FY20 Budget, Telemedicine, and more ...

Baker Files FY20 Budget Proposal; Eyes Tax on Opioids

Governor Charlie Baker last Wednesday released a $42.7 billion FY2020 state budget proposal that among other things, maintains level MassHealth provider reimbursement rates, attempts to give the state more bargaining power with pharmaceutical companies, taxes opioid manufacturers, and appropriates more funding for substance use disorder services.

According to the Executive Office of Health & Human Services (EOHHS), which provided an overview of its budget priorities, reimbursement rates for most providers are assumed to be held flat in FY2020. For hospitals, this means that while EOHHS assumes no growth in spending on a per-member basis, there will likely still be modest updates to the inpatient and outpatient rates.

Similar to its FY2019 budget request, EOHHS seeks the ability to negotiate outside of state procurement rules when dealing with pharmaceutical manufacturers for MassHealth-reimbursed drugs. If EOHHS cannot obtain a satisfactory Medicaid drug rebate, EOHHS could establish its own value of the higher cost drugs through a public process and publish those amounts on its website. And if further efforts to negotiate fail, a manufacturer can be referred to the Health Policy Commission (HPC), which can request drug pricing information and hold public hearings. The HPC could then, in turn, refer the manufacturer to the Attorney General.

Funding for the Department of Mental Health (DMH) and DPH increases 1% and 1.2%, respectively, over FY19. The governor’s “House 1” budget includes $266 million in funding across several state agencies for substance use disorder treatment services. This is a $48 million increase (22%) above estimated FY19 spending. The total funding includes $16.7 million to fulfill the requirements of Chapter 208, last year’s opioid law, including medication for addiction treatment within correctional facilities.

Baker’s budget would impose a gross receipts tax of 15% on the revenues of opioid manufacturers from the sale of their opioid products that are dispensed in the commonwealth. Revenues associated with drugs used for medication for addiction treatment and those used in inpatient settings are exempted from the tax. As reported by the State House News Service, Governor Baker said of the opioid tax, “The manufacturers have a lot to do with creating the crisis that we all are paying for every day and creating a mechanism in which they put something in to help pay for the carnage they've created, I think, is important.”
The House Ways & Means Committee will release its proposed budget during the second week of April.

tMED Coalition Calls for Improved Telemedicine in Mass.

tMED, the Massachusetts Telemedicine Coalition, which was convened by MHA and includes more than 30 healthcare provider, consumer and technology organizations, joined with Sen. Jason Lewis (D-Winchester) and Rep. Tom Golden (D-Lowell) last Friday to file legislation that would adopt a comprehensive telemedicine framework for Massachusetts.

The bill will ensure parity in insurance coverage for telemedicine services at the same payment rate as in-person treatment, streamline the credentialing process for Massachusetts licensed clinicians using telemedicine services within the state, and ensure a uniform and consistent approach that fosters innovation when defining telemedicine services.

Telemedicine is a tool that healthcare providers, payers, patients, and employers can use to improve access to care for patients, improve health outcomes for chronic illnesses, and reduce costs associated with seeking in-person medical visits with healthcare providers. Telemedicine allows all patients (regardless of whether they live in rural or urban areas) convenient access to all levels of healthcare services (including but not limited to primary care providers, specialists, and behavioral health clinicians).

By streamlining provider evaluations of patients suffering from chronic (and expensive) diseases such as asthma, congestive heart failure, chronic obstructive pulmonary disease, diabetes, and hypertension, telemedicine has been shown to improve outcomes.  Telemedicine also has been shown to help reduce hospital readmissions, lengths of stay, and emergency room visits. 

Telemedicine continues to be a priority this legislative session as Governor Charlie Baker, in his inaugural address, announced that it will be included in healthcare legislation that he anticipates filing this year. Both the House and Senate omnibus healthcare bills last session included forms of telemedicine coverage parity.

What to Expect in the Federal Healthcare Arena

As the nation awaits the outcome of the federal court case that ruled the Affordable Care Act unconstitutional, and as the public wonders when and if the federal government will ever get up and running full steam again, the American Hospital Association (AHA) last week laid out its 2019 public policy agenda.  Since the federal healthcare agenda is tied inextricably to the state’s, it’s worth taking note of what the AHA has in store.

Among many initiatives, AHA said it would:
“continue to actively defend the constitutionality of the ACA in the courts and promote its benefits in the halls of Congress and in the public arena.”
ensure patients have access to “a minimum set of essential health benefits and enforcing existing federal parity laws to ensure coverage for physical and behavioral health benefits, including substance use disorder treatment.”
“eliminate Medicaid Disproportionate Share Hospital cuts.”
“restore vital funding and prevent further cuts to the 340B drug savings program.”
“ensure patient access to the highest quality primary care and other outpatient services by rejecting additional payment cuts that don’t recognize legitimate differences among provider settings (also known as site-neutral payment policies).”
“pass the Standard Merger and Acquisition Reviews through Equal Roles (SMARTER) Act, which would help rebalance the merger review process to support the ability of hospitals to become more integrated, aligned, efficient and accessible to patients.”
“expand access to care through the use of telehealth and other technologies by providing Medicare coverage and reimbursement for such services and including telehealth waivers in all new care models.”
“continue to streamline and coordinate quality measures to focus on the ‘measures that matter’ most to improving health and outcomes while reducing burden on providers.”
“promote inclusion of sociodemographic factors affecting health in quality measurement programs to reduce health care disparities.”
“ensure patients’ access to accurate quality information by suspending and modifying the faulty hospital star ratings.”
“eliminate the Recovery Audit Contractor contingency fee structure and instead direct CMS to pay RACs a flat fee, as every other Medicare contractor is paid.”
“support state efforts to expand scope of practice laws, allowing non-physicians to practice at the top of their licenses.”
“support efforts to protect the hospital workforce from violence, especially in the emergency department, as well as policies to strengthen clinician resiliency.”

AHA’s full document is here.  In many instances, MHA and its members have worked with the state’s congressional delegation on the issues AHA has outlined, or the Massachusetts hospital community has sought legislative or regulatory solutions within the state to address the issues.

Hospitals Build and Adapt to Meet Patient Needs, Improve Facilities

As the healthcare sector rapidly evolves, hospitals are upgrading or expanding their facilities to meet the demands of patients. An aging and growing population, increasing patient volume, and deteriorating infrastructure combine with the need to re-define work spaces to increase privacy, ensure patient and workforce safety, and increase efficiencies. The bricks-and–mortar aspect of care is changing as quickly as how care is provided, coordinated, and paid for.  Here are a few examples:

UMass Memorial HealthAlliance-Clinton Hospital is opening a new emergency department today, increasing the number of patient beds from 24 to 37 and adding new layers of privacy for patients and providers. Clinton Hospital officials say the new layout will improve safety and include a much-needed private behavioral health sector.

Massachusetts General Hospital last week announced plans to build a 12-story complex on its Boston campus in order to expand access, modernize patient rooms, and more efficiently move those waiting in the emergency department into inpatient care. MGH expects the addition to add up to 300 beds, including those for cancer and cardiac care and transplant services. The hospital, with more than 1,000 beds now, is often at full capacity.

Nantucket Cottage Hospital’s new facility will open in mid-February, designed to meet the needs of a patient population that has exponentially grown since the original hospital first opened its doors in 1957.  The new building includes 14 new inpatient beds, a second operating room, almost 30 new primary care exam rooms, and expanded labor and delivery services.  All funding all funding for the new hospital was raised through private donations.

Melrose-Wakefield Healthcare has won state approval to build a single-story ambulatory surgery center at Lawrence Memorial Hospital in Medford.  The facility is a necessary part of the hospital’s plan to focus on outpatient services. The ASC addition will provide certain day surgeries, and will expand access to physicians specializing in primary care, cardiology, women’s health, and family medicine.

DPH Celebrates 150 Year Anniversary

Congratulations to the Massachusetts Department of Public Health, which this year celebrates its 150th year of existence.  DPH released a new logo last week that notes its sesquicentennial. The Massachusetts State Board of Health, now DPH, was established in 1869, with Dr. Henry I. Bowditch as its chairman.  While hospitals are some of the most regulated entities, reporting to a variety of agencies in state and federal government, hospitals’ relations to DPH are particularly strong. That relationship is in many cases collaborative. MHA-driven initiatives – such as recent ones combatting substance use disorder or promoting medication for addiction treatment or tobacco cessation, to name just a few – have often been devised and implemented collaboratively between hospitals and DPH.  Here’s to future years of collaboration and reasoned regulation.

MHQP’s 14th Annual Patient Experiences Survey

Massachusetts Health Quality Partners (MHQP) has released the results of its annual survey of patient experiences in primary care practices across the states. This is the 14th year that MHQP has surveyed patients; this year it received more than 60,000 responses from patients in 842 adult and 343 pediatric primary care practices, which represent more than 4,000 primary care providers.

The results were generally impressive. In adult practices, patients highly rated patient-provider communications (94.6%), how well providers know their patients (89.7%), office staff professional excellence (89.4%), ease of access to care (87%), and coordinating patient care (86.8%). Assessing patient behavioral health care received only a 71.1% rating and empowering patient self-care got a 62.6% score. The applicable ratings for pediatric services were all higher than the adult care scores.  In the general, open-ended patient comment section, MHQP said the good-versus-bad scores often revolved around the provider’s caring/compassionate attitude. That is, if clinicians treat people with respect and listen to their concerns, it resonates strongly – as does the opposite attitude.

The results of the survey are posted at MHQP’s website here.

Congratulations to Mass. Hospital Cancer Researchers

Cancer Research UK, a charity from Great Britain, has awarded researchers at Dana-Farber Cancer Institute and Brigham and Women’s Hospital a total of $50 million to continue their research into finding a cure for certain types of cancer.

Dana-Farber Cancer Institute’s Matthew Meyerson, M.D., PhD and Wendy Garrett, M.D., PhD, also of the Harvard T.H. Chan School of Public Health, received funding for their research into understanding how certain microbiomes lead to colorectal cancer and how the microbiomes can be manipulated to treat cancer.

Stephen Elledge, PhD, of Brigham and Women’s Hospital and Harvard Medical School, received funding for his studies into why genetic faults only affect certain tissues. He is working with collaborators from the US, the UK, and the Netherlands and his project is supported in partnership with The Mark Foundation for Cancer Research.

WEBINAR: Mitigating Ligature & Self Harm Risks

Suicide is one of the top 10 leading causes of death in the nation. In Massachusetts, the suicide rate increased more than 35% from 1999 – 2016. The Centers for Medicare & Medicaid Services (CMS) has taken notice, expanding the types of healthcare facilities and hospital areas that must comply with the Medicare Conditions of Participation (CoPs) regarding ligature and other self-harm risks. While CMS’ Interpretive Guidelines regarding ligature compliance are still in development, the agency has made its intentions for compliance clear in a recently released memo. Surveyors and healthcare providers must follow recommendations developed by The Joint Commission’s (TJC’s) multi-stakeholder Suicide Panel. Join us for this important webinar on Tuesday, February 12 from 1 to 2:30 p.m. and hear representatives from TJC and JLL healthcare consultants explain the steps that all hospitals should take to maintain compliance with Medicare CoPs. Hospital representatives will share practical ways to maintain CoP compliance and provide safer environments for at-risk patients. Visit here for more information, including registration details.

John LoDico, Editor