July 2010

July 31, 2010

The Senate will be making another attempt to extend enhanced FMAP (federal Medicaid reimbursement; background) on Monday (UPDATE: see below). The additional funds are critical for Massachusetts. Among the many programs dependent on FMAP is coverage for legal immigrants. Without these funds, we know additional cuts will need to be made to state health programs.

Senator Scott Brown is a critical swing vote. Please contact Senator Brown today to urge him to stand for the Commonwealth by supporting the FMAP extension.

Monday evening UPDATE: The vote has been postponed to later this week. Please call today.

You can submit a comment on his web site, or call his office at (202) 224-4543. Also, the Massachusetts Provider's Council has set up a draft email to Senator Brown, that lets you edit and click to send.

July 30, 2010

The proposed conversion of the Caritas Christi Hospital network from a non-profit to a for-profit owned by the Wall Street public equity firm Cerberus appears to be on the fast track. Health Care For All and residents in the hospitals’ host communities are looking to the Department of Public Health and Attorney General Martha Coakley to slow down the train and do their due diligence on this project before they give it the OK.

In comments submitted today to the DPH’s Public Health Council, Health Care For All requested that conditions be put on the sale to reduce the risk that comes with private equity money and ownership and what that means to the accessibility, affordability and quality care at the six Caritas hospitals.

The proposed purchase and for profit conversion of the six community hospitals that comprise Caritas Christi Health Care is unprecedented for the Commonwealth of Massachusetts and has significant implications for the future of health care in the state. In particular, Health Care For All has concerns about Cerberus’ long term commitment to the operation of the hospitals, Cerberus’ commitment to serving the broad needs of the community, and the ability of the Commonwealth to monitor operations and enforce future conditions at the hospitals.

Cerberus Capital Management is a Wall Street private equity firm that has never run a hospital. Its traditional business model consists of purchasing distressed properties, cutting expenses, and then selling the newly-slimmed down business for profit. The public has concerns on how this business model will apply to a network of hospitals providing health care to many of eastern Massachusetts’ most vulnerable residents. Many of the vital services that community hospitals traditionally provide are not money making practices.

With the conversion from a non-profit entity to a for-profit, Cerberus will take on four additional, and significant, financial obligations – taxes, investment return, staff at Cerberus, and continued funding of the pension fund. It is incumbent upon all parties to determine how Cerberus plans to maintain a commitment to the health of community residents currently served by Caritas Christi Health Care while also fulfilling its new fiscal obligations. We are concerned that Cerberus may cut vital services, such as behavioral health care, that have historically been money-losing enterprises. Will Cerberus reduce staffing levels? Will it close money-losing hospitals?

Health Care for All requests that the Public Health Council keeps the following four principles at the forefront in its deliberations and includes the following specific recommendation as conditions for their approval.

  1. Continue to run a transparent, accessible, and inclusive review process.

While understanding the need for the review process to move along in a timely manner, we want to make sure consumers, community groups and advocacy groups have the necessary time to negotiate with the network and the specific hospitals to develop conditions for the conversion. We encourage the DPH to work with the public to ensure the Determination of Need decision occurs after these negotiations are completed.

  • Ensure Cerberus’ Commitment to the Hospital Network, the Host Community, and its History

  • The provisions of the sale, as currently structured, call for a three year period during which Cerberus is obligated to maintain Caritas’ level of charity care and scope of services. (At around three years, private equity firms tend to sell, or flip the company.) When compared to other similar sales around the country, this is an unusually short time period. In at least one case, a twenty-five year clause was included. To ensure the long-term access to health care for the Caritas communities, Health Care For All calls for a seven-year minimum ownership period in which Cerberus commits to operate all six hospitals and to maintain or increase the percentage of patient service allocated to free.

  • Ensure Cerberus’ Commitment to Community Hospitals

  • Cerberus must continue its dedication to the community hospital ideal in its priorities and practices. Since its inception, the Caritas hospitals have been driven by an unwavering commitment to community health care. Community hospitals represent a cost-effective, culturally competent, and efficient acute care delivery system. Health Care For All believes that community hospitals are an integral part of the fabric and the well-being of a community. When run well, these hospitals provide vibrant and robust outreach, care and support for the communities they serve. In addition, community hospitals are vital to a community’s economic well-being as they are often the largest employers in the area.

    To provide a comprehensive assessment of the health needs of the community, Cerberus should carry out a Community Health Needs Assessment in all the six Hospital catchment areas within one year. Cerberus must address the results of the needs assessment, to the satisfaction of the DPH, through its services and community benefits program. Until this assessment is completed, all current services and community benefit programs must be maintained at current or higher levels.

    A robust, well-funded and accountable Community Benefits Program provides vital health services for a community. Programs should be developed in coordination with the concerns of community groups and the Community Health Needs Assessment. In addition, a process with public review needs to be established when the hospital wished to eliminate a program or service.

    July 30, 2010

    UPDATE 4:00 pm Friday: State House News Service is reporting that the conference committee compromise preserves the pharma and medical device gift ban and marketing restrictions. HCFA thanks the conferees and the House and Senate leadership for their support.

    Time is short, so we’ll be brief:

    With a day and a half remaining in the formal legislative sessions, it's now or never for anything controversial. The small business/individual health care premium cost control bill is the most important health priority in the pipeline. We hear the conference committee is making progress and we look forward to a bill being ready tonight so it can be voted on tomorrow. Also,

    • The Legislature should not repeal the drug and device company gift ban and disclosure law. It would be a step backwards on health care cost containment and giving patients information they deserve about their providers. Put patients ahead of profits.

      This sentiment is echoed in today’s Boston Globe:

      … Economic development. House and Senate leaders part company on multiple aspects of a complex economic-development bill. Here are two: First, in the guise of helping restaurateurs, the House would repeal a recent law requiring drug and medical device companies to disclose substantial gifts to medical professionals. The disclosure rules should stay, because drug and device marketing drives up health care costs…

    • Health coverage for over 20,000 low-income legal immigrants hangs in the balance. Unless something happens, the Commonwealth Care Bridge program ends August 31. The Governor has asked for authority to keep the program going on fumes for a few more months, and the legislature should grant that authority.
    • Congress is going to make another try to extend enhanced FMAP, with the Senate vote scheduled next Monday. The legislature should not lose the opportunity to direct where those funds go (if they are approved), and override the Governor's vetoes of FMAP-dependent line items.

    -Mehreen Butt and Georgia Maheras

    July 30, 2010

    Access to oral health care is essential to maintaining overall health. The Oral Health Advocacy Taskforce supports measures that promote access and delivery of crucial oral health services through having a strong network of multiple providers. In the current economic climate, it is essential that we find creative ways to improve access, and as the 2009-2010 legislative session draws to a close, a bill has made its way to the Governor's desk that, when enacted, will do just that.

    The Volunteer Dentistry Bill, proposed by the Massachusetts Dental Society, will improve access by allowing retired dentists to volunteer their services in qualified free-care programs. Dentists must abide by all of the requirements for a dental license set by the Board of Registration in Dentistry, but the fee for licensure will be waived. With 20% of the state's population living in dental health professional shortage areas, this is a welcome change.

    The bill was filed by Senator Marc Pacheco, and was also championed by Senators Harriette Chandler and Susan Tucker, and Representative John Scibak.

    At a time when MassHealth adult dental cuts have created another barrier to care, this measure will help to alleviate the barriers of provider shortages, geographic access, and cost.
    -Courtney Chelo

    July 29, 2010

    The small business health insurance bills passed by the House and Senate (S. 2447 and H. 4924) are being hashed out by a 6-member conference committee - 3 members from the House, and 3 from the Senate.

    The bill contains a number of provisions of direct interest to the brokerage industry, including a provision in the House bill that would add a representative of the broker organization (Mass Association of Health Underwriters - MAHU) to the Connector Board. Other provisions would hamstring the Connector's ability to offer affordable coverage to small businesses. HCFA opposes these provisions. As we've said before, in setting up the Connector Board in chapter 58, the legislature made a principled decision to not include representatives of any industry with a direct financial interest in the Connector’s decisions. We thought it was appropriate at the time to exclude representatives of hospitals, doctors, insurers and brokers. Watching the Connector operate since 2006 affirms our view that adding a broker representative to the Connector Board would be destructive to progress in health reform. Adding a broker to the Connector Board would create a direct conflict of interest, and set a precedent for other economic interests to seek representation.

    Here's what raising questions around the State House. One of the members of the conference committee, Rep. Jay Barrows, is the President and owner of the Barrows Insurance Agency, an insurance brokerage firm.

    While it's not clear if this is a direct violation of state ethics law, since there's no direct personal enrichment at stake, it does raise questions about appropriateness and the appearance of a conflict of interest. Certainly there should be

    July 29, 2010

    This week, advocates for children with special needs were pleased that the Autism Bill looks to be on track to move toward passage before the end of the Legislative session. The bill, which will require insurance coverage for a number of autism services, will provide much-needed help to thousands of Massachusetts’ families. The cost of this relief is a bargain at an estimated 83 cents per member per month.

    At a time when everyone is concerned with health care expenses, lead sponsor Representative Barbara L’Italien said, “We’re pretty confident we can manage those costs in a responsible way.”

    Along the same lines as the Autism Bill is legislation supported by the Children’s Mental Health Campaign – An Act Relative to the Coordination of Children’s Mental Health Care. This bill too would help parents of children with mental health needs by working to ensure that the care for these children is well coordinated between counselors, physicians, teachers, and other people in the child’s life.

    If the Autism Bill is a bargain at 83 cents per month, the Care Coordination legislation is a downright steal. According to a report by the Division of Health Care Finance and Policy, the cost of coordinating mental health care for children is a mere 5.5 cents per member per month, or 66 cents per year!

    With the end of the 2009-2010 session rapidly approaching, the legislature should move now to pass both the Autism Bill and the Care Coordination legislation. These parents can’t wait.

    The time is NOW to act!
    -Matt Noyes

    July 29, 2010

    Tomorrow at the State House, the Massachusetts Public health Association (MPHA) will be hosting a celebration for the signing of the School Nutrition Bill (download invitation here).

    The bill will be signed tomorrow by Governor Patrick. The law, championed by Representatives Koutoujian and Sanchez, and Senators Fargo and Richard Moore, and will promote healthier food options for close to one million Massachusetts public school students. The law is a strong step in the public health fight against obesity, overweight and chronic disease. Join MPHA, the Massachusetts Health Council, the School Nutrition Association of Massachusetts, American Heart and American Stroke Association, and Children’s Hospital Boston on Friday, July 30th at Noon at the Grand Staircase in the State House to celebrate this victory.
    -Mehreen Butt

    July 29, 2010

    Dr. Atul Gawande’s latest piece in The New Yorker, “Letting Go,” brought tears to my eyes multiple times. I have not read a lot on end-of-life care, and what I have read so far is often less personal and more theoretical - articles which tend to look at this extremely complicated and emotional topic from either the perspective of the patients and their families, who have to make wrenching decisions, or from the perspective of providers and how they do or do not work well enough with patients and families regarding this decision-making.

    This is the first piece I have read that is from both perspectives and gives a genuine and personal sense of the deeply difficult discussions and decisions that are made…difficult for the patients/families and for the providers. Dr. Gawande found a way to communicate a complicated and emotional issue so that the reader almost feels like he or she is there, with that family and patient and with the provider, trying to make sense of everything and figure out what to do. And the reader is made to think about what he or she would do if faced with similar situations and decisions. With all of the talk of “death panels” during the health reform debates, there was a squelching of any conversation outside of health policy wonk circles relating to end-of-life care and decision-making. Dr. Gawande’s article, in a non-policy-wonk magazine, can help start to open the door to having these conversations among the broader public:

    Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.”

    People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.

    The article, like his previous article on health spending, is getting a lot of attention in Washington this week. Our Campaign For Better Care and health quality work is focused on improving the health system to make it responsive to patient needs. Dr. Gawande's voice expands the debate in a human way that can not be ignored.
    -Deborah W. Wachenheim

    July 29, 2010

    Rep. Liz Malia Speaks At No On 1 Rally

    On Wednesday afternoon, the Committee Against Repeal of Alcohol Tax held the kick-off for its “Vote No on 1” campaign against the repeal of the alcohol tax outside the Massachusetts State House. Passionate speeches and a high energy level highlighted the importance of denying the alcohol industry a sales tax exemption. A question to repeal the alcohol sales tax will be on the State's ballot on November 2nd.

    Senator Tolman, Representative O'Day and Representative Malia and other advocates for the campaign spoke on reasons the alcohol tax is critical to both the financial and public health of the Commonwealth. As the state faces a large budget deficit this year, Massachusetts cannot afford to grant alcohol a special exemption. Alcohol is not a necessity and its sales have only increased since the tax was imposed in 2009, making an alcohol tax cut unnecessary and fiscally detrimental.

    The money collected from the tax directly funds substance abuse prevention and treatment programs, helping more than 100,000 people across the state. These programs save lives and keep families together, as several speakers illustrated through emotional personal anecdotes.

    Finally, the alcohol tax has been shown by numerous studies to reduce underage drinking. The younger someone is when they first encounter alcohol, the greater the risk of alcoholism later in life. Repealing the alcohol tax would have the negative effects of increasing the number of underage drinkers and potential alcoholics while simultaneously crippling state treatment programs.

    Health Care For All is a supporter of the “Vote No on 1” campaign because of the numerous benefits the alcohol tax provides to both individuals and the commonwealth as a whole. For more information, check out the Committee Against Repeal of the Alcohol Tax website: NoOn1MA.com.
    -Oliver McClellan

    July 28, 2010

    This week is the 20th anniversary of the Americans With Disabilities Act, which mandates equal opportunities for individuals with disabilities in employment, access to public facilities, transportation and telecommunications.

    Here in Boston, this important landmark was celebrated with a march and a rally on the Common. However, we should also use this as a reminder that there is still work to be done to truly create equity.

    Oral health is central to the health and well being of all people, including those with disabilities. Dental decay is a bacterial infection and can spread to the rest of the body if left untreated. What begins as a cavity can quickly progress into a life-threatening infection. Good oral health reduces long-term health care costs by reducing sources of infection, supporting communication, nutrition, and improving quality of life.

    Brushing and flossing alone are not enough- access to dental care is crucial to maintaining overall health. It is especially important for those who may have limited mobility and are unable to brush or floss on their own. Additionally, some people without use of their arms or legs rely on their mouth for day-to-day activities, such as maneuvering by wheelchair, dialing a telephone, turning on a light switch, and typing by manipulating a mouse stick with their mouth.

    Recent changes to MassHealth adult dental benefits make it more difficult for people to access critical components of oral health care such as fillings, root canals, treatment for gum disease and dentures. MassHealth no longer covers these services; people must instead try to gain access through a community health center.

    So as we celebrate this important anniversary, let’s continue to stand up for oral health. For more information on how to get involved, please contact Christine Keeves at ckeeves@hcfama.org.
    -Christine Keeves

    July 28, 2010

    HCFA urges the legislature to put patients first and not repeal the drug and device gift ban and disclosure law. Section 105 in the House version of the the Economic Reorganization Bill would repeal Massachusetts’ groundbreaking drug and device marketing gift ban. HCFA urges Massachusetts residents to contact their Senator and Representative and tell them that they do not want pharmaceutical and medical device company marketing practices to come between patients and their doctors.

    Currently, the gift ban and disclosure law forbids pharmaceutical representatives from wining-and-dining doctors to convince them to purchase brand name medications. It also requires disclosure of any ‘non-gift’ payments to providers. The gift ban and disclosure law is an essential part of Massachusetts’s efforts to curb health care costs and guarantee the ethical delivery of health services.

    The gift ban and disclosure law encourages the drug and device industry to put a limit on the over $6 billion spent annually on direct-to-physician marketing. The logic of restricting the inherent conflict of interest that impacts patient-centered care is perhaps best exemplified by the fact that medical schools like UMass, Boston University and now Harvard have passed their own stringent gift ban and disclosure policies.

    Opponents of the gift ban and disclosure law claim that it has forced medical conventions and drug and device manufacturers out of the Commonwealth and has caused a dramatic loss in profits in the restaurant industry. However, not only do medical conventions continue to flourish in Massachusetts, but a large number of drug and device manufacturers have in fact chosen to relocate to the Commonwealth since the gift ban was enacted. Further, it's clear that the recession, and not the gift ban, is the real reason behind restaurant industry losses, considering that states without a gift ban have experienced similar losses since 2008.

    The Senate recently appointed a conference committee to reconcile their economic reorganization bill with the House version. HCFA hopes that the committee responds to Senator Montigny’s (one of the conferees) view that the ban benefits everyone—since “all taxpayers become patients.” Patients need the comfort of know that their doctor is prescribing in the best interests of the patient, free of inappropriate outside influences.
    -Devin Cohen

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