Governor & AG on Healthcare, and more...

Governor Baker Lays Out Newest Health Reform Plan

Governor Charlie Baker last Friday introduced the latest legislative proposal to reform the state’s healthcare system – a multi-part initiative that focuses on improving access to behavioral health, managing high drug costs, expanding care via the use of telemedicine, adopting the Nurse Licensure Compact, and ending “surprise billing” for patients, among many other moving parts.
A major portion of the bill addresses the shared, long-standing concerns of the healthcare community that behavioral health is a much-in-demand component of the system but suffers from workforce shortages and administrative burdens.
The administration’s bill – An Act to Improve Health Care by Investing in VALUE – would, among other things outlined in a summary, compel insurance companies and providers to increase combined expenditures on primary care and behavioral health by 30% over three years. The bill promotes behavioral health reimbursement parity “through the establishment of a rate floor” for certain services, and requires payers to reimburse “non-licensed behavioral health professionals-in-training working in clinical settings.” Acute care hospitals would be required “to maintain clinical capacity to provide or arrange for the evaluation, stabilization and referral of patients with behavioral health conditions in emergency departments.”
Baker’s bill would prohibit providers from charging facility fees for certain procedures, strengthen enforcement of the state’s healthcare cost-growth benchmark, and prohibit surprise billing. Surprise billing disputes between providers and insurers would be resolved by establishing “an out-of-network default rate” based on the Medicare fee schedule.
MHA President & CEO Steve Walsh said after reviewing the top-line features of the bill released on Friday, “This legislation is a tremendous opportunity to evolve and improve the best healthcare system in the world. The commonwealth’s hospitals thank Governor Baker, Secretary Sudders, and their staff on this important next step in Massachusetts healthcare reform. Just as the needs of our patients change, so must the way we deliver accessible, high-quality care.”
The governor’s bill advances two of MHA’s priorities – allowing Massachusetts to join the multi-state Nurse Licensure Compact, and promoting telemedicine by establishing a regulatory framework and ensuring coverage parity by prohibiting insurers from denying coverage based on the sole fact that the service is provided via telemedicine. The bill also would place greater oversight on the pharmaceutical industry, and impose penalties on manufacturers that increase the price of a drug by a certain percentage tied to the Consumer Price Index.
“While we are still reviewing the details of the governor’s bill, we commend his continued focus on addressing some of the commonwealth’s most challenging healthcare issues, including increasing state oversight of the pharmaceutical industry, the necessary expansion of telemedicine services, and adding Massachusetts to the 34 other states already participating in the Nurse Licensure Compact to alleviate our current workforce shortage,” Walsh said. “Additionally, MHA stands with Governor Baker to end surprise billing, get patients out of the middle, and keep negotiations where they belong: between providers and insurers. We continue to advocate for a solution similar to the law adopted in New York State, which has ended the practice of surprise billing without disrupting patient access or increasing healthcare costs.”

AG Says Cost Tools, Payment Models Have Limitations

Attorney General Maura Healey will present a report at this week’s Health Policy Commission cost trends hearing showing that policymakers and the public should curb their expectations about driving down costs through the use of online price transparency tools and provider-insurer alternative payment models.
The AG’s report shows that while the state is meeting its healthcare cost growth benchmark, consumer costs – through rising premiums, and high-deductible insurance plans – continue to rise. Policymakers have created incentives to shift consumers to high-value, lower-cost providers, promoting insurers’ online cost estimator tools and alternative payment models where providers are given financial rewards to provide cost-effective care. But the report shows both incentives aren’t working as expected.
First, a small percentage of people seeking care don’t use the price transparency tools, and those that employ them don’t hold their providers to the estimates they were given, according to the report. The AG’s office also found that “Payers have tried different strategies to encourage use of the Cost Estimators, although most payers do not track whether members who use the tools are more likely to select higher-value health care options.”
As for the alternative payment models, such initiatives depend on closely tracking a patient’s care over a period of time. But the AG found that patients switch insurers and products frequently, meaning that providers can’t measure their own performance under the payment models, thereby rendering them ineffective. The AG also found that “[t]he methods payers use to assign (‘attribute’) patients with PPO plans to providers for the purpose of Alternative Payment Arrangements is complex and may serve as a barrier to incenting providers to effectively manage and care for their patient population.”
The report recommends that the healthcare system “manage expectations” about current price transparency tools being able to lower costs, while also working to improve the tools. The AG’s report also says: “Recognize that healthcare provider financial incentives to manage their patient populations are significantly hampered by the frequency with which patients switch health plans,” and “Standardize the methods used to assign patients to healthcare providers under alternative payment arrangements.”

State Commission Issues Medication Assisted Treatment Report

The Medication Assisted Treatment (MAT) Commission – created through Chapter 208 of the Acts of 2018, the so-called CARE Act – has completed its mandated report to the legislature on how MAT for opioid use disorder is currently being employed in Massachusetts and how its use can be expanded.
Medication assisted treatment is the use of medications, often in combination with counseling and behavioral therapies, for the treatment of substance use disorders. The three most commonly used medications used to treat opioid addiction are methadone, buprenorphine, and naltrexone.
In addition to creating the MAT Commission, Chapter 208 also requires acute care hospitals that provide emergency services to have the capacity to initiate opioid agonist therapy (namely buprenorphine) to patients that present after an opioid-related overdose. The patient must also be directly connected to continuing treatment prior to discharge. In 2018, MHA formed its own workgroup to develop guidelines for the use of buprenorphine within emergency departments. MHA’s guidelines (which are currently being updated) are cited in the state commission’s report.
MHA’s Director of Behavioral Health & Healthcare Policy Leigh Simons Youmans, who had a seat on the MAT Commission, said the state’s report adds an important piece to the multi-pronged strategy to combat the opioid scourge.
“There are many recommendations that the hospital community can get behind from supporting technical assistance for EDs providing MAT, to encouraging the establishment of on-demand treatment and referral services,” Youmans said. “Another creative suggestion involves creating loan forgiveness and repayment programs for clinicians-in-training specifically working in MAT, who also work in high-need areas with underserved populations.”

Judges Put a Hold on Public Charge Rule

A series of federal judges on October 11 stayed a U.S. Department of Homeland Security (DHS) “public charge” rule that patient advocates and healthcare interests, among others, said would adversely affect the health of immigrants.
The long-standing U.S. public charge rule requires visa applicants and individuals applying to become permanent legal residents to demonstrate that they are not “inadmissible” – that is, that they are not primarily dependent on the government for subsistence. This August, DHS expanded that rule to mean that anyone receiving almost any form of assistance – including non-emergency Medicaid services – would be considered a public charge. 
Fourteen states, including Massachusetts, brought suit against DHS in Washington state. Other attorneys general filed suit in other jurisdictions. They were joined by numerous healthcare interests and others who argued, among many other points, that expanding public charge to an immigrant seeking medical care would result in individuals avoiding needed care (such as vaccinations), while possibly becoming sicker and driving up healthcare costs for everyone. The rule was scheduled to take effect on October 15, but federal judges in California, New York, and Washington issued temporary injunctions. 
MHA has opposed expanding the public charge definition since DHS first issued the proposed rule in 2018. In June 2019, MHA joined a letter the Massachusetts Law Reform Institute sponsored that asked the Massachusetts congressional delegation to support legislation that would prohibit the use federal funds to implement DHS’s rule.

National Report Looks at Coverage Costs

As support for a Medicare for All-type healthcare system weakens in recent national polls, a new study from the Urban Institute and Commonwealth Fund outlines other ways to boost coverage and potentially lower costs. From Incremental to Comprehensive Health Insurance Reform: How Various Reform Options Compare on Coverage and Costs analyzes how eight healthcare reform packages intended to address the current system’s shortcomings affect health insurance coverage and spending by government, households, and employers. The report analyzes such proposals as enhancing subsidies and reinsurance under the Affordable Care Act, to enacting a full single-payer-type system.


Lawrence General Hospital’s President and CEO Dianne Anderson, R.N., is leaving her post after 10 years. Her last day at Lawrence General is November 6. Deborah Wilson, the hospital’s executive VP, will serve as interim CEO. Anderson is a former member of the MHA Board of Trustees, and this year received the association’s William L. Lane Hospital Advocate Award, which recognizes a hospital executive’s outstanding efforts on behalf of their organization, and extraordinary advocacy to achieve healthcare access and high-quality, safe care. Anderson is respected within the healthcare community for her strong advocacy both locally and nationally on behalf of not only the large percentage of Medicare and Medicaid patients her hospital served, but also for fair payments for all independent hospitals.
Michael R. Jaff, D.O., has resigned as president of Newton-Wellesley Hospital to become VP of clinical affairs, innovation and technology, and peripheral interventions at Boston Scientific, effective January 2020. Jaff, who is a member of the MHA Board of Trustees, has led Newton-Wellesley since October 2016. Dr. Gregg Meyer, Partners HealthCare’s Chief Clinical Officer, will serve as interim president.

Healthcare Legal Compliance Institute

Join us at MHA’s Compliance Institute and hear from legal and regulatory experts on some of today’s top issues for hospitals regarding healthcare law. We’ll cover current enforcement issues and hear directly from the offices of the Massachusetts and U.S. Attorneys General. We’ll also review the Stark and kickback laws, among other hot topics, and conclude with a roundtable discussion of leading hospital compliance officers who will look at ways to adapt in the current environment. The program takes place on Friday, November 8, from 8 a.m. - 12:15 p.m. at MHA Conference Center, Burlington, Mass. Click here to learn more, including registration details.

John LoDico, Editor