INSIDE THE ISSUE

> Boston Children’s Churchwell is New MHA Board Chair
> Sudders and Phelps Receive MHA Awards
> Mass. Leaders Address MHA Meeting
> State Budget Proposal
> Staffing Letter to White House
> Data on Staffing Shortages
> MHQP Primary Care Survey
> Congressional Action on Behavioral Health
> Mental Health Parity and Addiction Equity

MONDAY REPORT

Boston Children’s Churchwell to Lead MHA’s Board of Trustees

“While the issues facing our healthcare system have never been greater, neither has our sense of unity or resolve,” said Churchwell. “It is my honor to take the helm as the chair of MHA’s board, as it remains at the very center of the commonwealth’s response to the pandemic and countless other critical healthcare priorities. I am excited for what we will accomplish in 2022 as we strive to build an even better, more equitable system for the patients we serve.”

Churchwell has served for several years on MHA’s Executive Committee and was the inaugural chair of its Standing Committee on Diversity, Health Equity, and Inclusion. He has been an integral part of the association’s work to advance health equity, most notably through its push to improve board diversity across the healthcare sector.

Both Churchwell and MHA President & CEO Steve Walsh thanked Dickson for his leadership during his tenure as board chair. Dickson served as a tireless advocate on behalf of healthcare providers during a year of unprecedented pressures, and was a go-to, trusted voice on public health for community members.

The newest members of the MHA Board of Trustees, joining the full slate of members, are Michael Gustafson, M.D., president, UMass Memorial Medical Center; Cynthia Page, CEO, Encompass Health Rehabilitation Hospital of Braintree; and Lynnette Watkins, M.D., president & CEO, Cooley Dickinson Health Care.

MHA’s Executive Committee for 2022 is Chair Churchwell; Chair-elect Christine Schuster, R.N., president & CEO, Emerson Hospital; Treasurer Kevin Tabb, M.D., president & CEO, Beth Israel Lahey Health; Secretary Michael Lauf, president & CEO, Cape Cod Healthcare; Immediate Past Chair Dickson; and Past Chair Most Recently Retired Joseph “Jody” White, president & CEO, Lowell General Hospital and Circle Health, and executive vice president, Wellforce.

MHA Presents Hospital Hero and Lane Awards

The Lane Award is given each year to a healthcare leader who has demonstrated longstanding excellence, achievement, and compassion for patients and the system at-large.

“These leaders embody everything our healthcare community strives to be,” said Walsh.

“Secretary Sudders has worked day and night to steer the direction of healthcare in the state during our greatest time of need,” said Dr. Anne Klibanski, president & CEO of Mass General Brigham. “Healthcare leaders in Massachusetts could not fight this battle without her unrelenting commitment to the health of patients in our communities and the wellbeing of our caregivers.”

“Dave Phelps leaves an incredible legacy for the work he has done to transform Berkshire Health Systems into a strong, trusted resource for the people of Western Massachusetts,” Walsh said of the Lane award recipient. “His influence extends far beyond the region, as he has been a guiding light for what community hospitals can accomplish throughout his decades of service.”

The William L. Lane Hospital Advocate Award was established in 2004 to embody the spirit of William Lane, who served as a hospital CEO for more than 30 years and was among the most ardent advocates for hospitals in the commonwealth’s history. Phelps recently concluded his service as President and CEO of BHS after more than 31 years with the organization, including 28 as its chief executive.

“The scale of the transformation that Dave has achieved at our organization is a testament to his selfless leadership, bright vision, and tireless advocacy for the people of the Berkshires. There is no way to adequately thank him for all he has done to care for Berkshire County,” said Bart Raser, current Chair of the BHS Board of Trustees.

AG Healey & Massport’s Wieland Address MHA Meeting

Massachusetts Attorney General and recently announced gubernatorial candidate Maura Healey spoke at MHA’s 85th annual meeting last Friday, as did the CEO of the Massachusetts Port Authority (Massport) Lisa Wieland.

In her comments, Healey agreed with what hospital leaders had said earlier in the meeting – namely that the healthcare system emerging from the pandemic must redouble its efforts to address workforce issues. (Outgoing MHA Board Chair Eric Dickson, M.D., the CEO of UMass Memorial Health, had said in his farewell as chair, “I believe this year, 2022, must be the year of the healthcare worker.”) Healey said it’s clear there has to be a greater investment in today’s workforce as well as in building a pipeline to create an equitable workforce going forward. The AG noted that lack of diversity in the workforce leads to inequitable outcomes. Healey also said she is a “big believer” in social determinants of health, and urged the healthcare leaders in attendance to redouble their efforts in addressing food and housing insecurity in their communities, along with mental health and trauma services, among other social outreach initiatives.

For her part, Wieland discussed the similarities between what hospitals faced – she’s a board member at Boston Children’s Hospital – and what Massport experienced during the pandemic. Both faced workforce shortages and plummeting revenues as air travel all but stopped during the pandemic, she said, as she detailed how the quasi-public agency addressed the challenges.

Governor Baker Files FY23 Budget Proposal

Governor Charlie Baker released his proposed $48.5 billion FY2023 state budget, or H.2, last Wednesday. Aside from proposed tax policy changes geared at supporting seniors, parents, low-income workers, and residents who rent their homes, H.2 contains proposals that, if adopted, will affect hospital financing for the next five years, while also re-shaping the Massachusetts behavioral health system.

Key parts of the governor’s FY2023 budget involve the legislative mechanisms that are needed to support the state’s recent filing of the 1115 Medicaid waiver extension request to the Centers for Medicare and Medicaid Services (CMS). That waiver contains a new, MHA-proposed increased assessment on hospitals that will provide significant new financial support to hospitals and to 1115 Medicaid waiver priorities. The assessment and the related spending plan in the governor’s budget bring new funding to support health equity, clinical quality outcomes, safety net providers, delivery system reforms, and chronic underpayment of hospital services provided to MassHealth patients. It also supports non-hospital uses, including health-related housing needs, nutrition, and care coordination in the community.

“MHA and our members strongly support the hospital assessments and related Medicaid financing in the governor’s budget, which are key pillars of the state’s 1115 waiver proposal with CMS,” said Steve Walsh, MHA’s president & CEO. “MHA and our members stand in unanimous support of this proposal and we are grateful for the Baker Administration’s work to make our world-class health system even more accessible. We look forward to advocating for these budget and waiver plans as they move through the legislative and CMS processes.”

In the behavioral health arena, the governor’s budget focuses on reforming the ambulatory behavioral health system. The proposed budget includes $115 million to expand outpatient and urgent behavioral health services. In concert with the budget, EOHHS also announced last week details on how this $115 million proposal will help to implement the state’s Roadmap for Behavioral Health Reform. Proposals include establishing a 24/7 help line, launching a behavioral health urgent care program and community behavioral health centers to provide same-day evaluation and referral to treatment, reinvesting in community-based mobile crisis intervention, and new reimbursement incentives for primary care to increase the availability of mental health and addiction services in those settings. To address the opioid and substance addiction crisis, H.2 proposes $543.8 million across several state agencies.

Congress to White House: Help Fix Staffing Agency Problem

“We are writing because of our concerns that certain nurse-staffing agencies are taking advantage of [current] difficult circumstances to increase their profits at the expense of patients and the hospitals that treat them,” reads a letter signed by more than 200 members of Congress, from both sides of the aisle. “We urge you to enlist one or more of the federal agencies with competition and consumer protection authority to investigate this conduct to determine if it is the product of anticompetitive activity and/or violates consumer protection laws.”

The letter calling out nurse staffing agencies whose prices in some cases have tripled during the pandemic, was sent to Jeffrey Zients, the COVID-19 Response Team Coordinator at the White House.

“The situation is urgent and the reliance on temporary workers has caused normal staffing costs to balloon in all areas of the country,” the letter notes. Massachusetts Representatives Jake Auchincloss, Katherine Clark, Jim McGovern, Seth Moulton, Ayanna Pressley, and Lori Trahan are signatories. “This is not the first time the agencies have engaged in this sort of conduct. As the first wave of COVID-19 swept the nation in 2020, they similarly inflated their prices to hospitals. Hospitals have no choice but to pay these exorbitant rates because of the dire workforce needs facing hospitals around the country.”

Data Shows the Results of Workforce Shortages

How bad is the staffing crisis facing U.S. hospitals? According to the most recent data, 31% of U.S. hospitals that report data on staffing to the federal government indicated that they are anticipating a “critical staffing shortage” during the most recent week (January 19). As worker shortages increase, so does the acuity of patients, with average length of stay increasing by 8.8% over pre-pandemic levels.

To counter the staffing shortage, hospitals have contracted with expensive staffing agencies and labor expenses are up 12% on an absolute basis, and 19.5% on a per adjusted discharge basis compared to levels in 2019. As total hospital expenses have risen 19.9% on a per adjusted discharge basis, operating margins have declined. Median operating margins are down nearly 4% compared to pre-pandemic levels in 2019. Credit rating agency Moody’s gave the nonprofit and public health care sector a negative outlook, in large part due to rising labor costs, which they said could decrease operating cash flow up to 9%.

Hospitals continue to support policies that would provide behavioral health services for healthcare workers to prevent burnout, lifting caps on training slots and increasing funding for direct and indirect graduate medical education, and supporting local and state laws to bolster the ability of staff to work at the top of their license. As has occurred in Massachusetts, hospitals have been forced to temporarily shut down certain procedures and close units due to reduced staffing.

This data brief from the American Hospital Association contains the independent sources for the data cited above, as well as other data relating to the staffing issue.

MHQP Names Primary Care Practices Rated Highly by Patients

Massachusetts Health Quality Partners (MHQP) has announced the winners of the 2021 “MHQP Patient Experience Awards,” which recognize the primary care practices that perform highest on its annual commercial patient experience survey.

The survey, which began in 2018, was not conducted in 2020 due to the pandemic. In 2021, MHQP received more than 38,000 responses to the survey of commercially insured patients from across the state. The results were used to identify the top overall performing adult primary care and pediatric practices in nine performance categories: patient-provider communications, coordinating patient care, how well providers know their patients, assessment of patient behavioral health issues, ease of access to care, empowering patient self-care, office staff professional excellence, pediatric preventive care, and assessment of child development.

The award winners listed here will be celebrated at a virtual event hosted by MHQP on February 16, 2022.

Congress Turns Focus to Behavioral Healthcare

Last week, several congressional committees signaled a focus on mental and behavioral health as Congress kicks off the 2022 legislative session. The Senate Committee on Health, Education, Labor, and Pensions (HELP) announced a February 1 hearing titled, Mental Health and Substance Use Disorders: Responding to the Growing Crisis, featuring, among others, testimony from Michelle P. Durham, M.D., of Boston Medical Center. The House Committee on Ways and Means, chaired by Rep. Richard Neal (D-Mass.), has announced a February 2 hearing titled, America’s Mental Health Crisis. The Senate Committee on Finance is also expected to hold a hearing on mental and behavioral health in the near future. Additionally, the Finance Committee is preparing to announce a process to establish several working groups to develop a behavioral health proposal as part of the committee’s ongoing work related to this issue. The working groups are expected to focus on workforce, integration and coordination, parity, telehealth, and children and Medicaid.

The broad focus on policies to strengthen and close gaps in America’s mental and behavioral health care system comes at a critical time, as the COVID-19 pandemic has exacerbated mental and behavioral health challenges and increased demand for care in this space, with as many as four in 10 adults reporting symptoms of anxiety or depressive disorder.

Biden Administration Releases Report on Mental Health Parity

On January 25, U.S. Department of Health & Human Services, the Treasury, and Department of Labor issued their 2022 Report to Congress on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. That act is intended to prevent group health plans and health insurance issuers that provide mental health and substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical coverage. The 2022 report includes findings that indicate some health plans and health insurance issuers are failing to ensure parity. The report also includes information on the departments’ recent emphasis on greater parity enforcement and recommendations to strengthen consumer protections and enhance the departments’ enforcement abilities.

John LoDico, Editor