adviser to four U.S. presidents of both parties: Nixon, Ford, Reagan, and Clinton. He wrote about those experiences in his New York Times best-seller, Eyewitness to Power: The Essence of Leadership, Nixon to Clinton (Simon & Schuster, 2001). Additional confirmed sessions include: Elisabeth Rosenthal, M.D., editor-in-chief of Kaiser Health News and the author of An American Sickness, which takes a harsh look at the U.S. healthcare system; and Francis X. Campion, M.D., senior clinical informaticist for IBM Watson Health, and an internist at Atrius Health, who will discuss “Artificial Intelligence for High Value Healthcare.” Don’t miss this year’s Mid-Winter Forum.  View more details and registration information here.

John LoDico, Editor