INSIDE THE ISSUE

> Deals Reached on All Steward Hospitals in Mass.
> Carney & Nashoba
> Long-Term Care Bill
> Death Registry
> BH Loan Forgiveness

MONDAY REPORT

Lifespan, Lawrence, BMC Sign Agreements to Purchase Steward Hospitals

The fate of Steward Health Care in Massachusetts became clearer last week as six of the system’s hospitals were sold and the remaining two were closed.

Rhode Island-based Lifespan health system announced on Thursday that it was paying $175 million to purchase Steward Health Care’s Morton Hospital in Taunton and Saint Anne’s Hospital in Fall River. Lawrence General Hospital also announced on Thursday that it has inked an agreement to purchase Holy Family Hospital’s two campuses in Haverhill and Methuen for $28 million. On Friday, Steward announced that Boston Medical Center agreed to purchase Good Samaritan Medical Center in Brockton and St. Elizabeth’s Medical Center in Brighton for $143.5 million.

The Lifespan and Lawrence General payments are for the hospitals’ operations, buildings, and, notably, the land on which the hospitals sit. As has been reported in recent weeks, the successful bidders for Steward’s hospitals have been in negotiations with the entities that own the land under the facilities and that have been charging what the bidders considered onerous rents.

BMC’s agreement with Steward for Good Sam also includes the land under it, but the St. E’s purchase agreement does not. The asset purchase agreement for St. Elizabeth’s notes that the property owner, MPT, will not challenge the ability of the Commonwealth of Massachusetts to seize St. Elizabeth’s Medical Center by eminent domain, but that it reserves the right to challenge the purchase price ($4.5 million) Massachusetts had announced.

A hearing in the Texas bankruptcy court overseeing the dissolution of Steward is scheduled for Wednesday, September 4 at 11 a.m. ET. Presentations on all of the Massachusetts purchase agreements are expected at that time.

The deals, long in the making, are nonetheless far from being final. The bankruptcy court must approve the sales, as must state and federal regulators. The parties noted that “satisfaction of various sale contingencies” enumerated in the purchase agreement also must be fulfilled.

In announcing its purchase, Lifespan said it was finalizing an agreement with Massachusetts to receive “modest support” over a “limited timeframe” to help it assume control of St. Anne’s and Morton.

“I am confident our team has the experience and know-how to rebuild the infrastructure of these two hospitals and operate them as successful and thriving not-for-profit organizations,” said Lifespan President and CEO John Fernandez. Fernandez is well known in Massachusetts healthcare circles as the longtime former CEO of Mass Eye & Ear.

Abha Agrawal, M.D., president & CEO of Lawrence General Hospital, said of the asset purchase agreement Lawrence inked, “We are excited about the opportunity to build a true regional healthcare care system in the Merrimack Valley, one that puts quality and safety at the forefront of everything we do and is guided by the principle of caring for our community. We are grateful to the many stakeholders who have helped in this process, including our federal and state legislative delegations, local officials, and the unions who represent employees at Holy Family Hospital.” Agrawal said the state provided support to assist its purchase of the Holy Family hospitals. BMC will also receive state financial support for its purchase.

“We are pleased to have reached an agreement to transition the operations and now shift focus to finalizing the transaction, integration planning, and efforts to support the workforce and community,” said Boston Medical Center Health System President & CEO Dr. Alastair Bell upon news of the agreements Friday evening. “With this agreement today, we are grateful for the Healey administration’s leadership in averting a public health crisis, and for securing high-quality healthcare that will serve communities long into the future.”

Steward’s agreement with the purchasers is contingent on Steward receiving $42 million from the state to continue operations at the hospitals in September, as well as “accrued payroll obligations” prior to the deals being made final.

“This marks a new and hopefully brighter chapter for healthcare in Massachusetts,” said MHA President & CEO Steve Walsh. “We know these systems are ready for the hard work ahead to restore stability to Steward’s former hospitals, coordinate with other local providers, and create a new legacy for the patients, workers, and communities they serve.”

Carney and Nashoba Valley Hospitals Close

The bankrupt Steward Health Care system closed two of its Massachusetts hospitals on Saturday, August 31 — Nashoba Valley Medical Center in Ayer with 38 licensed staffed beds, and Carney Hospital in Dorchester with 91 beds.

The closures were the latest and most painful chapter in Steward’s well-documented mismanagement of the hospitals it had acquired across the U.S. A bankruptcy court in Texas is currently overseeing the complicated dismantling of the system.

While Massachusetts and Rhode Island hospitals made bids to acquire six other Steward hospitals in Massachusetts (see story above), no one could put together a viable plan that would result in Nashoba and Carney hospitals staying open. Carney has historically been one of the most economically challenged hospitals in the state, most recently having a negative 32% operating margin; Nashoba has reported negative operating margins for at least the last seven years, according to the state’s Center for Health Information and Analysis. Steward hospitals’ true financial performance has always been clouded by the system’s refusal to provide the state with requested data.

The hospital closures have generated great sadness, frustration, and anger in the communities they served. While Carney Hospital is just two miles away from Beth Israel Deaconess Hospital–Milton, Carney’s community of patients – like patients of other hospitals across the state – formed close bonds with the facility. Nashoba Valley’s closest hospitals are Emerson Health in Concord (17 miles) and UMass Memorial HealthAlliance-Hospital, Leominster (14 miles).

A patient care ombudsman reported to the bankruptcy court in Texas last week that the abrupt closure of Nashoba will “unduly tax” the ability of EMS providers to transport patients in a timely manner and will place great burdens on nearby emergency departments. “This toxic combination of delayed EMS response times and overtaxed EDs will lead to dire results for patients needing emergency care,” Ombudsman Suzanne Koenig wrote.

Koenig suggested that ambulances be stationed at Nashoba and Carney after the closures to ensure that people arriving for emergency care at the facilities have transport options to other hospitals. Governor Healey said on Friday that ambulances will indeed be stationed at Carney and Nashoba Valley 24/7 for seven days after Saturday’s closure.

Also on Friday, the state said it was in discussions with UMass Memorial Health about potential new uses for the Nashoba Valley facility. UMass Memorial Health President & CEO and MHA Board of Trustees member Dr. Eric Dickson had earlier in the week suggested converting parts of the hospital into an urgent care center or skilled nursing facility.

Legislature Sends Long-Term Care Bill to Governor

Last Thursday, the Massachusetts legislature passed and sent to the governor’s desk a comprehensive long-term care bill that will, among other things, help clear insurance company prior authorization logjams that have delayed transitions from acute care hospitals to post-acute care.

H.5033 approved by the House and Senate is the compromise bill that emerged from a conference committee created just days before the legislature’s formal session ended July 31. Even though there was not a compromise before the busy close of the session, negotiators considered long-term care a priority and emerged last week with a compromise bill that could pass both chambers unanimously in the informal session.

The bill tightens oversight of long-term care facilities, creates new career ladder and reimbursement models to retain workers in those settings, and requires DPH to support the licensure of “small house nursing homes.”

Of special interest to MHA and its members, the legislation establishes a two-year pilot program that requires commercial insurers licensed in Massachusetts to approve or deny requests for prior authorization for post-acute care services by the next business day following receipt by the payer of all necessary information to establish the medical necessity of the requested post-acute care services.

It also instructs MassHealth to establish 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 supervision for their safety and the safety of other residents and staff. (MHA’s monthly “throughput” surveys have identified patients who require 1-1 care as those who wait the longest for post-acute care discharge.)

The bill also:

• directs the Division of Insurance to develop and implement a uniform prior authorization form for the admission of patients from an acute care hospital to post-acute care settings to be used by all insurers, including MassHealth;
  
• creates a Long-Term Care Workforce Fund to address the current 20% staff vacancy rate at long-term care facilities, which limits the ability of facilities to accept patients;
  
• directs DPH to create a program for the certification, training, and oversight of certified medication aides to administer medications to long-term care patients, subject to oversight from nurses or physicians;
  
• makes permanent the COVID-era flexibilities that allow for the provision of basic health services at assisted living facilities; and
  
• requires DPH to study and report by July 31, 2025, on the feasibility of having qualified professional guardians give informed medical consent for indigent persons and whether such guardians would reduce hospital discharge issues.

“In addition to strengthening Massachusetts’ long-term care sector, this bill provides innovative tools to address some of the most persistent capacity, discharge, and access challenges occurring at our acute care hospitals,” said Adam Delmolino, MHA’s senior director, virtual care & clinical affairs. “By focusing on the long-term care workforce, the simplification of insurance authorizations, the needs of the most complex MassHealth patients, and important pandemic-era flexibilities, we are hopeful that this legislation can help free up some of the 1,700 hospital beds occupied by patients in need of post-acute care services. We commend the legislature for envisioning a more flexible, patient-oriented continuum of care for the commonwealth.”

Death Registration Process to Change September 30

The process for filing death notices with the state’s Registry of Vital Records and Statistics (RVRS) is changing on Monday, September 30. That’s when the state transitions from the current Vitals Information Partnership (VIP) system to the more streamlined, digitally based Massachusetts Vital Records Information Collaborative (MAVRIC).

Hospitals are often responsible for filing death registrations. Any death registration started in the VIP system, including those started on Sunday, September 29, must be completed before September 30. As of Monday, October 21, no one will be able to access VIP for death records. All existing, registered VIP records will be moved to the new MAVRIC system. Birth registrations, however, will still go through the VIP system. The MAVRIC birth module should be released in late 2025 or early 2026.

Over the past few months, MHA has assisted the state in disseminating information to the healthcare community about the necessity of training for the new MAVRIC system. RVRS’ online Knowledge Center for Registration Partners offers updated information on MAVRIC and trainings.

MA Repay Announces New Loan Forgiveness Program

The MA Repay program, designed to help certain healthcare workers pay off their student debt, has announced the availability of additional funding to assist behavioral health workers. The program from the Executive Office of Health and Human Services (EOHHS) is operated through the Massachusetts League of Community Health Centers.

Eligible professionals who commit to providing behavioral health services for four years in settings such as acute care hospitals, community health centers, community mental health centers, inpatient psychiatric hospitals, outpatient treatment facilities, schools, substance use disorder treatment centers, and more, can receive student loan repayment awards, ranging from up to $12,500 for mental health workers to $300,000 for full-time psychiatrists.

 Applications for the program opened on August 28, 2024 and close on September 25, 2024. Interested candidates can find more information and apply through the designated portal here.

Eligible applicants include psychiatrists, psychologists, physicians providing behavioral health care at community health centers, psychiatric mental health nurse practitioners, registered nurses, social workers, and other mental health professionals with qualifying degrees and outstanding educational debt.

In addition to new funding, the state will award remaining funds from the first three MA Repay initiatives:

• The Substance Use Treatment Provider Student Loan Repayment Program offers loan repayment for substance use disorder treatment professionals in eligible Massachusetts settings.
• The Behavioral Health & Primary Care Student Loan Repayment Program offers loan repayment for behavioral health and primary care professionals in eligible Massachusetts settings.
• The Child and Adolescent Psychiatrist Student Loan Repayment Program offers loan repayment for child and adolescent psychiatrists in Massachusetts community health centers and community mental health centers.

John LoDico, Editor