INSIDE THE ISSUE

> Optum/Steward
> Post-Acute Workforce Vacancies
> Credentialing Question Removed
> MHA On FY2025 Budget
> North Adams Reopens
> Measles!
> Transition

MONDAY REPORT

Optum’s Proposed Purchase of M.D. Practice Raises Questions, Concerns

Last week’s announcement that OptumCare, a subsidiary of UnitedHealth Group, has entered into an agreement with Steward Health Care to buy the troubled health system’s national physician network has raised numerous concerns and questions.

The proposed acquisition was revealed in a mandated Notice of Material Change that Steward Operations Holdings (SOH) LLC filed with the Health Policy Commission. SOH is the sole corporate member of Stewardship Health Medical Group, Inc., which employs primary care physicians and other clinicians across nine states, including Massachusetts.

“As described in the notice, this is a significant proposed change involving two large medical providers, both in Massachusetts and nationally, with important implications for the delivery and cost of healthcare across Massachusetts,” HPC Executive Director David Seltz stated. “Details of the proposal will be reviewed by the HPC to examine potential impacts on healthcare costs, quality, access, and equity. The sale cannot be completed until after the HPC’s review and any concurrent review by state or federal antitrust authorities.” The HPC has 30 days to conduct its review.

MHA welcomed the HPC oversight, issuing a statement saying, “a transaction of this magnitude must be subject to a stringent and transparent approval process that invokes Massachusetts’ best oversight tools – the very same oversight that local hospitals are held to.”

The HPC does not have the authority to stop the deal, but if it finds that the acquisition will have detrimental effects on the state’s healthcare system, it could refer the case to Massachusetts Attorney General Andrea Joy Campbell’s office. On Wednesday, Campbell was quoted in the Boston Globe as saying her office will “use every tool available” to address the acquisition.

The further influence of UnitedHealth Group into Massachusetts generated concern from elected officials. Congressman Jake Auchincloss (D-Mass.) called the potential acquisition “alarming,” adding, “UnitedHealth, a Fortune 5 leviathan already under federal antitrust investigation, has spent five decades corporatizing healthcare to the detriment of patients and physicians.” Senator Elizabeth Warren (D-Mass.) said, “Optum, a UnitedHealth Group subsidiary, is already the largest employer of physicians in the country — controlling over 10% of American doctors — which means this deal raises significant antitrust concerns in Massachusetts and nationally.” And Massachusetts House Speaker Ronald Mariano (D-Quincy) said the proposed sale of the doctors’ practice “has the potential to significantly impact the competitiveness of the healthcare market in Massachusetts and cause further disruption during a period of acute instability in the healthcare system.” He urged a full HPC review as well as “rigorous” reviews by “state and federal antitrust authorities.”

The proposed Optum/Steward acquisition – like other aspects of the Steward Health Care story in Massachusetts – presents many unanswered questions. What regulatory authority does Massachusetts have over the deal aside from weighing antitrust considerations? If Massachusetts regulators can indeed alter the sale in some way, how does that affect the acquisition in the eight other states where the physician practice operates? Will the sale of the physician practice make Steward’s hospitals in Massachusetts – which Steward is currently trying to sell – any less attractive to buyers? Will those hospitals be recapitalized by any revenue Steward gets from the Optum sale, or will the revenue be diverted to other purposes?

“After Steward recklessly took on massive debt that is continuing to that put hospitals in Massachusetts and across the country into financial crisis, the Massachusetts healthcare system must move away from Steward’s financial insecurity,” Senator Edward Markey (D-Mass.) said. “With this announcement, Optum must demonstrate that it can meet the even greater responsibility to preserve and protect healthcare access in the commonwealth, and I hope they will live up to that responsibility by controlling costs and putting patients and providers first.”

Markey, chair of the Senate Health, Education, Labor and Pensions Committee’s Subcommittee on Primary Health and Retirement Security, is holding a field hearing in Gardner Auditorium at the State House on Wednesday, April 3 from 11 a.m. to 2 p.m. The meeting is called “When Health Care Becomes Wealth Care: How Corporate Greed Puts Patient Care and Health Workers at Risk.”

The Number and Cost of Post-Acute Care Hospital Workforce Shortages

Total spending for temporary contract labor among all responding hospitals to-date increased from $1.1 million in 2019 (pre-pandemic) to $12.5 million in 2023 – an uptick of more than 11 times the 2019 figure, MHA’s survey found. The post-acute care hospitals report that such temporary labor expenses are unsustainable for these their organizations.

MHA conducted the survey in 2023, seeking information on 56 positions to see how many were filled and the average hourly wage they were paid both before the pandemic (2019) and in 2023. The response rate among 12 IRFS and LTACHs accounts for 60% of all post-acute care hospital beds in Massachusetts.

Overall, the aggregate vacancy rate for positions in MHA member post-acute care hospitals was 9.4%. However, the vacancy rate for LPNs (24.1%) and R.N.s (14.8%) was much higher. There are 534 open positions and 432 vacant full-time-equivalent positions across Massachusetts post-acute care hospitals.

Other healthcare positions, known as “allied health” roles, also showed vacancies, with rehabilitation aides, pharmacists, and physical therapists all in especially short supply.

When asked what support is needed to attract and retain staff, the post-acute hospitals placed additional wages, salaries, and bonuses at the top of the list, followed by the creation of career ladders for certified nurses aides and RNs.

“These organizations are a critical piece of the healthcare landscape in Massachusetts, as they treat medically complex patients in need of sustained, long-term care,” said MHA’s Adam Delmolino, senior director of virtual care and clinical affairs. “When they do not have the necessary workforce, care throughout the entire system is threatened. We can trace the ‘throughput’ problem hospitals are experiencing – the ability to efficiently transfer patients to the next level of care – directly to these workforce shortages.”

Credentialing Question of Concern Formally Removed

At the end of last year, Massachusetts took the nation-leading step in which every hospital, health system, and local health plan committed to eliminating potentially stigmatizing or invasive questions from their credentialing processes. The initiative was led by MHA after receiving unanimous approval from its Board of Trustees.

Last week, the Integrated Massachusetts Application (IMA) – the formal document that is used by Massachusetts health plans and nearly 40 Massachusetts hospitals to credential clinicians – was finally edited to remove this invasive question 20: “Have you engaged in the illegal use of drugs within the past ten (10) years?” (The delay in removing the question was due to the Council for Affordable Quality Healthcare (CAQH) having to adapt its provider data portal that is used by all 50 states for health plan credentialing.)

Each year, thousands of local physicians and healthcare professionals go through the credentialing process to ensure they are in good standing to deliver safe patient care. However, the forms used within this process have often included outdated, unnecessary questions about clinicians’ mental health history and past drug use. Caregivers have been discouraged from seeking behavioral health services because they know they will encounter these overly broad questions and fear their livelihoods will be threatened as a result of answering honestly.

MHA, working with the Massachusetts Medical Society, local health plans, and leading national healthcare organizations championed removing the question. The National Committee for Quality Assurance (NCQA), which accredits health plans nationwide, then moved to make the change, which allowed Massachusetts to update the IMA. Hospitals using their own credentialing forms have also committed to removing any outdated or potentially invasive questions.

In addition to being loaded on the CAQH site, the IMA is available on the Healthcare Administrative Solutions website.

MHA’s Budget Letter Recognizes Constraints, But Outlines Concerns

It’s April, meaning the state budget-writing process is underway in the Massachusetts House, to be followed by the Senate’s budget action in May.

Last week, MHA drafted a letter to House and Senate Ways and Means Committee leadership, outlining in broad strokes the hospital community’s priorities and concerns with a potential FY2025 state budget.

The letter notes what has been made clear to numerous advocacy groups across the commonwealth this year – namely, opportunities for new funding initiatives in the FY2025 state budget are highly unlikely. Nevertheless, MHA’s letter points out the continuing struggles of the healthcare sector, especially considering the uncertainties of the large Steward Health Care safety net system exiting the state.

Of greatest concern, MHA wrote to the budget leaders, are MassHealth provisions in the governor’s proposed FY2025 budget that was released in January. Because federal funds that were flowing to the state due to the public health emergency have ended, while the state is projecting substantial Medicaid spending growth, the governor’s budget includes several MassHealth savings initiatives that MHA says could negatively affect providers and Medicaid Managed Care Organizations.

In its letter, MHA also reprised its ongoing concern with the funding of the Health Policy Commission (HPC) and Center for Health Information and Analysis (CHIA). While recognizing the importance of the regulatory agencies, MHA noted that the state has never fulfilled its financial obligation of funding one third of HPC’s and CHIA’s budgets, as intended by the law that created them. Since their establishment in 2012, the HPC and CHIA have been funded entirely from hospital, ambulatory surgical center, and surcharge payer assessments. “It is also important to note that the HPC’s proposed budgetary increase is well above the annual cost growth benchmark that the entities that fund these agencies are held to under Chapter 224,” MHA wrote.

North Adams Regional Hospital Reopens

Congressman Richard Neal (D-Mass.) was instrumental in helping the hospital achieve the CAH designation by working to change the designation for such hospitals.

When operating at full capacity, North Adams Regional expects to serve an average of 8-10 patients and will be licensed to care for up to 18. It will offer a full range of services from a 24/7 emergency department to surgical care, outpatient services, imaging, and inpatient care. The average length of stay of patients must be four days or less; more complex cases will be treated throughout the BHS system.

“The reopening of North Adams Regional Hospital is a historic opportunity to advance the health and wellness of the Northern Berkshire community,” said Darlene Rodowicz, president and CEO of BHS. “Expanding access to care for North Berkshire through a Critical Access Hospital is a key part of our strategic plan; we are thankful to Congressman Neal and his Massachusetts colleagues in the House and Senate, our Berkshire state legislative delegation, the municipal leaders across North Berkshire and the many people in the community who have steadfastly supported our plans to reopen NARH to provide the highest standard of care that the North Berkshire community expects and deserves.”

“Throughout my career in public life, I have stood by the notion that legislation changes lives. Today’s announcement is a living example of that belief, as the reopening of North Adams Regional Hospital will have a profound impact on communities throughout North County for years to come,” Congressman Neal said.

More Measles Cases in 2024 Than in All of 2023

The CDC announced last month that already in 2024 there have been 58 confirmed cases of measles across the U.S., compared to 58 total cases throughout all of 2023.

Last week, DPH issued an alert calling on schools and healthcare providers to ensure students are current with the measles, mumps, and rubella (MMR) vaccine.

Children who are not traveling internationally should receive their first dose of MMR at age 12 to 15 months and their second dose at 4 to 6 years. All U.S. residents older than age 6 months without evidence of immunity who are planning to travel internationally should receive the MMR vaccine prior to departure, the CDC and DPH advise.

DPH also reminded healthcare facilities that if they think a patient has measles, don’t allow them to remain in the waiting room or other common areas of the facility; they should be isolated immediately, ideally in a single-patient airborne infection isolation room (AIIR) if available, or in a private room with a closed door until an AIIR is available.

Transition

Tufts Medicine has announced that Tufts Medical Center President Diana Richardson has left her post, as has Chief Physician Executive Michael Tarnoff, M.D. Phil Okala, Tufts Medicine COO, will serve as Tufts MC president on an interim basis. Michael Dandorph, Tufts Medicine president & CEO, said he would be convening a clinical advisory committee of physicians across Tufts Medicine for input on the chief physician executive role.

John LoDico, Editor