INSIDE THE ISSUE

> Rx Bill
> Long-Term Care Bill Passes Senate
> Steward Says It Will Close 2 Hospitals
> U.S. Senate’s Steward Inquiry
> Transition

MONDAY REPORT

Pharma Bill, Including Some 340B Protections, Passes House

The Massachusetts House last week unanimously passed H.4891, An Act promoting access and affordability of prescription drugs, which would impose regulations on the pharmaceutical industry and is aimed at reducing the rising cost of drugs. Last November, the Senate approved a similar prescription drug pricing bill. The bills now head to a conference committee with a rapidly approaching, end-of-session deadline of this Wednesday, July 31, to reach an agreement and get a compromise bill to the governor’s desk.

MHA worked through the amendment process in an attempt to provide protections for hospitals that rely on the 340B drug discount program to help manage rising pharmaceutical costs and fund their services to populations that have been historically underserved. The House passed an amendment filed by Rep. Danielle Gregoire (D-Marlborough) that prohibits the MassHealth program from further diluting the 340B program.

Last week, Massachusetts hospitals CEOs informed MHA that as the crush of bills pile up in the final days of the session, one of the greatest priorities is protection of 340B. Hospital leaders have continued to report that if the assaults on 340B from for-profit pharmaceutical companies continue, it would jeopardize their very viability. Following extensive pushback from MHA and its members, a pharma-backed amendment, which was widely viewed as nothing more than an attempt to further erode the federal program using state legislation, was not included in the final House proposal.

“The potential loss of any more hospitals must be top of mind for all of us at this time of incredible fragility, especially considering Steward Health Care’s announcement on Friday that it plans to close two local facilities by the end of August,” said MHA President and CEO Steve Walsh.

Senate Passes Long-Term Care Bill

The Senate last week passed S.2889, An Act relative to long-term care and assisted living aimed at improving the quality of post-acute care by, among other actions, facilitating the establishment of small house nursing homes, mandating new infection outbreak response plans and anti-social isolation policies, and new training and education programs. The bill also creates an LGBTQ+ bill of rights for aging residents to prohibit discrimination based on their LGBTQ+ identity or HIV status.

Both the House and Senate bills require MassHealth and licensed commercial insurers in the state to act on a prior authorization request for post-acute care services by the next business day once the payer has received all necessary information to establish the medical necessity of the services. Additionally, both pieces of legislation would direct state agencies to develop a uniform prior authorization form for commercial insurers and MassHealth to use for admission to post-acute care facilities or transitions to home health agencies.

And to assist with addressing the capacity crisis in hospitals, the Senate legislation establishes a skilled nursing facility rate add-on program for bariatric patient care and a rate add-on program for 1-on-1 staffing of at-risk residents requiring 24-hour monitoring and supervisions for their safety and the safety of other residents. The program could include but not be limited to patients with severe mental illness, aggressive behaviors, elopement risk, or those that are registered sex offenders. In MHA’s May Throughput Report, data indicated that there are more than 40 patients statewide who require 1-on-1 supervision and who are waiting discharge to skilled nursing facilities.

The House version of the bill that was passed in the fall includes language to study and propose recommendations to address acute care hospital throughput challenges and the effects of persistent delays in discharging patients from acute to post-acute care settings. It also adopted provisions backed by the Massachusetts Senior Care Association, MHA, and labor unions to create the role of medication aides in skilled nursing facilities. The Senate also approved an amendment supported by MHA requiring DPH to study and report on “the need and feasibility of qualified professional guardians to give informed medical consent for indigent persons and whether such guardians would reduce hospital discharge issues and increase access to long-term care and preventive care.” Additionally, both bills included language supported by Mass. Senior Care and MHA to establish a fund to address the workforce and capital needs of skilled nursing facilities.

Like the prescription drug bill (see above), and the healthcare oversight bill that both chambers passed, the long-term care bills now move to a conference committee with just days to reach an agreement.

Steward, Citing Lack of Bids, Says It Will Close Carney, Nashoba Valley

Steward Health Care announced on Friday that it did not receive qualified bids on two of its Massachusetts hospitals – Carney Hospital in Dorchester and Nashoba Valley Medical Center in Ayer – and therefore plans to shutter the facilities on or around August 31, 2024.

As of Monday Report’s deadline, Steward had not filed with the bankruptcy court in Texas any documents detailing the qualified bids it has received for its other Massachusetts hospitals: Good Samaritan Medical Center in Brockton, St. Elizabeth’s Medical Center (Brighton), Morton Hospital (Taunton), St. Anne’s Hospital (Fall River) and Holy Family Hospitals (Methuen and Haverhill).

Steward did file documents late on Friday detailing its accelerated closure plans for Carney and Nashoba Valley. Part of that filing is an agreement between the Executive Office of Health and Human Services and Steward to provide approximately $30 million in state funding to support continued hospital operations at Steward’s Massachusetts hospital in August 2024 as those facilities are closed or sold off.

Last Friday, MHA President & CEO Steve Walsh said of the hospital closures, “The company’s announcement today was not easy for anyone to hear – not for local patients, not for the dedicated workers at Carney and Nashoba Valley, and not for the other area healthcare providers that MHA represents.”

Steward Health Care has not been a member of MHA since January 2012.

“Community members and healthcare professionals should know that MHA and our member hospitals have their backs,” Walsh continued. “For the past eight months, we have been working daily with the state to prepare for any scenario that comes our way – including any potential closures. Although this is a challenging time for our healthcare system, our member hospitals stand ready and prepared to meet the needs of every patient. We will continue to rely on tight collaboration among regional hospitals, support from state leaders, and much-needed flexibilities from other components of the healthcare ecosystem as this situation evolves.”

Governor Maura Healey slammed Steward and its CEO Dr. Ralph de la Torre for “greed and mismanagement” that led to the closures.

“For the remaining hospitals, we know that Steward received several bids to not only maintain but improve five of their hospitals in three key regions,” the governor said. “It is time for Steward and their real estate partners to finally put the communities they serve over their own selfish greed. They need to finalize these deals that are in their best interest and the best interest of patients and workers.”

De la Torre Subpoenaed to Testify Before U.S. Senate Committee

The U.S. Senate’s Health, Education, Labor, and Pensions Committee voted last Thursday to begin an investigation into Steward Health Care and to subpoena Steward’s CEO Dr. Ralph de la Torre to testify.

The vote in favor of the investigation was 20-1 with Sen. Rand Paul (R-Ken.) voting no, and the subpoena vote was 16-4 with Paul joined by Republican Senators Tommy Tuberville (Ala.), Markwayne Mullin (Okl.), and Ted Budd (N.C.) in voting no. Massachusetts Senator Ed Markey, who sits on the HELP committee, was thanked by Committee Chair Bernie Sanders (I-Vt.) for bringing the Steward issue to the attention of the Senate.

In opening the 25-minute hearing, Sanders said Steward engaged in an “elaborate Ponzi scheme” to buy hospitals and then sell the land out from under them to a company that “then charged exorbitant rents.” Ranking committee member Bill Cassidy (R-La.) said the HELP committee had never had to issue a subpoena before but was compelled to after de la Torre ignored the committee’s June 25 request, did not offer an alternate date to testify, and did not send a Steward executive to speak on the company’s behalf.

De la Torre’s testimony is set for September 12.

Transition

Dr. Lynette Watkins, the president and chief operating officer of Cooley Dickinson Hospital since September 2021, has announced she is leaving the position to pursue other opportunities. With her resignation, Watkins also relinquishes her post on the MHA Board of Trustees, and as chair of the board’s Clinical Issues Advisory Council (CIAC). Dr. Assaad Sayah, the CEO of Cambridge Health Alliance, will serve as CIAC chair. At an MHA board meeting last Thursday, Watkins was praised as being a strong advocate for health equity, smart healthcare policy, and women’s leadership, and for being an accessible and collaborative colleague.

John LoDico, Editor