Massachusetts Health & Hospital Association Alzheimer’s Plan Roadmap; CHARM; Managing Costs
INSIDE THE ISSUE
> Alzheimer’s Operational Plan
> CHARM Group Formed
> Insurance Company Poll
> Telehealth
> COVID Testing
> Workforce Strategies
> Pediatric Vaccination
> Transitions
MONDAY REPORT
How to Create an Operational Plan for Alzheimer’s Care
More than 200 people attended an MHA education program last Thursday during which MHA and the Alzheimer’s Association introduced a roadmap to assist healthcare providers prepare for implementation of a state-mandated operational plan for Alzheimer’s and related dementias.
The state’s Alzheimer’s and Related Dementias Acute Care Advisory Committee – established by the legislature – in 2017 issued a report of recommendations to provide optimal care to persons with dementia in acute care settings. In 2018, these recommendations were incorporated into legislation and passed into law as Chapter 220 of the Acts of 2018: An Act Relative to Alzheimer’s and Related Dementias.
Section 8 of the law requires all licensed hospitals to complete and implement an “operational plan for the recognition and management of patients with dementia or delirium in acute-care settings.” In July 2021, the required date for implementation was extended from October 2021 to October 1, 2022, due to the COVID-19 pandemic.
The MHA roadmap outlines an operational plan for senior leadership, recommendations of who should be on the team to implement the plan; identification of the six broad categories of an operational plan and the pathways to take to implement it, and suggested outcome measures for ongoing quality assurance and performance improvement.
To access MHA’s one-hour webinar, which includes case examples from hospitals implementing their own operational plans, please click here.
CHARM Makes Pitch for Locating Federal Research Initiative in Mass.
A group of Massachusetts life science and health entities, including MHA, universities, the Massachusetts Biotechnology Council, and others have joined to form Coalition for Health Advances & Research in Massachusetts (CHARM). The Coalition’s main goal is to position Massachusetts as the site for ARPA-H — the Advanced Research Projects Agency for Health – the new division within U.S. Health & Human Services charged with improving the U.S. government’s capabilities to speed research that can prevent, detect, and treat a range of diseases, including cancer and Alzheimer’s disease.
President Joseph Biden proposed ARPA-H earlier this year and the agency’s initial funding ($1 billion) was included in a March 2022 omnibus bill. The focus now is on determining where ARPA-H will be located; CHARM was formed to rally support for locating ARPA-H’s headquarters in Massachusetts to take advantage of the area’s hospitals, universities, and intellectual capital.
Today’s announcement of CHARM’s creation is timely as President Biden is scheduled to speak at the JFK Library in Boston today to give a speech on his “cancer moonshot” initiative. The speech coincides with the sixtieth anniversary of President Kennedy’s moonshot speech.
CHARM steering committee members include Massachusetts Biotechnology Council, MHA, Association of Independent Colleges & Universities in Massachusetts, University of Massachusetts, Boston University, Harvard University, Northeastern University, Massachusetts Institute of Technology, Vertex Pharmaceuticals, Massachusetts Competitive Partnership, the Commonwealth of Massachusetts, Massachusetts Life Sciences Center, City of Boston, and members of the Massachusetts Congressional delegation.
Controlling Healthcare Costs Does Not Mean Shifting Costs
When asked who they think should be doing more to control healthcare costs, 87% of respondents to a new poll from the state’s largest health insurance company, Blue Cross Blue Shield of Massachusetts, said insurers should take the lead. (The federal and state governments were next, followed by hospitals). The poll found that 57% of the public is “extremely” concerned about inflation and the cost of living, followed by housing costs (41%), and then healthcare costs (30%).
Throughout the pandemic, hospitals have been struggling financially – even with the large influx of federal relief funds. As has been widely reported, the cost of labor has been the greatest expense as many workers left hospital employment, forcing facilities to rely on expensive travel agencies. An MHA survey of hospitals this summer found there are more than 5,000 open R.N. positions, and that as of March 31, 2022, temporary R.N. staffing costs stood at $445 million – up from $181 million annually at the start of the pandemic in FY2020.
The last report from the state’s Center for health information and Analysis (CHIA) in June 2022 showed that the statewide median operating hospital margin was negative 2.5%, a decrease of 2.7 percentage points compared to the same period the previous year. The negative operating margins – meaning that hospital expenses are outpacing revenues – takes into account the federal monies hospital received from COVID-19 relief legislation.
The financial hole hospitals are in is exacerbated by the fact that they are locked into contracts with health insurance companies who can pay pre-pandemic, pre-inflation reimbursement. Recent media stories have included calls from insurance interests for additional regulation from state government, and from academic interests calling on hospitals to report even more data to the Health Policy Commission (HPC) and on the HPC to hire more staff to analyze that data.
However, HPC Commissioners in April, when setting the state’s cost growth benchmark, conceded that the last two years of the pandemic have been, as then-HPC Chairman Stuart Altman said, “anything but normal for all aspects of our society, particularly the healthcare system, whether it is their need to take on added responsibilities due to COVID, or to bring on added expenses that are needed to keep their hospitals high quality.” At that meeting, HPC Commissioner David Cutler said he expects some providers to demand price increases in their negotiations with insurers coming out of the pandemic, adding, “We should be very clear that it is not our intention to force organizations to go bankrupt because their costs have risen in the pandemic and that some leniency in some circumstances should be appropriate.”
“Controlling healthcare costs, as we know from experience over many years in the commonwealth, is the responsibility of all components of the healthcare system. And it is one that healthcare providers are deeply committed to – even as their own financial situations deteriorate,” said MHA’s Senior Director of Managed Care Karen Granoff. “Providers and health plans must work together to address rising costs and to create a truly patient centric system of care delivery. At the same time, health plans must be mindful of the extraordinary pressures providers face coming out of the pandemic and dealing with unprecedented inflation and staffing shortages. Controlling costs should never mean merely shifting costs or creating unnecessary administrative burdens.”
Trahan & Telehealth Interests Warn CMS of “Digital Divide”
A collection of Massachusetts telehealth advocates, along with U.S. Representative Lori Trahan (D-Mass.) are urging the federal Centers for Medicare and Medicaid Services (CMS) to change its proposed rule governing how physicians will be paid through the Medicare program in 2023.
The calendar year 2023 physician fee schedule proposed rule from CMS determines how doctors are paid for the services they provide Medicare beneficiaries in a variety of settings, including physician offices, hospitals, ambulatory surgical centers, skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries’ homes. CMS also uses the rule to insert other quality, affordability, and innovation strategies into the healthcare system.
The 2023 rule contains a number of provisions governing the use of telehealth, namely relating to coding and how telemedicine will exist after the end of the declared COVID-19 public health emergency.
In its letter to the CMS Administrator Chiquita Brooks-LaSure, the Massachusetts Telemedicine Coalition (tMED), of which MHA is a founding member, raised a number of concerns with the proposed rule, especially regarding CMS’ plan to end reimbursement in many cases of ”audio-only” telehealth services. Through its rule, CMS is urging the use of video-based telehealth services.
“While some services may be more appropriately delivered via video or other technology, many services have been – and can continue to be – delivered effectively using audio only,” tMED wrote. “Patients in our state are still facing challenges bridging the digital divide because broadband internet, the availability of devices, and digital health literacy is still a challenge for many populations and, due to these challenges, we urge CMS to use the tools at its disposal to continue to ensure access to services for disadvantaged populations via the audio-only modality.”
Representative Trahan, joined by her colleagues Annie Kuster (D-N.H.) and Peter Welch (D-Ver.) — who are members of the House Energy and Commerce Committee’s Health Subcommittee — voiced similar concerns about the elimination of audio-only reimbursement in their letter to CMS.
“Receiving high quality, affordable care should not require internet access,” the lawmakers wrote. “Taking advantage of video telehealth services requires digital literacy. Overall, 45 percent of adults experience some type of technology or access barrier to participate in telehealth services. We urge CMS to consider how ending coverage for audio-only telehealth for most services will compromise the provider-patient relationship and disproportionately impact populations who face barriers to accessing care.”
3.5 Million COVID-19 Tests Coming to Cities and Towns
The Baker Administration is making 3.5 million at-home COVID-19 antigen tests available to municipalities, which can then distribute the tests to residents. Cities and towns can also request personal protective equipment, such as KN95 masks. Municipal requests must be made through September 16, and shipments from the state will occur in October. An additional 1.5 million rapid antigen tests will be made available to Massachusetts food banks.
While some people may be letting their guard down in regard to COVID-19, the virus still remains a threat and testing for it is a straightforward way to stop its spread. As Secretary of Health and Human Services Marylou Sudders said last week, “Testing is one critical tool for managing COVID-19, rather than COVID managing us.
AHA Releases Part 3 of its Workforce Strategy Series
The American Hospital Association (AHA) has released the third and final part of its series on strengthening the nation’s healthcare workforce. “Building the Team” focuses on recruitment and retention strategies to counter a workforce landscape altered by COVID-19. The AHA notes the “dramatic drop” in 16-24-year-olds that traditionally occupy entry-level jobs, pandemic-related reductions in immigrations, and “reluctance among those over 55 to return to work at the same rate as others.” The AHA report also focuses on ways that healthcare facilities can undertake robust diversity and inclusion strategies, and outlines staffing innovations – such as the broad adoption of telehealth – to help address the growing workforce challenges all hospitals and health systems are facing.
October 25: 27th Annual MIAP Pediatric Immunization Conference
The Massachusetts Immunization Action Partnership (MIAP) is holding its 27th annual pediatric immunization skills building conference on Tuesday, October 25. The conference will be conducted in hybrid form with in-person conference registration limited to 150 people on a first-come, first-serve basis, and the remaining attendees participating virtually. The in-person portion will be held at the Massachusetts Medical Society’s Conference Center at Waltham Woods
The target audience for the full-day conference is physicians, nurses, nurse practitioners, physician assistants, medical assistants, community outreach and public health workers, immunization coalition members, and office staff who work in pediatric healthcare settings or civic organizations. Plenary sessions will include state and national immunization updates, future vaccine technologies, COVID vaccines for children, and improving vaccine confidence by building a pro-vaccine presence on social media. There will also be breakout sessions. Learn more about the program and register by visiting here.
Transitions
Amy Lee is the new president of Nantucket Cottage Hospital, effective October 17. She is currently COO and VP at Central Maine Medical Group/Central Maine Healthcare. Prior to that, Lee served as VP for Primary Care, Medical Specialties, Physician Residency Programs & Patient Contact Center at Carle Foundation Hospital, a 433-bed facility in Urbana, Illinois. Lee received a BA from Augustana College in Illinois, a Master of Jurisprudence in Health Law from Loyola University in Chicago, and an MBA as well as a Master of Health Care Administration from St. Ambrose University in Iowa. Lee takes over Jeanette Ives Erickson, R.N., who served as the hospital’s interim president since February 2022.
Louis Woolf, who has served as president & CEO of Hebrew SeniorLife since 2009, announced his retirement from the post, effective June 2023.
An engaging and effective healthcare leader, Woolf has a long association with MHA, having served on its Board of Trustees and chairing what is now known as the Continuum Care Council, which helps guides the post-acute care advocacy of the association.
At the outset of the pandemic, Governor Baker called on Woolf and Massachusetts Senior Care Association President Tara Gregorio to develop a statewide training and accountability program to improve infection control in Massachusetts nursing homes.