Medicare for All is Not the Answer, and more...

Medicare for All is NOT the Answer

The United States healthcare system is in need of constant improvement to help drive down costs and improve quality. But scrapping the entire current system and replacing it with a “Medicare for All” plan would cause more harm than good, MHA President & CEO Steve Walsh said last week.
Policy makers in Washington now debating various “single-payer” plans should instead “prioritize preserving and expanding the gains that have been made nationally through the Affordable Care Act (ACA),” Walsh said.
“Despite delivering promising results in many states, not every area of the country has been able to take advantage of the opportunities offered by this comprehensive package of policies,” he added. “Even more disturbing, efforts to dismantle the ACA continue through funding cutbacks coupled with ongoing legal and regulatory challenges. Proposals such as “Medicare for All” carry significant risk for our complex system of patients, healthcare providers, and taxpayers. We should instead focus our attention on stabilizing the ACA.
Walsh noted that Medicare is currently an “essential program” for seniors and disabled Americans, and that “because of its importance, its support remains a national priority.” But he warned that “the long-term effect of Medicare expansion comes with the risk of an underfunded program, resulting in a two-tiered system of care – middle-class and low-income elders would struggle with limited coverage, while wealthy Americans could supplement the available benefit. We fear that the many proposals grouped under the ‘Medicare for All’ banner put the viability of the program – which is already strained – directly at risk.”
Walsh said, “Without doubt, more work needs to be done to improve healthcare services, to close the coverage and access gaps that remain, and to make healthcare more affordable and sustainable. But, ‘Medicare for All’ is not the answer. As we’ve learned in Massachusetts, there is no single solution that will cure the many challenges of our complex healthcare system. Instead, we should focus on building upon all that is currently working. Let’s defeat the challenges to the ACA and secure its full implementation nationwide.”
Read Walsh’s full blog posting here.

Boston Medical Center to Lead Large Opioid-Fighting Program

The National Institutes of Health (NIH) has selected Boston Medical Center (BMC) as one of four national sites that will receive a combined $350 million to combat the opioid crisis.
BMC will use its $89 million share of the funding to partner with 16 communities in Massachusetts to test the effect of Office-Based Addiction Treatment (OBAT) and other measures with the goal of reducing opioid deaths by 40% within three years. BMC said eight sites will implement OBAT and eight will implement OBAT and additional programs, such as community education, accelerated access to medication during hospitalization, jail, and detoxification, as well as prevention and intervention programs in communities, schools, and doctor’s offices. The hospital-community partnership will “measure the impact of integrating evidence-based prevention, treatment and recovery interventions across primary care, behavioral health, justice and other settings,” according to an NIH media release. 
Boston Medical Center; University of Kentucky, Lexington; Columbia University, New York City; and Ohio State University, Columbus were chosen because they are in states “hard hit by the opioid crisis,” according to NIH. NIH Director Francis Collins said there were applications from more than a dozen states for the funding. Kentucky and Ohio ranked among the top five states for overdose deaths in 2017 while Massachusetts ranks among the top 10, according to the CDC.
The Massachusetts effort will be led by Jeffrey Samet, M.D., chief of General Internal Medicine at BMC and a professor of medicine at Boston University School of Medicine. 
“We will take what we’ve learned at Boston Medical Center and across Massachusetts over the past 20 years and work with our partners to bring those initiatives together to make a serious dent in the overdose death rate,” Samet said. “It means pulling out all the stops.”
The $350 million comes through the National Institute on Drug Abuse (NIDA), part of the NIH, and is being carried out in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA). RTI International, based in North Carolina, will serve as the study’s coordinating center, responsible for data analysis and health economics research.
According to the NIH, the study will “track communities as they reduce the incidence of opioid use disorder, increase the number of individuals receiving medication-based treatment for opioid use disorder, increase treatment retention beyond six months, provide recovery support services and expand the distribution of naloxone.”

MHA to House: Solidify Safety Net Funding, Addiction Treatment

The Massachusetts House of Representatives today begins debate on the proposed FY2020 state budget, and the nearly 1,400 amendments to it that have been filed.
The budget draft that emerged from the House Ways & Means Committee on April 10 envisions $42.7 billion in spending, but left relatively unchanged MassHealth reimbursement rates from the previous year.
MHA’s six priority amendments focus on restoring funding to support services provided to MassHealth and Health Safety Net patients, as well as initiatives to strengthen treatment and payment for care for those with opioid use disorder. Here are summaries of those amendments (with their sponsor in parenthesis):
Amendment #1261 (Rep. Michael Finn (D-West Springfield)) would provide additional funding for Disproportionate Share Hospitals (DSH). The number of MassHealth patients and the cost of providing care to them have grown, as has the number of hospitals that qualify for DSH status. Yet the funding over the last five years has dropped from $51 million to $13 million. MHA seeks $20 million in FY2020, and an additional supplemental payment of $10 million for those hospitals that provide a significant amount of behavioral health services.
Amendment #438 (Rep. Dan Cahill (D-Lynn)) would set MassHealth outlier payments at 75% of the cost of care. In FY2019, MassHealth reduced from 80% to 50% the additional payments it provides acute hospitals for services provided to the most complex and sickest MassHealth patients. In arguing for the payment update, MHA wrote, “Extraordinary care provided to the most complex MassHealth patients carries with it the need for extraordinary support. Hospitals should not have to assume nearly 50% of the cost of these types of cases through a financial loss.”
Amendment #1100 (Rep. Mike Moran (D-Boston)) would ensure a full $15 million state transfer to the Health Safety Net and offer protections so that funding for the program is not diverted to other uses. The state regularly declines to contribute its legally mandated $30 million share of funding for the safety net. (Hospitals and insurers each contribute $165 million annually.) In recent years, the legislature has included language in the state budget requiring that Massachusetts transfer “up to” $15 million into the safety net fund to help pay for care to the uninsured. However, the “up to” language has been interpreted by the administration to mean no transfer of any funding at all. The FY2020 House Ways & Means budget assumes a $15 million transfer; however, it also continues the problematic “up to” language. Amendment #1100 seeks to ensure the legislature’s intent to provide a $15 million transfer is fulfilled.
Amendment #1071 (Rep. Danielle Gregoire (D-Marlborough)) directs MassHealth to offer coverage for tele-behavioral health services for fee-for-service patients, similar to the coverage afforded to patients who participate in MassHealth managed care programs.
Amendment #1142 (Rep. Marjorie Decker (D-Cambridge)) would require payers to provide payment for the provision of nasal naloxone rescue kits in hospital emergency departments and outpatient and community-based settings in order to mitigate future overdose risk for those with opioid use disorder.
And Amendment #1153 (Rep. Decker) directs $500,000 to the Massachusetts Consultation Service for Treatment of Addiction and Pain (MCSTAP) so that, in addition to providing clinical support, MCSTAP would also offer case management and care navigation services to assist providers as they help patients access community-based treatment for opioid use disorder.

CMS Proposes Updated Funding, Medication Handoff Measures

The Centers for Medicare & Medicaid Services (CMS) last week issued its proposed FY2020 inpatient rehabilitation facility prospective payment system rule. CMS proposes rebasing the market basket it uses to set reimbursements from 2016 as opposed to 2012, which means its projections are more up to date. Under the proposal, net payments for inpatient rehabs would increase by 2.3% relative to FY 2019.
In the rule, CMS proposes two new measures IRFs would need to report: 1) Transfer of Health Information to the Provider–Post-Acute Care (PAC), and 2) Transfer of Health Information to the Patient–PAC. The first measure assesses whether or not a current reconciled medication list is given to the subsequent provider when a patient is discharged or transferred from his or her current PAC setting. And the second measure assesses whether or not a medication list was provided to the patient, family, or caregiver when the patient was discharged from a PAC setting to a home, a group home, assisted living facility, hospice, or other such setting.

Healthcare Costs Affecting Health, Finances

About 43% of insured Massachusetts residents in 2017 reported having a healthcare “affordability issue” during the past 12 months, and about 23% said they had an unmet health need due to cost.
The state’s Center for Health information and Analysis (CHIA) issued those conclusions last week in an eight-page report entitled Affordability Issues Persist Despite Near Universal Health Insurance Coverage. The data in the report comes from the 2017 Massachusetts Health Insurance Survey – a telephone poll of about 5,000 households conducted between April and July of 2017.
An “affordability issue”, according to the report, consists of any one of the following: problems paying family medical bills; family medical debt (paying off bills over time); any unmet healthcare need due to cost; and high family spending on out-of-pocket healthcare expenses. Low- and middle-income people had more affordability issues than those with higher incomes, and those with fair and poor health had more affordability issues than their healthier peers.

Joint Commission Issues Two Notices on Drug Use & Perinatal Care

The Joint Commission recently issued two notices – one a “Quick Safety” heads up about caregivers’ illicit use of drugs, and the other a more formal proposal to create new perinatal standards for its hospital accreditation program.
In this Quick Safety notice, the The Joint Commission noted that about 10% of healthcare workers are abusing drugs, and that diversion of controlled substances in healthcare settings “can be difficult to detect and prevent without a comprehensive controlled substances diversion prevention program.” The notice outlines patterns and trends that indicate potential diversion and suggests a program that focuses on “prevention, detection, and response.”
In an April 17 notice, The Joint Commission announced it is considering the development of standards for perinatal care in the hospital accreditation program (HAP), specifically related to the care of patients experiencing hemorrhage or severe hypertension/preeclampsia. The three-page proposed standards, as well as an online tool for commenting on them before the May 29 deadline are here.

Dispose of Those Old Prescriptions Responsibly

To prevent unused prescription drugs from finding their way into the wrong hands, each year the federal Drug Enforcement Administration sponsors the national Prescription Drug Take Back Day in which anyone can anonymously dispose of unused, unwanted, or expired prescription drugs. (Don’t just flush your drugs; doing so will eventually corrupt the ecosystem.) This year’s Drug Take Back Day takes place on Saturday, April 27. Click here to find a collection site near you. Last year, 5,839 collection sites nationwide collected 914,236 pounds of unused prescription drugs.
MHA and its hospital members have been at the forefront of the drug disposal issue. As part of its comprehensive guidance on opioid management within hospitals, MHA’s Substance Use Disorder Prevention and Treatment Task Force (SUDPTTF) issued a series of documents, including ones that hospitals can use to inform patients about local disposal options for prescription medications. Review MHA’s efforts relating to substance use disorder here.

An Overview of Healthcare Financial Management

Healthcare delivery methods and payment systems are changing rapidly. Alternative provider models; convenient, quick clinics in easy-to-reach retail locations; smartphone-based doctor visits; and Internet consults between ED physicians and nursing homes are changing the face of healthcare. Amazon, Berkshire Hathaway and JPMorgan Chase have joined forces to reduce healthcare costs. Because of this, carefully managing the financial health of the organization is more important than ever. The program runs on Wednesday, May 8 from 8:30 a.m. - 3 p.m. at the MHA Conference Center, Burlington, Mass.

This program will review the importance of budgeting and show participants how to read and better understand performance reports and dashboards. We will introduce a proven method of determining the real underlying causes of budget deviations, explore an objective way to examine departmental performance that highlights both high-performing departments and those in need of some assistance, and examine three ways to look for improvement in routine work processes.
The course is taught by William J. Ward, MBA, Associate Professor of Health Finance and Management, Johns Hopkins Bloomberg School of Public Health. Learn more or register by clicking here.

John LoDico, Editor