The Senate Budget, New QIO, Measles, and more ...

State Senate Debate Begins Tomorrow

The State Senate begins debate tomorrow on the Senate Ways & Means proposed state budget for FY2020 and the 1,100-plus amendments to it that have been filed.
Hospitals are hoping that the Senate approves much needed relief for disproportionate share hospitals and compels the state to contribute funding to the Health Safety Net. Hospitals are also aligned in supporting amendments that address MassHealth payments for the most complex and sickest patients; provide insurance coverage for nasal naloxone rescue kits given to patients in hospital emergency departments; ensure access to telebehavioral health services for all MassHealth patients; assist providers with additional case management and care navigation as they help patients access community-based treatment for opioid use disorder; and, finally, to ensure that MassHealth does not prevent safety net hospitals from getting the pharmaceutical manufacturer discounts to which they are entitled under the federal 340B program.
The hospital request for the disproportionate share hospitals is that they receive an additional $17 million, but because of the state-federal Medicaid match formula, the net cost to Massachusetts would only be an additional $6.8 million.
The Health Safety Net, which funds care for the uninsured and underinsured, is consistently underfunded and its budget shortfall is covered by hospitals alone. That means that in FY2019, hospitals are estimated d to absorb $69 million in unfunded care – and the shortfall is expected to grow in FY2020. This is in addition to the $165 million hospitals contribute to the Health Safety Net through an assessment for care provided to low-income patients. Hospitals are asking the state to clarify the $15 million state budget directive included in the Senate budget. For the past four years, the permissive language related to this transfer has resulted in no financial support from the state for this important program.
Of the many amendments filed, the hospital community will be joining with nursing organizations, physicians and many others to raise strong opposition to #435, put forth by the Massachusetts Nurses Association, the union representing less than 25% of nurses in the state. Under the guise of promoting multiple studies on nursing-related issues, it actually sets the stage for the imposition of government-mandated ratios in acute care hospitals.
“The premise of mandated nurse staffing ratios has been rightfully and definitively rejected by policymakers and the voters of Massachusetts,” said MHA’s Vice President of Clinical Affairs Patricia Noga, R.N., PhD. “Our collective focus should now be centered on meaningful workplace supports for the entire healthcare workforce. That’s why the hospital community is working collaboratively on numerous cross-sector initiatives focused on safety, engagement, professional development, and wellbeing, with the aim of identifying ways to improve our workplaces and support all members of the care team.”

The Solution to Rising Measles Cases is Vaccinations

Measles was declared eliminated from the United States in 2000. But it’s back. 
According to the CDC, from January 1 to May 10, 2019, 839 individual cases of measles have been confirmed in 23 states. This was an increase of 75 cases from the previous week and is the greatest number of cases reported in the U.S. since 1994. (A complete CDC measles toolkit is here.)
In Massachusetts there has been one confirmed case to date in 2019, out of 87 cases investigated, according to the Department of Public Health (DPH).
In April, DPH’s Divisions of Epidemiology and Immunization put out this Clinical Measles Alert containing guidance for providers. It urges assessing all staff and patient immunity to measles and vaccinating those without evidence of immunity. If a caregiver feels a patient may have measles, promptly isolate the patient, contact your local board of health and DPH (617-983-6800), and obtain specimens for testing. (Boston providers should also contact the Boston Public Health Commission at 617-534-5611.)
Vaccinations are key, and countering false claims about them is necessary. Even though some physicians have reported being harassed by “anti-vaxers,” DPH notes caregivers are in the best position to promote vaccines.
“When it comes to vaccinations, patients and parents trust the expertise and recommendation of their healthcare provider more than anyone or anything else. Explain to patients that measles, mumps and rubella (MMR) vaccine is the best protection against measles infection,” according to the April measles alert from DPH.

One of the Medicare QIOs is Changing On June 8

One of the two Medicare Quality Improvement Organizations (QIOs) serving Massachusetts is changing. Effective June 8, 2019, KEPRO will be serving as the Massachusetts-specific BFCC-QIO, replacing Livanta. 
A Beneficiary and Family Centered Care (BFCC) QIO manages all beneficiary complaints and quality of care reviews to ensure consistency in the review process. They also handle cases in which beneficiaries want to appeal a healthcare provider’s decision to discharge them from the hospital or discontinue other types of services.
The other type of QIO – a Quality Innovation Network (QIN)-QIO – will continue unchanged as HealthCentric Advisors. Among their other duties, QIN-QIOs develop strategic initiatives, such as reducing healthcare associated infections, reducing readmissions and medication errors; and work with providers (including but not limited to hospitals and nursing homes) to support clinical practices in using interoperable health information technology.

Hospitals: Working Beyond Their Walls to Improve Health

That Massachusetts hospitals provide compassionate, life-saving care to all is a given. What is perhaps less known is that each day they undertake important initiatives to reach deeper into their communities to improve health. Here are just two examples:
The South Shore Community Behavioral Health Initiative (SSCBHI), led by South Shore Health, last week awarded $1.8 million in community grants to two local non-profit agencies. The Police Assisted Addiction and Recovery Initiative (PAARI) and Bay State Community Services, Inc. will each receive $930,000 grants for their work targeting behavioral health patients, specifically in improving their access to medical care and services, housing, transportation, food, clothing, and insurance. The $1.8 million is part of a total $2.4 million from South Shore Health; Greater Brockton Health Alliance, South Shore Community Partners, and Blue Hills Health Alliance will each receive $180,000 over the next three years.
“This first-of-its kind grant program on the South Shore reflects our organization’s deep commitment to promoting good health within the community and by removing barriers to accessing behavioral healthcare for the most vulnerable among us,” said South Shore Health President & CEO Gene E. Green, M.D.

Boston Medical Center recently reported on its successful effort to screen primary care patients for social determinants of health and then enter the data into the electronic health record, which automatically prints out referral information for resources that can help the patient.
The system, called THRIVE, helps clinicians better address the social needs of patients to improve their overall health. The one-page screening tool is available in six languages and is filled out by patients in the waiting room. It asks about eight social determinants of health domains: homelessness and housing insecurity, food insecurity, inability to afford medications, lack of transportation to medical appointments, utilities, caregiving, unemployment, and educational aspirations. It also asked patients if they wanted assistance with any of the needs they had identified on the THRIVE screening tool. 
“The ability to successfully incorporate this critical information into the electronic medical record is a true game changer when it comes to addressing the whole patient,” said Pablo Buitron de la Vega, M.D., a physician in general internal medicine and the study’s lead author. 
BMC is now screening all patients with THRIVE in all ambulatory primary care clinics, including family medicine, pediatrics, obstetrics and gynecology, and general internal medicine. To date, BMC has screened more than 57,000 patients – 28% report having at least one need and 19% request help with at least one need. Housing, food and education are the most prevalent health-related social needs of BMC’s patients.

Candidates Sought for Patient and Family Peer Support Network

The Betsy Lehman Center, which is the non-regulatory agency affiliated with the state’s Center for Health Information & Analysis, announced that it is creating a Patient and Family Peer Support Network to provide help for patients and families to receive support after a medical error or an adverse event.
The Center is looking for previous or current patients who have experienced a medical error and/or an unanticipated outcome and who are interested in becoming a peer supporter. The Center will then train select volunteers so they can help other patients and family members in the aftermath of a medical error or adverse event. Hospitals are encouraged to reach out to their communities to suggest candidates. Those interested in becoming a peer supporter can fill out this form.
Last November, the Betsy Lehman Center began recruiting hospitals to initiate a pilot program for clinician peer support following medical errors and unexpected outcomes. Fifteen hospitals and outpatient practices signed up for the pilot program.

AHA’s Value Initiative Executive Forum in Boston on July 11

Join the American Hospital Association’s next Executive Forum on July 11 in Boston. The forum is part of a series of events to explore hospitals’ and health systems’ role in addressing value and affordability in health care. This complimentary, AHA-members-only event will convene health care leaders from our region and beyond to discuss how to improve value through consumer-driven innovation and collaboration with a diverse range of stakeholders. The agenda features an exciting lineup of speakers to spark discussion around how hospitals can improve outcomes, enhance the patient experience and reduce cost in their hospitals and communities. View the full agenda and register

Leapfrog Ratings Out; Mass. Scores Well

The Leapfrog group that attempts to rate hospitals’ quality of care released its latest rankings last week. The Massachusetts ranking (#4 nationally) stayed the same as last year but the percentage of hospitals receiving “A” grades went up from 44.07% to 48.27% of included hospitals. No Massachusetts hospital received lower than a C grade.
Leapfrog is one of many organizations that provide reports and rankings of hospital performance. These organizations use different quality measures, performance data, and methodologies to calculate scores. While quality data reporting is a critical tool to promote performance improvement, different combinations of measures can lead to variation in scores for the same hospital. As a result, individual hospitals may perform well on one report card and poorly in another.

TeamSTEPPS Master Training Class

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals. It has become the gold standard in healthcare team training. The conference runs on Wednesday, July 10 & Thursday, July 11, from 8 a.m. to 4:30 p.m. at the MHA Conference Center, Burlington, Mass. The Master Training Course is a two-day, in-person course with a train-the-trainer approach. It educates participants on TeamSTEPPS Fundamentals, provides them with resources for training others, and ensures that they gain the knowledge and training required to implement and coach the behaviors needed to achieve positive results. The course will be taught by Karyn Baum, M.D., professor of Medicine & Interim Chief Medical Officer, University of Minnesota Medical Center, and Master TeamSTEPPS Trainer. We encourage hospitals to send three or more individuals to the trainings. Learn more here.

John LoDico, Editor