INSIDE THE ISSUE

> Better Together Report
> Session Winds Down
> CHIA’s Bleak Report
> Hospital Community Benefit Report
> Tufts Medicine’s New Facility
> Emerson Hospital Rebrands
> New Name for AllWays
> Deployable Medical Teams
> Transition

MONDAY REPORT

MHA Report Analyzes Pandemic Response With Eye Towards Future

Better Together’s recommendations center on how providers, policymakers, and other healthcare interests in Massachusetts can address the:

• essential role of collaboration and effective communication across the entire care continuum, and in collaboration with the state;
• changing nature of care delivery, including the necessary expansion of telehealth;
• need to grow and empower the healthcare workforce, including how to support and deploy a limited workforce while alleviating employee strain and burnout;
• continued focus on health equity and behavioral health to ensure quality care for all;
• role of dynamic data and analytics, including the need of a real-time situation awareness tool; and
• future of the supply chain, involving, among other actions, the development of a statewide emergency supply chain infrastructure.

Learn more at this Better Together microsite.

The report comes at a key time as hospitals, physician practices, and the healthcare community as a whole attempt to recover from enormous financial and operational pressures the pandemic placed on them. The current inflationary pressures are also affecting providers especially hard on two fronts. First, providers locked into fixed commercial health insurer contracts negotiated in previous years are unable to counter the rising costs of their daily operations that are tied to the spike in gas, food, and other costs. Secondly, patients, facing their own rising monthly bills, are beginning to defer care, meaning when they return to their caregivers in future months, they’ll be sicker and require more expensive care – further putting cost pressure on providers.

“Massachusetts’ COVID-19 response has been nothing short of remarkable,” said MHA President & CEO Steve Walsh. “But our ability to weather the storm and avoid some of the dire scenarios seen in other states was no accident. Our members recognized the importance of taking a comprehensive look at what we have learned over the past two-plus years and use those lessons to chart a path forward. This report is intended to do just that.”

“Since our earliest preparations for COVID-19 in Massachusetts, the common theme has been collaboration,” said Dr. Paul Biddinger, Medical Director for Emergency Preparedness at Mass General Brigham, who served as an expert advisor for the project. “Now, we must maintain this momentum and act together on the lessons learned so our healthcare organizations are best prepared to care for our patients, protect our workforce, and serve the commonwealth in times of crisis.”

Last week, the legislature’s Joint Committee on COVID-19 and Emergency Preparedness and Management also released its report on the pandemic. The committee, chaired by Sen. Joanne Comerford (D-Northampton) and Rep. William J. Driscoll, Jr. (D-Milton), held 16 public hearings across the state between February 2021 and January 2022, and its report focuses significantly on actions to improve the six Health and Medical Coordinating Coalitions (HMCCs), which were instrumental in the state’s coordinated response to COVID-19. Both the MHA and the state report stress continued collaboration to strengthen the state’s emergency response.

Waning Days of Session Sharpens Focus on Key Issues

As of today, there are just fewer than four full weeks left to the 2021-2022 formal legislative session that, barring a special rules change, ends at midnight on July 31.

The legislature and administration have been very responsive to the healthcare community over the course of the two years of the session, which coincided with the most trying times for the healthcare community due to the pandemic. MHA and its members are advocating for a final legislative push to get key pieces of legislation – required for the continued viability of the healthcare system – over the finish line before July 31.

Behavioral Health and Boarding

A Mental Health Bill Conference Committee is now meeting to hammer out an agreement between House and Senate versions of a sweeping behavioral health bill. Hospitals are especially supportive of Section 61A of the H.4891, which would compel commercial insurance companies to help resolve the crisis that regularly finds 600 or more patients each day boarding in hospitals awaiting an inpatient bed or other placement. Insurers currently give hospitals one lump-sum payment for a boarder – regardless of the length of time a patient is boarding. Section 61A would finally require reimbursement for boarders from commercial insurers so that hospitals have the resources needed to best care for them – a step the MassHealth program has already taken.

Hospital Finances

As seen in the report last week from the state’s Center for Health Information & Analysis (see story below) hospital finances remain precarious. Hospitals, faced with negative or shrinking operating margins, are counting on the legislature to devote a portion of remaining American Rescue Plan Act funding to their recovery before the session closes. Specific line items in the budget also would result in hospital relief.

Nurse Licensure Compact

The NLC allows Massachusetts to join 39 other states in a joint licensing agreement that permits qualified nurses to have one multistate license from the state in which they reside, with the privilege to practice in their home state and all others that are members of the Compact. MHA, nursing groups, other provider organizations, the Baker Administration, many legislators, and the Health Policy Commission – among others – have long supported the commonwealth’s entry into the Compact.

Telehealth

MHA as the convenor of tMED – the Massachusetts Telemedicine Coalition – is urging the legislature to support an extension of reimbursement parity for chronic disease management and primary care services for an additional two years. Without the extension of reimbursement parity, providers are facing a “reimbursement cliff” as of December 31, 2022.

Workplace Violence Bill

Various versions of workplace violence legislation are moving through the State House. MHA has been working to ensure that whatever compromise bill emerges from committee creates statewide standards for healthcare employers to use in conducting risk assessments, developing a workplace violence plan, and providing further supports for victims of violence on the job.

CHIA Report: Hospitals are Hurting

Last Thursday, the state’s Center for Health Information and Analysis (CHIA) issued a report on hospital and health system financials for FY22 through March 31, 2022. The report paints a disturbing picture of healthcare finances for the facilities that took unprecedented steps to protect the public from COVID-19, but which are still reeling from the two-plus-year public health emergency.

The statewide median operating margin was negative 2.5%, a decrease of 2.7 percentage points compared to the same period last year. The teaching hospital cohort reported the lowest operating margin of –4.6%. The negative operating margins for all acute care hospitals accounts for government relief received to date.

This CHIA update includes the latest Omicron wave – which peaked in early calendar year 2022. During this period, hospitals were required to pause 50% of elective surgeries, with many suspending elective procedures entirely, which in turn harmed revenues. Expenses remained high for costs associated with the pandemic, including substantial increases in temporary staffing costs.

“It’s clear that Massachusetts healthcare organizations are feeling the economic crush of this public health crisis more than ever,” said Dan McHale, MHA’s VP for Healthcare Finance & Policy. “Inflation has added an entirely new layer to healthcare organizations’ financial pressures in 2022. Unlike other sectors, providers cannot simply pass along the increased costs of labor, energy, and supplies to consumers. That means they are absorbing these skyrocketing overhead costs all on their own, while still navigating the same economic challenges that have existed since COVID-19 began –particularly significant cost increases related to traveling nurses and staffing agencies.”

McHale noted that MHA and its membership are grateful for the government relief devoted to the healthcare sector throughout the pandemic, and added, “We continue to explore every opportunity for additional support and are confident that the legislature will devote much-needed funding for providers’ recovery as the session comes to a close.”

Here’s How Hospitals Contributed $786 Million in Community Benefits

In Fiscal Year 2020, the Attorney General’s Office created a new “Coronavirus” program tag that allowed hospitals to identify COVID-specific community benefit programs they undertook. Many of these new programs, as well as ongoing and innovative programs created under the state’s targeted priority areas, or through each hospital’s Community Health Needs Assessment, focused on health equity and the social determinants of health. These efforts were extraordinarily important given that the COVID-19 pandemic not only disproportionately affected communities of color and other disenfranchised populations, but also underscored historic oppressive actions that contribute to present-day health inequities.

“Massachusetts hospitals deserve commendation for not only addressing statewide health priorities relating to chronic disease, mental health, substance use disorders, and housing instability, but also for weaving into their actions in these areas and others a serious commitment to recognizing and resolving inequities in healthcare delivery,” said MHA’s Director of Health Equity Akriti Bhambi.

The publication highlights programs from hospitals around the state that target specific areas, such as addressing the digital divide and combatting youth obesity. It also focuses on regional collaborations where hospitals join together and with community groups to present a coordinated effort to address particular health concerns within a region of the state.

Hospital community benefits programs – provided at no cost to those being served – are not reimbursed by state or federal governments, by any health insurance company, or through any public subsidy.

Tufts Medicine Focused on Expanding Behavioral Health Access

Tufts Medicine announced last week that it is partnering with Tennessee-based Acadia Healthcare Company to build a 144-bed inpatient behavioral health facility on the site of the former Malden Hospital.

The new $65 million facility will replace the current hospital building and occupy a smaller footprint. Once it receives regulatory approval and is built, the facility will consolidate the inpatient behavioral health services of two of Tufts Medicine’s hospitals – MelroseWakefield and Lawrence Memorial in Medford. Tufts Medicine said, “The combination of services will contribute to the new center of excellence of comprehensive inpatient care, and the partnership will look to augment current services by developing innovative care delivery models to better integrate behavioral health services.”

“There is a critical need for capacity in behavioral health in the commonwealth,” said Michael Dandorph, president and CEO of Tufts Medicine. “Our plans to redevelop the Malden Hospital site into a state-of-the-art behavioral health hospital will help address the constraints on access to care that our healthcare providers and our patients and families face every day.”

Emerson Rebrands to Emerson Health

AllWays to Become Mass General Brigham Health Plan

DPH Seeks Deployable Medical Teams

The Department of Public Health (DPH) has issued a Request for Responses (RFR), seeking input on how to address issues arising when the capacity of the healthcare system is insufficient to meet patient needs.

Specifically, DPH is looking for a variety of provider types to provide therapeutic services during capacity challenges. However, only hospitals are eligible to apply for the other ask in the RFR – that is, the ability to provide Deployable Medical Teams (DMTs) to resolve capacity problems. DPH defines the DMTs as follows: “…hospital-based units comprised of clinical and non-clinical personnel with capabilities specified by the Department that would be prepared to deploy upon request of the Department in standardized team configurations and operate under a pre-identified set of mission assignments, defined list of team capabilities, approved costs and resource requirements, and a common understanding of responsibilities, authorities, and liabilities. Deployment of DMTs may be requested by the Department to provide additional healthcare system capacity through activities that that may include but not be limited to mass casualty event triage, establishment and operation of alternate care sites or field hospitals, healthcare facility staffing support, and public health interventions.”

Transition

David Elgarico has been appointed CEO of MetroWest Medical Center, effective July 18. He replaces Ava Collins. Elgarico comes to Massachusetts from Quorum Health where he served as CEO of McKenzie-Willamette Medical Center in Springfield, Oregon. Elgarico is a member of the American College of Healthcare Executives and was co-founder and chair of the ACHE’s Asian Healthcare Leaders Forum. He received his Master’s in Health Administration from the Medical University of South Carolina in Charleston, and his Bachelor of Science in Physical Education from the College of Charleston.

John LoDico, Editor