May 2015

May 23, 2015

The State Senate finished its work on the Fiscal Year 2016 budget early in the morning on Friday.  A number of HCFA's priorities were included in the final budget, including funding for early intervention, an earmark for the Office of Health Equity in EOHHS, and a restructuring of CHIA to allow for oversight of an independent agency. Other priorities of ours, such as reinstating full dental coverage for adults on MassHealth, were not approved by the Senate. A bright spot in the budget was some real progress on a number of public health initiatives, where HCFA collaborated with our partners at the Mass Public Health Association on several issues. We asked Rebekah Gewirtz, Executive Director of the MPHA, to let us know about their good news in a guest post:

Mass in Motion logoThe Massachusetts Public Health Association (MPHA) is thrilled to announce that because of statewide advocacy efforts on the ground and the tireless leadership of our senate champions, Mass in Motion once again received dedicated funding of $250,000 in this year’s Senate budget.  Last year was the first year funds were earmarked specifically for Mass in Motion in the state budget. We know the reason it continued is because senators understand how important funding is to promoting the health of all communities and particularly low income and communities of color, most impacted by chronic disease. 

In addition, for the first time, language to fund the Massachusetts Food Trust program, also known as Healthy Food Financing, was included in the Senate budget.  While we have work to do to achieve our goal of a $2.5 million state budget appropriation, this language affirms the importance of the program even in a year when there is a budget deficit.  Another key public health victory was passage of an increase in the Earned Income Tax Credit, which is proven to help lift low income, working families out of poverty and in turn, improve health outcomes.  Studies have linked increases in the EITC with positive outcomes for maternal child health including a marked decrease in low birth weight babies.  Another positive outcome from the Senate budget was a new excise tax on flavored cigars.  Products like candy flavored cigarettes and cigars are intended to hook kids and are aggressively marketed to a younger audience.  Some $4 million in revenue from this new excise tax would be directed to tobacco control and cessation programs. 

Overall, this was a difficult budget year.  Many programs were cut or underfunded.  MPHA has always supported progressive revenue measures to ensure we have adequate funds to support key public health programs like Mass in Motion and the Food Trust.  And also for those programs that protect essential public health services like those provided by the state laboratory at Hinton.  Lab funding was once again reduced this year, which concerns us greatly.  We need to continue to raise awareness about how the lab impacts our lives each and every day – from inspectors for the food we eat to air quality monitoring that protects the air we breathe. 

The victories we saw in the Senate budget do not conclude the budget process.  The budget now goes to conference committee where we need to work hard to preserve our hard fought victories.  For more information on how to get involved in your own community or with us in the State House, please see our website at www.mphaweb.orgAlso: please support our work by attending our upcoming spring awards breakfast.  At the breakfast we honor 4 public health heroes across the state who work arm in arm with MPHA and our allies at HCFA and elsewhere to fight for systems change to improve the health and wellbeing of all residents of the Commonwealth.  The breakfast is on June 5th from 8:30-10:30am in the State Room at 60 State Street.  For tickets also check out our website.  We’ll see you there!

    -  Rebekah Gewirtz

 

May 20, 2015

MACRMI logo

MACRMI (The Massachusetts Alliance for Communication and Resolution following Medical Injury) held its 3rd annual CARe Forum yesterday. MACRMI works to advance the development of Communication, Apology and Resolution (or CARe) programs in Massachusetts hospitals. These programs are intended to foster openness and transparency following the occurrence of a medical error or an unanticipated outcome. There are many resources on the MACRMI website.

Yesterday’s forum included updates on the CARe program in Massachusetts, which has so far been implemented at pilot sites at Beth Israel Deaconess Medical Center, Baystate Medical Center, and the affiliated hospitals of both institutions. Also Sturdy Memorial Hospital and Atrius Health have been added as pilot sites.

The highlight of the day was the afternoon panel which focused on a specific error that occurred at BIDMC. All parties involved spoke about the error and the CARe process that followed, including the patient, her attorney, the hospital’s attorney, staff from the patient safety division of the hospital, and the chief surgeon of the department within which the error occurred (though he was not directly involved in the incident). The patient and her attorney both spoke via pre-recorded videos. The patient (named Tricia) had been at BI for gallbladder surgery. A number of months later she noticed on a report from her time in the hospital that there had been an incidental finding of a mass on a CT scan relating to the gallbladder surgery. She was never notified of the mass and then through her own outreach found out that she had Stage 3 ovarian cancer.  As a result of this delayed diagnosis and the fact that she should have been notified about the finding months earlier, she found an attorney and they sent the hospital a pre-litigation letter.

The hospital reached out to see if the patient could come in and meet with them so they could hear more from her.  This meeting did occur and the patient and her husband both felt that they were listened to and heard. They also received an apology from the staff in attendance and the staff explained changes they made to protocols to prevent something similar happening to another patient. She continues to get treatment for the ovarian cancer at BI because she still trusts them and their care. Luckily, it was determined that the delay did not lead to a long-term impact on her care and she is currently cancer free. The hospital did offer compensation to her, and after discussing her options with her attorney she agreed to accept, thus avoiding a lengthy legal process.

This panel was an example of how the CARe process can work to bring the patient and the providers together as human beings to talk about what happened and apologize. The patient’s attorney, Jeff Catalano, was a leader in working with the medical society to pass legislation (within Chapter 224) to promote apology, disclosure and compensation and he has continued to educate other attorneys about CARe programs and the impact on patient safety and transparency.

This kind of program, as it spreads across more hospitals, will hopefully lead to more openness and discussions both among hospital staff and between staff and patients/families about errors and how to prevent their recurrence. As hospitals develop and implement the programs, it is vital that they engage patients and families in the process. Patient and Family Advisory Councils (PFACs) are ideal vehicles for bringing in the patient and family perspective to the development of the CARe program.  

      - Deb Wachenheim, HCFA's Patient/Family Organizer and Coalition Coordinator

MassHealth notice regarding new coverage of dentures
May 15, 2015

 

Today marks a milestone in the 5-year effort to restore full oral health and dental benefits for adults on the MassHealth program. Today, MassHealth is restoring coverage for dentures (here's the official notice), another step along the road we hope leads to full coverage of all dental care.

In 2010, the Governor eliminated almost all dental benefits for adults on the MassHealth program - over 700,000 people, including 120,000 very low-income seniors. The cut reversed a legislative directive to include all dental services for MassHealth members, included as part of the Romneycare law, chapter 58 in 2006.

Lack of access to comprehensive and consistent oral health care creates a serious burden for the most vulnerable residents of the Commonwealth and can lead to pain, suffering, and in the worse cases, death. Fortunately, dental disease is almost entirely preventable when people have access to prevention and treatment services.

Oral health is overall health. Dental decay is linked to many complex, costly health problems, such as heart disease, stroke, HIV/AIDS, and diabetes. Oral disease can cause needless pain and suffering, and may spread throughout the body. Oral disease negatively impacts the management of chronic diseases such as diabetes, heart disease, and HIV/AIDS in that if one is unable to chew, eat or have dental function, they may not be able to adhere to dietary or prescription regimens.

Our Helpline hears regularly from people impacted by the cuts. A Mattapan man, unemployed and with eight recent extractions, is unable to afford the dentures he needs. He can neither eat nor speak properly and he certainly cannot interview for jobs. A Springfield woman with diabetes and mental illness told us she had to have all of her teeth pulled. Her doctor warned that without dentures, which are not covered by MassHealth, she will only get sicker. Across the Commonwealth, residents’ health is deteriorating dangerously because of a lack of access to basic oral health care and treatment.

Over the past few years, the legislature has slowly restored some benfits, including fillings and cleanings. The budget for this fiscal year (which runs from last July 1 to June 30 of this year) included limited funds for full, but not parital dentures. But the limited amount forced MassHealth to delay implementation to today, just 45 days before the end of the fiscal year.

We continue to push for full restoration of all benefits. Senator Jason Lewis, Senate chair of the legislature's Public Health Committee, recognizes that without access to comprehensive care, patients are forced to turn to emergency rooms, clinics, and inpatient hospitalization for treatment, and the Commonwealth wastes millions in emergency oral health care treating diseases and infections that could have been prevented. He is sponsoring a budget amendment in the Senate (Amendment 896) that would add funding to restore all dental benefits for adults on MassHealth. The Senate is expected to vote on the amendment early next week.

A group of HCFA activists will be gathering at the State House on Tuesday evening to meet with their senators about the dental care amendment. Please contact your state senator to add your voice.

   - Brian Rosman

May 14, 2015

Participants at HCFA's 3rd annual PFAC Conference - May 2015

Over 200 Patient and Family Advisory Council (PFAC) members from across Massachusetts gathered at the College of the Holy Cross conference center on Tuesday for a full day of learning and networking. With 64 hospitals and clinics represented at the conference, attendees came from as close by as Worcester and as far away as Nantucket and the Berkshires. Many of them took time off from work or from family responsibilities for the opportunity to learn from one another and from other experts in the field.

Jim Conway of the Harvard School of Public Health kicked off the day with an inspiring keynote address. Jim has a long history working in and promoting patient safety, quality improvement, and patient- and family-centered care. He was at Dana-Farber when it established its first PFAC and he has advocated for patient/family/community engagement through his work at the Institute for Healthcare Improvement (IHI) and elsewhere.  Jim is a true believer in the power of the patient and family voice in improving health care.

Participants had a choice of 12 breakout sessions throughout the day, with topics ranging from recruitment and goal-setting to mental health care, end-of-life care, and patient safety. All sessions ended with participants completing “Taking Action” forms so that they could think about what they learned and what their next steps would be toward implementation, including bringing the information back to their PFACs.

Represenative Denis Provost and Former Senator Richard Moore received recognition at the 2015 PFAC Conference

At lunch, attendees saw a recorded message from EOHHS Secretary Marylou Sudders thanking them for their dedication and reminding them of the importance of their work for all health care consumers in Massachusetts. We had the opportunity to thank former Senator Richard T. Moore and Representative Denise Provost for their leadership in passing the Massachusetts PFAC mandate in 2008. Frank Saba, CEO of Milford Regional Medical Center, and Jo-Ann Morgan, co-chair of the Milford PFAC, presented an award to Senator Moore. Mary Cassesso, President of the Cambridge Health Alliance Foundation and Chief Community Officer at CHA, and Barbara August, co-chair of the CHA PFAC, presented an award to Rep. Provost.

Kevin Dow and Barbara Williams, members of the Massachusetts PFAC Advisory Board (coordinated by HCFA), spoke about the Board and its agenda. The agenda will guide the Board’s work for the coming year and also gives broad goals to which all PFACs should aspire:

  • All PFACs must take the lead on their own initiatives and/or be deeply involved in an existing hospital initiative;
  • All PFACs must be involved in the hospital beyond the PFAC itself (eg. staff trainings, hospital committees, and more);
  • All PFACs must be representative of the communities served by the hospital.

We welcome PFAC members to join the Advisory Board as it engages in this work over the coming year. Please contact Margo Michaels at mmichaels@hcfama.org to learn more.

PFAC members who attended the conference were excited to learn from one another during breakout sessions, by viewing posters that 24 PFACs created and had on display during the conference, and by networking throughout the day. Attendees left the conference energized and inspired to strengthen their PFACs and become true partners with their hospitals and clinics in improving care for their communities.

 

May 11, 2015

2015 PFAC report coverHealth Care For All, in partnership with its Massachusetts PFAC Advisory Board, released its 4th annual summary of the efforts of Massachusetts Patient and Family Advisory Councils (PFACs). HCFA was the lead advocate for the 2008 law requiring all Massachusetts hospitals to establish PFACs. The PFAC regulations require all hospitals to write annual PFAC reports outlining their activities over the previous year. All Massachusetts hospitals' 2014 annual reports are posted on the HCFA website. The latest HCFA report summarizes all of these individual reports, giving a snapshot of Massachusetts PFACs' efforts and development.

This year's report highlights a number of impactful PFAC projects, with a focus on those that ar PFAC-initiated (and then implemented in partnership with the hospital), that involve patients and families in the hospital beyond the PFAC itself (eg. serving on hospital committees, serving on hiring committees, acting as co-trainers for staff), and that seek to engage diverse voices from the communities served by the hospital.

Over the past few years we have seen more PFACs become valued partners in improving care in their hospitals and in the communities, but many PFACs are still seen as separate from the rest of the hospital and are not empowered to initiate projects or to become deeply and meaningfully involved in hospital initiatives. A key ingredient to a successful PFAC is real and open support from the hospital leadership. The leadership needs to create a culture where patient and family involvement is a priority and is vital to any decision-making at the institution.  There are hundreds of PFAC volunteers across Massachusetts eager to bring their experiences and their perspectives to improving care. They can only make a difference when they have a true partnership with their hospitals.

On May 12, over 230 of those volunteers from 64 hospitals and health centers will gather in Worcester for the third annual Massachusetts PFAC conference. They will celebrate their accomplishments, share their challenges, and discuss how to work together to further PFACs' development and efforts.

        - Deborah Wachenhiem

May 11, 2015

Governor Baker grabbed a lot of attention last week over an arcane corner of health insurance regulation - small group rating rules.

We've written about this issue before. Here's the quick skinny: when Chapter 58 in 2006 merged the individual and small group health insurance markets, larger firms complained that they would face premium increases, due to the addition of the typically sicker-than-average individuals to their pool. So Massachusetts allowed insurers to offer discounts to the larger small groups. But, the discounts are matched by surcharges added to premiums paid by individuals and smaller small groups. So larger small groups (typically companies with 35-50 workers) pay less than they should, and individuals and small firms pay more than they should. The spread resulted in the winners saving around 10% on average, with some companies saving over 18% of the fair premium.

Massachusetts also allows discounts and surcharges based on the industry, so some groups of companies, typically those with older workers, pay more than the average premium, while others get a discount.

The whole system is a zero-sum game, with every discount matched by a surcharge imposed on someone else.

Then along comes the ACA, which bans all of these distortions and adjustments. The Patrick administration complained that moving from our system directly to the ACA would cause big premium shifts. So the state worked out a deal with the federal officials to phase out our system over four years. In 2014 and 2015, we can only use 2/3 of the state factors, and next year, 1/3. The plan is for them to be gone by 2017.

Now the Baker administration has asked to freeze the phase-out and lock in our current system indefinitely (here's his letter).

We disagree.

Here's our counter letter to federal HHS Secretary Burwell (pdf). We're urging the federal government to continue on the path of phasing out the state-specific rating rules:

Our state-specific rating factors are discriminatory and unfair, and result in unwarranted premium rate increases to individuals and many small businesses. The artificial surcharges and discounts tilt the playing field in the wrong direction. They should be phased out as agreed. ....

HCFA supports the HHS decision to permit Massachusetts to phase out the state’s rating factors over a transition period, as this will ease the gradual implementation of the premium impact of these rules for small employers in the state. We support the CMS rating rules because eliminating certain rating factors will lead to fairer health insurance premiums overall and lower premiums for individuals and smaller small group employers.
 

The business community is also on board with the administration, at least the larger small businesses that benefit now from their juicy discounts. What makes this issue so frustrating for us is that it exemplifies a standard poli sci conundrum: government policies that take from a broad group to benefit a small group get lots of support from the winners, and the losers in the deal don't even know they're losing. We hope the federal policymakers stick with their principles and make their decision in the whole public's interest.

      -- Brian Rosman

 

May 7, 2015

Our friends at the Parent Professional Advoacy Leage are longtime partners in the Children's Mental Health Campaign we help lead with them and others.

Their director, Lisa Lambert, just posted an insightful blog with observations about the never-ending role of parents in their childs's well being, even as their child grows up. She writes:

When providers, emergency services and mental health providers ignore parents of young adults, it can send a message. When adult mental health systems exclude family involvement, that message is even stronger. The message I hear when this happens is, We don’t value parents and family involvement. If I am hearing it, my son or daughter probably is as well. Sure, there are privacy concerns and it’s important that young adults learn to take the lead in treatment and life decisions. But they may not want to do that every time. Sometimes we all need a team and parents can be valuable team members.

Well worth reading the whole thing, here: Don’t call me an adult ally, I’m a parent. Always was, always will be.

May 5, 2015

CHIA, the state’s Center For Health Information and Analysis, released their Findings from the 2014 Massachusetts Health Insurance Survey today. The package includes a report, and chartpack (with powerpoint), along with detailed data tables and a methodology explainer.

The survey is back after not being conducted for two years, with a new methodology that probably reaches more low income and uninsured people. The new methodology means you can't directly compare the numbers in the 2014 results to past surveys; hence the different colors and break in the line in the chart below. The survey was conducted during May through July of 2014. They plan to resume annual surveys, with the 2015 survey being fielded starting in a week or so.

Lots and lots of numbers here. If you're into this blog, you'll probably want to look at the whole thing. Our big takeaways:

Insurance Coverage rates in MA

Coverage

  • Coverage rates high: Our health insurance coverage rate remains very strong. In total, 96.3% of all Bay Staters had insurance at the time of the survey. For kids, it’s even better, with 98.2% covered.
  • Churn and gaps are still problems for many. Adults surveyed reported that 12.3% of them had a period of being uninsured in the past year.
  • Who is left out: The remaining uninsured are working age adults, disproportionately male, single, Hispanic and lower income. Almost all are likely eligible for state assistance through MassHealth or the Connector.

 

Source and Use of Care

  • With high coverage comes high rates of people reporting a usual source of care other than an emergency room. Some 88% of the state’s residents reported having a usual source of care.
  • But real racial and ethnic disparities still exist in this measure. The rate was 90.3% for non-Hispanic Whites, but 78.9% and 80.7% for Blacks and Hispanics, respectively.

Types of care forgone due to cost 2014

Affordability

  • More than one in three adults are skipping care they need because of cost. Overall, the rate was 27.9%, and it was 35.2% for adults. While the rate of those reporting unmet need due to cost is very high among the uninsured, even those with coverage throughout the year had a 25.3% rate.
  • The biggest unmet need due to cost is dental care. For adults, 25.9% reported not getting dental care they needed due to cost.

The policy implications to us are clear from the data:

  • The expansion of public programs through state health reform and the ACA has been a huge success. But we must expand outreach and simplify the application and enrollment process to reach the uninsured and assure continuous coverage for those eligible.
  • Health disparities remains a problem, requiring serious, ongoing state responses.
  • Our success in controlling the growth rate in total medical spending as not led to relief for patients, who continue to ration their needed care because of high cost sharing. We need to reduce cost sharing for high-value services, and find ways to integrate oral health into broader medical care.

HCFA is working hard on all these issues, and we hope policymakers will take today's survey results as another wake-up call for the critical agenda facing the state on health care.

             - Brian Rosman