INSIDE THE ISSUE

> Change Healthcare Cyberattack
> HPC Discusses Capacity
> Isolation, Paxlovid & Vaccines
> Nursing Workforce Grants
> New Maternal Health Advisory Group
> The Patient Experience

MONDAY REPORT

Cyberattack on Change Healthcare Reverberates Through System

The Change Healthcare cybersecurity breach that has been roiling the national healthcare system continued to disrupt many Massachusetts hospitals last week.

Change Healthcare provides a variety of services to hospitals and health plans, including eligibility verification, claims processing, and prior authorization submissions. The company’s products also help providers with their pharmacy operations, among many other operational tasks. When they were informed of the breach, many facilities took the prudent step – which federal cybersecurity experts recommended – of disconnecting from Change services. That in turn stopped, in some cases, the filing of claims and, therefore, payment for care provided.

In addition to previous advice, last Wednesday, the Federal Bureau of Investigation (FBI), the Cybersecurity and Infrastructure Security Agency (CISA), and U.S. Health & Human Services sent out a flash notice to hospitals urging them to take immediate action to mitigate against the threat of ransomware – specifically ransomware developed by ALPHV Blackcat and marketed to its threat affiliates. This Joint Cybersecurity Advisory updates a previous advisory first issued in December 2023. Later on Wednesday, the cybercriminals at ALPHV took credit for the Change attack, and on Thursday, UnitedHealth Group – the parent of Optum/Change Healthcare – confirmed that ALPHV Blackcat was indeed the culprit.

While no Massachusetts hospital is reporting a direct attack, the fallout from the loss of Change Healthcare systems is beginning to be felt in the commonwealth. MHA heard from its membership last week that the disruption ranged from minimal to significant depending on how many Change Healthcare systems the hospital was using.

MHA has begun talks with state officials and commercial payers about bridge payments where needed as well as potential flexibilities relating to claims deadlines and temporarily waiving prior authorizations, among other mitigations. Blue Cross and Blue Shield of Massachusetts and Point32Health have reached out to providers, offering alternatives to Change Healthcare and workarounds, while other Massachusetts insurers have developed similar processes. Nationally, the American Hospital Association is requesting that the Centers for Medicare and Medicaid Services consider providing prospective Medicare payments to hospitals until the issue is resolved.

“This is a serious disruption for every Massachusetts healthcare organization that relies on Change Healthcare for their daily operations – especially those that are now unable to get paid for the various services they provide to patients,” said MHA’s Senior Director of Managed Care Karen Granoff. “It’s yet another layer of financial distress on a system that is already struggling to stay above water. MHA and our members are working closely with state officials and our national partners as this situation evolves, and we will be advocating for any supports needed to minimize the effects on patient care, healthcare professionals, and the overall stability of the system.”

HPC Council Discusses a System Still Out of Kilter

The Health Policy Commission (HPC) Advisory Council last Thursday addressed the Massachusetts healthcare system’s capacity issue in which, on any given day, 500-plus behavioral health patients are boarding in hospital emergency departments and units, and up to 1,000 other patients are stuck on inpatient floors, awaiting discharge to the next level of care.

HPC Executive Director David Seltz presented the council with seven succinct slides showing recent trends are intertwining to explain the capacity crunch. For example, emergency department (ED) visits are below pandemic levels, but the time patients – especially behavioral health patients – are spending in EDs is increasing. The data shows total hospital admissions have declined steadily since before the pandemic, including a 17% drop in “scheduled” admissions, which include elective surgeries and procedures. But while admissions are down, average length of stay in hospitals has increased significantly. Stays are longer because many patients who need the next level of care often have nowhere to go. That’s because employment in skilled nursing facilities and home health care agencies has plummeted since before the pandemic – dropping 23.3% and 12.6%, respectively, Seltz’s slides showed.

One hint of good news came from Advisory Council member Tara Gregorio, the president and CEO of Mass Senior Care Association, who noted that the nursing home sector she represents has been able to increase wages, reduce the excessive costs of temporary labor, and hire more workers. While building the workforce has allowed skilled nursing facilities (SNFs) to accept more discharges from hospitals, Gregorio noted that 95% of SNF beds are now occupied.

“We are still a system that is on the brink,” said MHA’s President & CEO Steve Walsh, who has a seat on the Advisory Council. “As an industry, we have not yet recovered. So we should apply the same principles of collaboration and flexibility as we did to get through the darkest days of COVID.”

Walsh said he took encouragement from the fact that Massachusetts has great healthcare policy minds and a COVID-tested record of being able to bring providers, insurers, labor, state government, and others together to find solutions.

But he stressed that at this point, the provider community “can’t report progress, but can only report survival. We’re facing a perfect storm of challenging wait times for patients that have to defer care and often don’t have primary care, of an exhausted workforce that has done everything they can to meet the demands of those patients, and of an under-resourced management that’s desperately trying to keep services open and keep their beds staffed for the patients and communities they serve.”

Walsh closed by urging Massachusetts to center healthcare policy conversations on the crisis at hand, and to prioritize workforce, equity, and care innovation as a way out of the crisis.

So what would success and progress on the capacity crisis be like for the HPC? That’s the question Gregorio asked at the end of the presentation. HPC Board of Commissioner Chair Deborah Devaux answered: “I think it really is in the eyes of the provider system in terms of being able to feel that we’re now in a manageable situation for both staff and patients. I’m certainly hearing some progress today but I’m not hearing anyone saying we’re back to our usual level of concern and balance.”

COVID-19: Updates on Isolation, Vaccines, and Paxlovid

The CDC announced on Friday that it was dropping its recommendation that people testing positive for COVID-19 isolate themselves for five days. The new guidance is to return to normal activities when, for at least 24 hours, symptoms are improving overall, and if a fever was present, it has been gone without use of a fever-reducing medication.

“Once people resume normal activities, they are encouraged to take additional prevention strategies for the next 5 days to curb disease spread, such as taking more steps for cleaner air, enhancing hygiene practices, wearing a well-fitting mask, keeping a distance from others, and/or getting tested for respiratory viruses,” the CDC said.

Also last week, CDC Director Mandy Cohen endorsed a recommendation from the CDC Advisory Committee on Immunization Practices (ACIP) that adults 65 and older “should” get an additional updated 2023-2024 COVID-19 vaccine dose. ACIP members debated on whether to phrase the recommendation as “may” or “should” get the additional shot, ultimately deciding for the stronger language. The CDC says people 65 and older can receive an additional dose of any updated COVID-19 vaccine at least four months after their previous shot.

In other COVID news, DPH sent out a reminder last week that Paxlovid – the five-pill regimen that helps fight the COVID-19 infection – will no longer have emergency use authorization (EUA) after March 8. Post March 8, all EUA-labeled Paxlovid must be returned or destroyed. (Eligible pediatric patients can still receive a differently authorized version of the drug.)

Paxlovid under a New Drug Application (NDA) is still available, but it will now be distributed through the commercial market as opposed to being distributed for free by the government. However, there are still cost-savings available through the government-launched PAXCESS Patient Support Program; a prescription is needed to enroll a patient in the program, and depending on a person’s commercial insurance they may be eligible for significant cost savings. Those on Medicare and Medicaid can get the drug for free through the end of the year. Here’s an FAQ document about the transition from government to commercial distribution.

Nursing Workforce Grant Applications Open

AARP, the American Association of Critical-Care Nurses, and the “Future of Nursing: Campaign for Action” initiative are seeking proposals that strengthen and diversify the nursing workforce, expand innovative nurse recruitment and retention strategies, and create and sustain healthy work environments. Awardees will receive grants of up to $25,000. Proposals, which are due April 5, must be “creative, replicable, and offer promising systemic changes” in building the nursing workforce, according to the Campaign for Action website. As shown in MHA’s Workforce Toolkit, many Massachusetts hospitals and health systems are undertaking creative strategies to recruit and retain healthcare workers, including nurses.

MHA Forms Maternal Health Advisory Group

MHA held the first meeting of its Maternal Health Advisory Group last Thursday with the intent of coordinating the wide variety of ongoing work across the state in the maternal health, perinatal-postpartum, and birthing equity space.

Maternal health is also a focus of the Healey Administration, which commissioned this report on the topic and tasked DPH with providing actionable recommendations to advance birthing health equity across the state.

MHA’s advisory group, which has strong representation from across the membership, will provide a forum for discussion, feedback, and advancement of maternal and birthing equity among MHA members. This includes sharing updates, information, and resources regarding initiatives, policy, legislation, and regulations, in addition to advocacy at the state and federal level.

MHQP Survey Results Show Racial Disparities in Primary Care

MHQP’s 2023 statewide Patient Experience Survey shows that White, Black, Asian, and Hispanic/Latino patients view the care they received from primary care practices differently, with the non-White groups reporting worse experiences in many categories.

For example, Black adult patients had statistically worse experiences in the categories Coordinating Patient Care, Assessment of Patient Behavioral Health, and Patients’ Trust in Their Providers. However, Black adults felt about their same as White adults when it came to assessing primary care practices on Patient-Provider Communications, How Well Providers Know Their Patients, Ease of Access to Care, Office Staff Professional Excellence, Self-Management Support, and Willingness to Recommend the practice to others.

But for Asian and Hispanic patients, the results were worse with Asian adults reporting worse experiences than Whites in all categories, and Hispanics reporting the same except for the staff professionalism and self-management categories.

MHQP’s work adds another layer to the ongoing efforts to create a more equitable healthcare system. Over the next five years under the Section 1115 Medicaid waiver, all Massachusetts hospitals will be held accountable for reducing healthcare disparities. The commitment to data collection, improvement of the patient experience, coordination among providers, and more over the five-year waiver period will fundamentally change the way providers address and invest in equitable care, through every part of the patient journey.

John LoDico, Editor