HB2442/SB2137, HB3226/SB1245, HB3240, HB1200/SB1224, SB1264
Disease Prevention, Screening and Mandated Benefit

Joint Committee on Public Health

The Massachusetts Health & Hospital Association (MHA), on behalf of our member hospitals, health systems, physician organizations and allied health care providers, appreciates the opportunity to submit comments on the following bills.

Massachusetts hospitals are deeply committed to providing timely and high quality stroke level care to all patients. Currently, hospitals are reporting detailed quality measures on stroke care to the federal government (CMS Hospital Compare measures regarding mortality and readmissions which are shared with the state’s Center for Health Information & Analysis (CHIA)). In addition, hospitals are also reporting detailed utilization information on stroke services to both the Department of Public Health and CHIA. Furthermore, hospitals are required to meet specific state licensure and standards of care for providing stroke services within every hospital. Given this detailed level of licensure, utilization and quality reporting, we are strongly opposed to HB2442/SB1237.

HB2442/SB1237 seeks to establish a statewide stroke licensing system through an outside entity with no control or monitoring of patient care services by the state’s hospital regulator – the Department of Public Health (DPH). In essence, this bill would require the development of a tiered approach to stroke center certification that would improperly force more lower-acuity patients to be sent to a tertiary or higher certified “Comprehensive stroke center” facility, thus by-passing care available at the community level. It would also require all hospitals to pay for additional quality reviews (in addition to the ones outlined above), meet new operational requirements in addition to national standards, and meet annual external accreditation review.

In all of the new requirements outlined previously, hospitals would be required to pay substantial fees to the American Heart Association (AHA) / American Stroke Association (ASA) in order to meet stroke certification and licensure. In essence, it would remove the current licensure reviews and certification by the Department of Public Health (DPH) as the hospital regulator for this specific service in the state. It would eliminate the existing comprehensive designation, quality reporting, and utilization reporting of stroke cases through the DPH and CHIA, while at the same time requiring duplicative quality metric reporting to CMS, The Joint Commission, and now the AHA / ASA.

Based on recent state-level data from 2013, 50% of all Massachusetts stroke patients could potentially get appropriate stroke care at a lower cost and in a community-based care setting. HB2442/SB1237 would contravene current practices for community care by requiring ambulance providers to bypass care at the community level in favor of care at a tertiary hospital -- solely because such facilities would have a higher certification – and despite evidence showing
that there are no current gaps in service statewide. MHA continues to believe that there should be a collaborative approach for DPH, hospitals, ambulance providers, the AHA, and other stakeholders to conduct a state-level review of the current stroke designation and levels of care.  There is a substantial amount of utilization and quality data that could be analyzed to determine how to improve existing access to and point of entry for stroke level services statewide. Absent the review and analysis of such data, the hospital community is concerned that the wholesale restructuring called for by HB2442/SB1237 would result in greater disparities of care, increased costs into the system, create a lack of effective oversight, and impede statewide healthcare planning – without offering any benefit to patient care. At a time when the legislature is asking providers to decrease costs while advancing statewide planning and care coordination, any proposal removing regulatory oversight of key clinical services of stroke to an outside entity is simply bad public policy.

As an alternative, MHA would strongly request that the committee consider focusing solely on proposed Section 51L in HB2442/SB1237 and the principles outlined in HB3226/SB1245.  These provisions would require the statewide EMS councils to work with ambulance and hospital providers to develop appropriate stroke point of entry plans to ensure patients are triaged and transported to the most appropriate and nearest facility. While we disagree with the concept  of focusing solely on patients who may have an emergent large vessel occlusion as proposed in HB3226/SB1245, the general principles of focusing on the point of entry and improving care coordination are goals worthy of consideration.. Such an approach would establish a meaningful
process to address the current challenges in ensuring timely access to care and best utilizing available data and information, in a manner that can be tied to the hospital and ambulance licensure authority of DPH. We would appreciate the opportunity to work with the committee to develop sensible, appropriate language to accomplish these goals.

MHA strongly supports HB3240 which would provide a mechanism for health care providers to obtain information regarding potential exposure to HIV/AIDS in those circumstances when the provider has come into contact with blood or other bodily fluids while providing medically necessary services. MHA supports the principle that appropriate protections need to be in place to ensure the safety of all health care professionals during the delivery of health care services.
We also believe that health care professionals should be afforded the fullest possible set of facts and knowledge when they have potentially been exposed to a disease or illness to assist with treatment decisions. It is important to note that when a potential exposure occurs, time is of the essence in regard to testing and administering appropriate medication or clinical support to a person who may be infected. Delays necessitated by waiting for a court order or informed
consent for release of records could further compromise the safety of clinical staff. It is important to note that HB3240 provides substantial patient protection by limiting the release to only the person who was infected to ensure that health care providers have accurate and timely information for their own health and safety.

While MHA is generally supportive of the goals outlined in HB1200/SB1224, and SB1264, we believe that the bills are duplicative of Chapter 228 of the Acts of 2014, developed by the Alzheimer’s and Related Dementias Acute Care Advisory Committee. Currently this committee is working with providers, advocates, and patients to develop a set of standards for educating providers as well as working with patients and families of patients who have Alzheimer’s and
related dementia. The goal of Chapter 228 was to develop uniform standards and services in a non-regulatory framework to ensure that all providers are meeting the goals of improving the services we offer to such patients. As a result, we are concerned that, as drafted, these bills would impede the work of the advisory committee that has which has been meeting for over a year and is about to issue their report and follow-up operational recommendations. For this
reason, we would urge the committee to take no action on these bills until the report and all of the related recommendations have been implemented statewide.

Thank you for the opportunity to offer comments on this important matter. If you have any questions or concerns or require further information, please contact Michael Sroczynski, MHA’s Vice President of Government Advocacy, at (781) 262-6055 or msroczynski@mhalink.org.