INSIDE THE ISSUE

> Steward Bankruptcy Hearing
> St. E’s Eminent Domain Case
> DOI to Insurers: Be MORE Flexible
> CHIA on Quality, Satisfaction
> Rx Cause of Health Spending Increase
> New COVID-19 Vaxes OK’d

MONDAY REPORT

Steward Hearing Delayed, Rescheduled for Tomorrow

A much-awaited hearing last Thursday before the U.S. Bankruptcy Court in Texas to determine the fate of the Steward Health Care hospitals in Massachusetts was once again delayed by Steward and its landlords. The new hearing date is tomorrow, August 27.

If the hearing does indeed go forward, the bids for five Steward hospital in Massachusetts from Boston Medical Center, Lawrence General Hospital, and Rhode Island-based Lifespan could become public.

Boston Medical Center has bid on Good Samaritan Hospital in Brockton and Saint Elizabeth’s Medical Center in Boston (see story below). Lawrence General Hospital made offers for Holy Family Hospital’s two campuses in Haverhill and Methuen. Lifespan would be the new owner of Morton Hospital in Taunton and Saint Anne’s Hospital in Fall River.

As is its right under the court-approved Bidding Procedures Order, Steward did not have to give any reason for delay. But at the start of the bankruptcy court’s Thursday hearing on other matters relating to Steward’s hospitals in Florida and Pennsylvania, a lawyer for Steward said, “we’re very close to the finish line” in Massachusetts.

If and when the purchases go through, the U.S. Bankruptcy Court will have to resolve a related issue between Steward, which owns the hospital operations, and MPT, which owns the land beneath the hospitals. The two entities are arguing in the court about how money from a successful bidder will be apportioned between them. Specifically, Steward filed an adversary complaint accusing MPT of violating the bidding procedure by unilaterally negotiating with bidders without the participation of Steward. “MPT has been leveraging its position as owner of the hospitals’ real estate assets to extract value from bidders that undercut [Steward’s] interests and has been otherwise interfering in the bidding process in ways that have caused bidders to ascribe an unreasonable and excessive value to hospitals’ real estate assets, such that the [Steward] will realize negligible value, if any, for the operating assets,” Steward wrote.

In a related filing, MPT wrote, “In reality, it is the Debtors [Steward] who have prevented sales from going forward, not to protect public health or the like but to attempt to force MPT to transfer real-estate value to the Debtors and their lenders as the price of allowing sales to go forward that are necessary to avoid closures.”

St. Elizabeth’s Property Owners Will Challenge Eminent Domain Taking

As the healthcare community waits until tomorrow for the scheduled bankruptcy hearing in Texas to hear the latest on bids for five Steward hospitals in Massachusetts (see previous story), the fate of the sixth Bay State Steward hospital – St. Elizabeth’s – was clouded last week.

As previously reported, Massachusetts announced it would take the St. Elizabeth property in Brighton by eminent domain for a price of $4.5 million. On August 20, ACREFI, which controls the underlying property along with Apollo and MPT, wrote to the Executive Office of Health and Human Services (EOHHS) saying it flatly rejected the offer that “significantly undervalues the real property underlying St. Elizabeth’s.”

In its letter, ACREFI noted that the $4.5 million is less than the annual taxes paid on the property ($5,141,772.40), which has a tax-assessed value of “over $200,000,000.” Therefore, ACREFI wrote, it “intends to exercise its constitutional and statutory rights to vigorously challenge any proposed award at the valuation reflected by the Commonwealth’s proposed offer, and expects that such a challenge will be successful and result in a substantially larger award.” The company said it was open to further negotiations with the state on the fate of St. E’s.

The State House News Service quoted the Healey administration as saying in response to the letter, “Steward and Apollo need to stop playing games with people’s healthcare. We are moving forward with plans to take St. Elizabeth’s by eminent domain.”

DOI Clarifies Its Bulletin Relating to Steward Flexibilities

As Monday Report reported last week, the Division of Insurance issued Bulletin 2024-09 requesting that commercial health insurance companies extend flexibilities so that patients of Steward’s Carney and Nashoba Valley hospitals – which are scheduled to close – can continue to receive care covered by the insurers.

Last Thursday, at the request of MHA and supported by other provider groups, DOI clarified that Bulletin to say it expects the order to apply to “to all admissions, surgeries, procedures, imaging, and other specific pre-authorized services that were scheduled to take place within the physical structure of Carney Hospital and Nashoba Valley Medical Center upon notice of the updated location and date of service. In addition, the Division also expects that patients will not be required to attain referrals for procedures, imaging, specialty services and other services that require referrals if those referrals have already been processed. As noted within the Bulletin, the Division expects that the facilities will notify carriers about inpatient admissions and procedures within 24 hours of admission or provision of the services that were scheduled to take place in Carney Hospital or Nashoba Valley Medical Center.”

CHIA Report Looks at Quality Measures, Patient Satisfaction

The latest report from the Center for Health Information and Analysis (CHIA), which focuses on primary care healthcare outcomes and patient experiences, found that most quality measure scores are improving and that while patients generally reported high satisfaction with their providers, the satisfaction scores varied by race.

CHIA used the Healthcare Effectiveness Data and Information Set (HEDIS) to assess quality and the Patient Experience Survey (PES) to assess how patients felt about their care. The PES results were provided to CHIA by Massachusetts Health Quality Partners (MHQP). All of the results are posted on this interactive dashboard from CHIA. The most recent data in the report is from two years ago – 2022.

The key takeaways from the report include:

• 13 of 18 health quality measures improved between 2020 and 2022.
• Almost all measure changes – either improving or declining – were within four percentage points between 2020 and 2022.
• Adult satisfaction with their providers remained high, with measures relating to Communication, Office Staff, Willingness to Recommend the provider, Knowledge of Patient, and Integration of Care all exceeding 90%, and with Trust earning an 87.7% score.
• However, while scores from White patients mirrored the overall state scores, the results from Asian and Black patients were more variable.
• In the Integration of Care, Trust, and Adult Behavioral Health measures, the discrepancies between the races were greatest.
• All races found the primary care practices came up short in the Self-Management Support measure.

New Report: Employers Worry About Pharmaceutical Costs

A group that surveys large employers has released a report indicating that the companies expect to spend nearly 8% more on healthcare in 2025, with the bulk of the increase attributable to rising pharmaceutical costs.

The Business Group on Health (BGH), which says its membership in total provides health coverage for 60 million workers, surveyed employers in June and July of 2024, and received results from companies that in total cover 17.1 million people in the U.S.

Those respondents say the projected 8% increase in spending is mainly due to increased pharmaceutical costs, especially costs relating to GLP-1 anti-obesity medications. BGH said “most employers called for a combination of market and government reform to curb drug prices.”

While the employers said that cancer care is the top condition driving costs, cardiovascular conditions are among the top three cost drivers.

“Fully 79% of survey respondents reported that improving access is a top mental health priority for 2025,” BGH wrote. “To address both access and cost, employers said they were continuing to pursue strategies such as no- or low-cost virtual counseling, eliminating out-of-network barriers and the use of on-site counselors.”

FDA Okays New COVID-19 Vaccines from Moderna, Pfizer

The U.S. Food and Drug Administration (FDA) last Thursday granted emergency use authorization for updated COVID-19 vaccines from Moderna (Spikevax) and Pfizer (Comirnaty).

The new vaccines are targeted to fight the Omicron variant KP.2 strain.

Individuals 12 years of age and older are eligible to receive a single dose of the updated Comirnaty or Spikevax vaccines; if previously vaccinated, the dose is administered at least two months since the last dose of any COVID-19 vaccine. Individuals of other ages or those who are immunocompromised can receive other series of doses of the two vaccines; details are included in the vaccine fact sheets.

Vaccines from the two companies are expected to become available immediately. The FDA said that going forward it expects to reassess the composition of COVID-19 vaccines annually as it does for flu vaccines.

John LoDico, Editor