Sugary Drinks, Payment Caps, and more...

MHA Focuses Attention on Zero-Value Beverages

Sugary drinks that have no nutritional value and are known to increase Type 2 diabetes, obesity, and heart disease are being targeted in proposed legislation that MHA strongly supports.

“An Act to Promote Healthy Alternatives to Sugary Drinks,” sponsored by Sen. Jason Lewis (D-Winchester) and Rep. Kay Khan (D-Newton) would implement a tiered-tax on non-alcoholic sugar-sweetened beverages based upon the drink’s sugar content. Proceeds from the tax would help fund a variety of community health initiatives.

“Sugary drinks are the single largest source of added sugar in the American diet,” said MHA’s V.P. of Clinical Affairs Patricia Noga, R.N. “Sugary drinks, unlike junk foods which may contribute some nutrition to the diet, are just ‘empty’ calories. To make matters worse, sugary drinks result in proven harm, with consumption directly linked to expensive, chronic illnesses such as Type 2 diabetes and cardiovascular disease.”

The bill recommends three tiers of taxation: drinks with little or no added sugars (7.5 grams of sugar per 12 ounces) will not be taxed at all; drinks with moderate amounts (7.5 to 30 grams) of added sugars will be subject to a 1-cent-per-ounce tax; and drinks with 30-plus grams per 12 ounces would face a 2-cent-per-ounce assessment. Beverages consisting of 100% natural fruit or vegetable juice with no added sugars would be exempt from the tax.

How much is 7.5 grams of sugar? About 1.5 teaspoons. How much sugar does a 12 ounce can of Coca Cola have? About 39 grams or about 9.3 teaspoons.

In the national discussion over sugary drink taxes, opponents often contend that poorer communities will be harmed by increased drink prices.  But proponents note that beverage companies often spend a disproportionate amount of advertising dollars marketing sugary drinks to poorer communities. In fact, studies have shown lower-income African-American and Latino neighborhoods had more outdoor ads for sugary drinks than lower-income and higher-income white neighborhoods.  In these same neighborhoods, there is a disproportionately high rate of heart disease, Type 2 diabetes, and other chronic diseases that are brought on, in part, by consuming sugary drinks. The revenue from the proposed legislation’s tiered tax on sugary drinks could be one of the most effective policy strategies to achieve health equity. Optimally, the law could encourage the beverage industry to reformulate their products to reduce added sugars, thereby improving public health.

Duals Program Due for Changes (But Concerns Remain)

The state’s bold experiment with its dual eligible programs is getting some revisions, while raising some concerns among hospitals and physicians.

Dual eligible individuals have both Medicare and Medicaid coverage, meaning they are low-income and qualify for Medicare based on their age or disability. The One Care program serves individuals who are between 21 and 64 years old at the time of enrollment.  Senior Care Options (SCOs) are available to dual eligible individuals 65 and older.  Currently, there are approximately 68,000 individuals in both programs with another 239,000 in traditional fee-for-service.

Last August, the Executive Office of Health & Human Services (EOHHS) submitted a concept paper to the Centers for Medicare and Medicaid Services (CMS) on its proposed changes to both programs, which included plans to increase enrollment and address some of the financing aspects.  CMS and the state are expected to reach agreement on the changes sometime this fall. Last week, EOHHS released a request for responses (RFR) for health plans that want to participate in a revised One Care program.
Throughout the process, MHA and the hospital community have been involved, weighing in on the state’s concept and supporting the duals program as a way of achieving improved care at potentially reduced costs.  The One Care and SCO programs have improved the lives of many disabled and elderly Massachusetts residents, providing them with a beneficial alternative to traditional fee-for-service that also has the potential to achieve savings through enhanced care management and coordination.

But along each step of the process, MHA has cautioned against one potential element of the state plan – imposing a payment cap on certain providers.  For both hospitals and professional services, the One Care RFR allows EOHHS to direct One Care health plans to establish payment rates that are no greater than a certain percentage of the Medicare fee-for-service rate and not less than a certain percentage of the MassHealth fee-for-service rate.  Medicare is the primary funding for hospital and physician services provided to dual-eligible patients. 

“The general notion of government intervention in setting reimbursement terms between health insurance companies and providers is bad policy on a number of levels,” said Dan McHale, MHA’s senior director of State Government Finance and Policy. “These rate setting policies have the effect of tilting the playing field to the imbalanced favor of the insurers, leaving providers with little ability to negotiate. If a healthcare provider demonstrates added value to a health plan as a key network provider or through its care management efforts, the provider and health plan should be permitted to negotiate and mutually agree to contract terms.”

The new program is scheduled to take effect January 1, 2021.  Health plans interested in participating as One Care plans have until May 24 to respond to the RFR and it is expected that EOHHS and CMS will select plans in late fall 2019.

DOI to Insurers: Don’t Judge People that Possess Narcan

Last year, an insurance company denied life insurance coverage to a Boston Medical Center (BMC) nurse because she included Narcan on her application’s medication list.  Narcan (naloxone) reverses opioid overdoses and is available over the counter to help stem the incidences of opioid-related deaths in the commonwealth. Massachusetts law allows Narcan or other such medicines to be dispensed without prescriptions to friends and family of individuals at risk of overdose, or to anyone else (such as a BMC nurse with an expertise in addiction treatment) who is in a position to help those with substance use disorder.

But insurance companies may mistake someone carrying Narcan as someone with a substance use disorder and consider that person an insurance risk.  That’s what happened to the BMC nurse last year and that’s what caused the state’s Division of Insurance this month to issue a bulletin on the issue.

“The Division expects that prior to making an underwriting decision, carriers will obtain information sufficient to determine if an applicant has obtained a prescription for a medication that is not relevant to the applicant’s health or is designed to prevent disease,” DOI wrote.  Denying coverage outright because someone had obtained Narcan “would defeat the Commonwealth’s important public health efforts,” according to DOI. Another example of insurance company overreach, DOI wrote, may involve drugs used not only to treat HIV infection but also as a pre-exposure prophylactic to prevent HIV.

Massachusetts’ continued efforts to combat substance use disorder are working. According to DPH estimates released last week, there will be a total of approximately 1,974 opioid-related overdoses in 2018, down 4% from 2017’s 2,056 deaths. It’s the second consecutive year opioid-related deaths have dropped in Massachusetts.

Here’s Who in the Legislature Will Greatly Influence Healthcare

Committee chairs in the Massachusetts legislature, as well as the leadership of the House and Senate, influence what gets done in the State House. Last week, the Senate and House announced leadership positions. As hospitals and healthcare are an integral part of the state’s culture and economy, numerous committees have a say in legislation affecting the sector. Here we’ll focus on a few key committee chairs; all the chairs and leaders in both chambers are Democrats.

House: Speaker Robert DeLeo (Winthrop) and Majority Leader Ronald Mariano (Quincy)
Senate: President Karen Spilka (Ashland) and Majority Leader Cynthia Creem (Newton)

House Ways & Means: Rep. Aaron Michlewitz (Boston)
Senate Ways & Means: Rep. Michael Rodrigues (Westport)

Health Care Financing: Rep. Jennifer Benson (Lunenburg) and Sen. Cindy Friedman (Arlington)
Mental Health & Substance Use & Recovery: Rep. Marjorie Decker (Cambridge) and Sen. Julian Cyr (Truro)
Public Health: Rep. John Mahoney (Worcester) and Sen. Joanne Comerford (Northampton)
Elder Affairs: Rep. Ruth Balser (Newton) and Sen. Patricia Jehlen (Somerville)
Financial Services: Rep. Jamie Murphy (Weymouth) and Sen. Jim Welch (West Springfield)

HPC IDs Administrative Simplification as a Priority

The Health Policy Commission’s (HPC’s) annual Cost Trend Report is an interesting, dense collection of facts and figures about the Massachusetts healthcare system. Within the 70-plus page 2018 report is a six-page section outlining 11 policy recommendations, 10 of which are “renewed recommendations” from previous years’ reports.

The one new recommendation from the HPC focuses on a subject for which hospitals and physicians have advocated continually – namely, administrative simplification. The HPC recommended that: “The Commonwealth should take action to identify and address areas of administrative complexity that add costs to the health care system without improving the value or accessibility of care.”

“… [A]dministrative complexity is endemic in the U.S. health care system, including in payment arrangements, insurance billing and coding, risk adjustment, quality measurement reporting, provider credentialing, and use of electronic health records,” HPC wrote. To simplify the system within the commonwealth, the HPC said in the coming year it would collaborate with stakeholders to identify, prioritize, and develop strategies to address unnecessary administrative complexity.

HPC said it would also expand its focus on pharmaceutical pricing.

Save the Date: Communication, Apology, and Resolution Forum

The Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI) – of which MHA is a member – is holding its seventh annual CARe forum on Tuesday, May 7, from 10 a.m. to 2 p.m. at the Massachusetts Medical Society in Waltham. Registration begins in March, but mark your calendar now. The Communication, Apology, and Resolution (CARe) process helps everyone involved after an adverse event in a hospital. At the May forum, MACRMI members and trained actors will present two case simulations of the CARe process after an adverse event, along with implementation background and guidance.  Attendees are encouraged to participate in moderated discussion panels following each simulation.  The event is free and lunch will be served. More details to follow.

Does Your Team Have a Social Determinants of Health Innovation?

The American Hospital Association (AHA) has launched the 2019 Innovation Challenge – a juried award program to spread technological approaches that address social determinants of health. Teams from AHA member hospitals and health systems can apply for awards by submitting an entry about an early-stage program designed to address the social determinants of health, which include food, housing, and transportation, among other factors. The top three proposals will receive $100,000, $25,000 and $15,000 to help implement their ideas. Submissions are open through May 24, and the winners will be announced at July's AHA Leadership Summit. The challenge is sponsored by First American Healthcare Finance. Visit the Innovation Challenge website for more information, including how to apply, and view a video about this year's challenge.

In Memoriam

Raymond Sanzone, the former CEO of both Brookline Hospital and Tewksbury Hospital, passed away on February 7. He was 77 years old. Ray was a member of the MHA Board of Trustees between 1987 and 1988.  He is survived by his wife of 54 years, Carol (Dellavolpe), four children, and nine grandchildren. Donations can be made in his name to the Northborough Public Library, c/o Friends of the Northborough Library, 34 Main Street, Northborough, MA 01532 or northboroughlibrary.org to support those who shared his love of reading.

Project Management for Healthcare

The fundamental purpose of project management is to be one step ahead of potential risk that could show itself during your project planning and execution. The trick is to plan, organize and control as many of the steps as possible to mitigate unnecessary consequences. This seminar is designed to do just that; it will provide you with strategies that you can use right now, wherever you are in your project timeline. Whether it’s starting with the project plan or building the right team for the task, key strategies on time management, effective communication, and maintaining motivation will be presented. A “how to” related to workflow diagrams will be a significant takeaway. During implementation, knowing pertinent decision making and leadership essentials become indispensable, and knowing how to manage and measure change becomes the proof of the project’s success. Tactics covering these critical topics and more will all be addressed in this one-day program, which takes place on Friday, March 8 from 8:30 a.m. – 3 p.m. at MHA's Conference Center, Burlington, Mass. Learn more here.

John LoDico, Editor