"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

May 30, 2014

DPH Chart showing decline in central line infections

The MA Department of Public Health recently released its latest set of data (read it here, and scroll down to HAI Data Update) on healthcare-associated infections in Massachusetts acute care hospitals. The data looks at central line associated bloodstream infections (CLABSI) and a number of surgical site infections (coronary artery bypass graft, knee replacement, hip replacement, abdominal hysterectomy and vaginal hysterectomy).

Massachusetts hospitals ICUs overall have rates of CLABSIs that are lower than or equal to what would be predicted based on earlier data but burn ICUs have rates higher than expected. For surgical site infections, aggregate rates are lower than or equal to predicted except for vaginal hysterectomy SSIs which are higher than expected. This higher rate had already been a concern at DPH and they convened a workgroup to look more closely at possible explanations. So far they have not found a conclusive cause for this high rate.

This most recent data release only includes aggregate data, with just a few hospital specific items in the slides. For the most recent hospital-specific infection data, you have to look back to a June 2013 data release (on the same webpage, called “2012 Hospital Specific Data Sheet). While we appreciate that there has been an aggregate data update one year after the last update, it would be helpful to Massachusetts consumers to have access to annually updated data for every acute care hospital. We encourage DPH to update both aggregate and hospital-specific data on a regular basis and to widely publicize the data release so that the media and the general public are aware of its availability and how to interpret it.

For additional infection data, visit the CHIA website to see a summary of changes in infection rates in MA from 2008-2012. This shows statewide decreases in rates of CLABIs, abdominal hysterectomy SSIs, and colon surgery SSIs but an increase in catheter-associated urinary tract infections (UTIs). 

   -Deb Wachenheim

HPC Agenda slide
May 28, 2014


The Health Policy Commission (HPC) met on Thursday, May 22 to cover a range of HPC activities including updates on the patient-centered medical home certification program, the registration of provider organization program, and the CHART Phase 2 investments. Slides from the meeting (pdf) have lots of details on the discussion. Keep reading for our detailed summary of the agenda points and discussion.

May 27, 2014

Have you ever experienced a long wait in an emergency room?  Did it ever push you to the brink of frustration that you wanted to pull your hair out? Or your teeth? 

That may be because the elimination of most MassHealth adults' dental care resulted in more trips to Massachusetts emergency rooms for dental issues. In addition to adding to the overcrowding of emergency departments, those dental visits were expensive, costing way more than the charge for regular dental care.

In 2010, MassHealth adult dental benefits were severely cut. Until recently, if a MassHealth member has a case of tooth decay causing some serious pain they only have a few covered options: go to the emergency room for the pain, or visit a dentist who could only diagnose the problem and ultimately pull the tooth. Fillings, dentures, and many other services were not covered. This year, coverage for fillings was restored, but many other services are still not available.

Following the cut in benefits, oral surgeons at BU School of Dental Medicine noticed that the Boston Medical Center Emergency Department was being flooded with patients seeking dental care. They just published a study in The American Journal of Public Health looking at the data. The study (here is BU's summary, and the full report (pdf)) analyzed dental-related Emergency Department visits to BMC, comparing data collected three years before and two years after MassHealth adult dental benefits were significantly cut (July 1, 2007 to June 30, 2012).

Comparing average visits and spending in 2007-2009 to 2011, the study found:

  • Dental-related ER visits for adults increased by 14%. The greatest growth was among those 55 to 64 years old, which jumped an astonishing 50%. ER visits by seniors 65 and older went up by 45%.
  • The average cost per dental-related ER visit also soared by 27%. Combine more visits and increased costs per visit, and total dental spending in the BMC emergency department increased by 44%, from $8.4 million to $12.1 million.

The study's conclusions are clear:

This study found the largest increases in people with caries and soft tissue pathologies. These conditions are best treated in dental practices and community health centers. Importantly, individuals seeking dental treatment in EDs do not receive definitive treatment. Most dental treatments provided in the ED are transitory or palliative (temporary treatment, analgesics and antibiotics, or referral to a dental care provider) and have significant implications in terms of cost

One of the study co-authors commented pointedly, using researcher understatement: “Use of EDs for dental care points to an inappropriate use of resources and lack of continuity of dental care,”

The findings of the report support what oral health advocates have been saying for years: lack of treatment options causes the state to waste millions on emergency room care for dental issues. As the cuts continue, the state will continue to spend more and more on palliative care.

The just-concluded Senate budget includes funds to restore coverage for dentures as of April 1, 2015. This would be another step to ending this cruel, costly cut. Soon a House-Senate conference committee will meet to craft the final budget. Please call your representative and senator today (find yours here), and urge them to support this small step towards restoring MassHealth dental coverage.

   -Courtney Chelo


May 23, 2014

Massachusetts Alliance for Communication and Resolution following Medical Injury


All hospitals should CARe, or in other words, all hospitals, and other health care providers, should implement the Communication, Apology and Resolution (CARe) program that was the focus of a gathering yesterday at the MA Medical Society.

The CARe program focuses on internal communication and communication with patients and families following the occurrence of a medical error or unanticipated medical outcome. The conference was organized by the Massachusetts Alliance for Communication and Resolution Following Medical Injury (or MACRMI). Six hospitals in Massachusetts (BI, BI-Milton, BI-Needham, Baystate, Baystate Franklin, and Baystate Mary Lane) have been part of a pilot program looking at how to implement the CARe initiative. Atrius Health and Sturdy Memorial Hospital will be implementing CARe soon.  Look through the MACRMI website for lots of great CARe resources.

Kenneth Sands , the Senior VP for Health Care Quality at BIDMC, spoke about the lessons learned from implementing the CARe program. Many of the lessons learned have to do with the culture change that needs to happen for a hospital to successfully implement the CARe program. He said that what helps CARe succeed includes leadership buy-in, an existing baseline culture of safety, having staff dedicated to overseeing the program, and support (both clinician peer support and support resources for patients and families).

One audience member asked if patient and family advisors from the PFAC had been invited to participate in any of the processes following the occurrence of a medical error. Evan Benjamin, Senior VP for Health Care Quality at Baystate, said that they have started to invite PFAC members to sit in on root causes analyses discussions and that their presence has been powerful, bringing more of a focus to the patient and the communication with the patient.

See this trailer below for a preview of an upcoming documentary (release date TBD - it's still a work inprogress) on the project, “Full Disclosure: The Search for Medical Error Transparency.”


Secretary Polanowicz addresses the PFAC Conference
May 19, 2014

On May 14, HCFA held its second annual statewide Patient and Family Advisory Council (PFAC) conference. The conference took place in Worcester and brought together 175 participants from 54 hospitals and health centers. Twelve workshops covered a wide variety of topics, including recruiting to represent the community, improving patient safety and transparency, raising the PFAC’s profile in the hospital, educating the public on end-of-life care and palliative care, and more. See a list of workshops here.

The keynote speaker was EOHHS Secretary John Polanowicz. He spoke of the importance of patient and family involvement in improving care and he also spoke from a personal perspective about his health care experiences while caring for loved ones. Participants were overwhelmingly positive about the day and are excited about future opportunities to continue making connections across PFACs. The Worcester Telegram and Gazette covered the day. Read their coverage of our event here

HCFA was the lead advocate for the 2008 law requiring all MA hospitals to establish PFACs and since then we have had a role in ensuring successful implementation. HCFA gathers all PFACs’ annual reports and posts them on our website so that members of the public can learn about PFACs’ work and so that PFACs can learn from one another. Just two days before the conference we released our third annual report summarizing the work of Massachusetts PFACs based on our analyses of their 2013 annual reports.  We also coordinate monthly PFAC webinars covering topics such as recruitment strategies, placing patients and family members on hospital committees, and improving mental health care.  

HCFA is organizing a Statewide PFAC Advisory Board to work with us as we continue our PFAC efforts and take them to another level, including convening regional PFAC gatherings and looking at policy initiatives. We are excited to continue working with the many dedicated patients and family members who participate in PFACs across the Commonwealth.

-Deb Wachenheim

Advocates of Barrier Free Care bill assemble at State House for picture
April 14, 2014

One of the things we hear over and over is that people cannot afford their co-pays and deductibles. Momentum is building on legislation (H. 3976) to eliminate co-pays for some very high value treatments.

Health Care For All activists and staff came together to lobby their state legislators on behalf of the “Barrier Free Care” Bill.  Fifteen activists plus HCFA staff members shared their stories and asked their legislators to work with committee members and leadership to make sure the bill gets passed.   

Angela Huntsberry of Dorchester has to ration test strips and re-use needles to stay on top of her diabetes.  This raises the likelihood that Angela, who has already lost two family members to diabetes-related complications, will suffer a catastrophic event that will create even more cost. Angela should be able to access the care she needs without having to choose between her medication and food. Angela related how when she lost her job, she went on MassHealth and had no copays for her diabetes medication and could afford to take the proper dosage on time. When she finally got a new job, she went onto her employer’s plan, but even with coverage, now had copays and wound up limiting her care.  Angela and others like her visited the offices of over 30 State Representatives and Senators to tell their stories and say why they support Barrier Free Care legislation.

The legislation would establish a commission to assess which chronic illness medications and procedures would qualify as “high value”-incredibly valuable to the patient with relatively low cost to the insurer-and, as a result, would be co-pay free.  The concept behind the legislation is known as Value Based Insurance Design and is founded on the premise that we get better health outcomes and reduce the cost of acute care by making sure that individuals with chronic illness can actually access what they need.

Then, on April 8th, Health Care For All participated in a legislative briefing at the State House hosted by the Prevention Caucus to answer specific questions. Senator Jehlen explains the benefits of Barrier Free CareSenator Pat Jehlen of Somerville, the bill’s Senate sponsor, outlined its components and effectively summarized the positive effects the bill would have.  Dr. Richard Lopez, the chief medical officer of Atrius Health, was on hand to further frame the problem of co-pays as a barrier to care while a representative from the Massachusetts Pharmacists Association also detailed the rationale behind the MPA’s support for the bill. Caucus co-chairs Senator Harriette Chandler and Representative (and Senator-elect) Jason Lewis spoke strongly in favor of the bill. Sen. Jehlen expressed her optimism about the bill’s future and encourage her fellow members to work for the bill’s passage this year.  

This bill has legs -- we are working hard to make sure that co-pays and deductibles are no longer barriers to necessary care that saves lives.

-Andy Gordon and Ari Fertig

Sally knocking on door
March 13, 2014

No March Deadline for Getting Help Paying for Health Insurance in Massachusetts!

You may have heard that the last day to enroll into a Health Connector health plan is March 24th. That is the case only if you are seeking a health plan from the Health Connector without getting help to pay for it and/or if you want your coverage to start for April 1st. BUT - if you are seeking help paying for a Health Connector Qualified Health Plan or qualify for MassHealth – you do not have a deadline for getting help. People that need help paying for health insurance in Massachusetts can apply anytime during the year and get free or lower-cost health insurance coverage!  Please contact our free HelpLine at 800-272-4232 if you have questions about getting health insurance in Massachusetts.

Março não é o prazo final para obter ajuda para pagar por um seguro de saúde em Massachusetts!

Você pode ter ouvido que o último dia para se inscrever em um plano de saúde do Health Connector é 24 de março. Esse é o caso somente se você está procurando um plano de saúde do Health Connector sem receber ajuda para pagar por esse plano e/ou se você quer que a sua cobertura começe no dia 1 de Abril. Porém - se você está procurando ajuda para pagar por um plano de saúde do Health Connector ou se você se qualifica para MassHealth - você não tem um prazo para obter ajuda. As pessoas que precisam de ajuda para pagar por um seguro de saúde em Massachusetts podem aplicar a qualquer momento durante o ano e obter uma cobertura de seguro de saúde grátis ou de baixo custo! Entre em contato com a nossa Linha de Ajuda gratuita no 1-800-272-4232 se você tiver dúvidas sobre como obter um  seguro de saúde em Massachusetts.

¡No hay una fecha límite en Massachusetts para obtener ayuda para pagar por el Seguro Médico!

Quizá usted ha oído que el último día para registrarse en los seguros médicos del Health Connector es el 24 de marzo. Eso se aplica solamente si usted está buscando por un seguro medico del Health Connector sin que le den ayuda para pagar por él y/o si usted quiere que su cobertura empiece el 1o. de abril. PERO – si usted está buscando ayuda para pagar por un Seguro de Salud Calificado por el Health Connector o si califica para MassHealth – usted no tiene una fecha límite para obtener ayuda. Las personas que necesitan ayuda para pagar por su seguro médico en Massachusetts puede solicitarlo en cualquier momento durante el año y obtener una cobertura medica gratis o a bajo costo! Por favor llame a nuestra Línea de Ayuda gratis al 1-800-272-4232 si usted tiene preguntas acerca de cómo obtener seguro medico en Massachusetts.

-Kate Bicego

February 24, 2014

It isn’t often that an organization as busy as Health Care For All has the opportunity to take a deep breath, look at the challenges ahead, appreciate our staff and volunteers and strategize about the most effective way to interact, invite, engage and move toward our mission in cyberspace.  Fortunately, we have carved out the time and today you are invited to see the results. hcfama.org has been redesigned to be a more inviting and accessible tool for all.  It isn’t perfect yet, but our expectations are high that this update of our website will allow us to accelerate our successes.

I find myself wanting to shout “The new phonebook is HERE! The new Phone Book is HERE!!” but the 1979 Steve Martin reference is not quite universal in the halls of 30 Winter Street, to say nothing of the antiquated notion of an alphabetical list of phone numbers in hard copy.  What is unanimous however is Health Care For All’s need for and creative use of technology to do the work we were founded nearly 30 years ago to do – to create a more consumer centered health care system that is accessible, affordable, and delivers patient centered and culturally competent comprehensive care for everyone. 

The tools at our disposal to do our jobs may have changed, but the basic value placed on each person’s story and experience has not changed at all.  Welcome to the new hcfama.org.  Please come and explore and let us know what you think.  Our expectation is that conveying updates and information will be much easier, and engaging constituents and educating consumers will have fewer barriers as we work hard to improve our health care delivery system!

-Amy Whitcomb Slemmer

February 21, 2014

Health Connector Dashboard report showing progress on screening backlog of applications

The State House New Service has already dubbed Sarah Iselin as the "Health Connector web czar." And her official title is apparently "Special Assistant to the Governor for Project Delivery." Whatever her title, she's making big steps forward..

Today she released the first "Massachusetts Health Exchange Dashboard." The document includes the following updates of progress made this week: 

  • The Health Connector has processed all of the roughly 22,000 applications which had been entered into the system. Of these, nearly 15,000 people have been placed into temporary MassHealth coverage, and around 7,000 were found to be already covered.
  • They made progress on the 50,000 paper application backlog. Of these, 28,000 were screened. Among those screened, 4,000 were discovered to be duplicates, and 15,000 were already covered. This leaves 9000 remaining of the screened applications to be processed, and an additional 22,000 to be screened. Precessing will occurn weekly now, as opposed to the previous monthly schedule.
  • Additional staff have been hired to process applications. By early next week, the Connector expects to have 233 newly trained agents, ramping up to 318 within 2 weeks.

These were encouraging signs of progress. We particularly commend the administration for the transparency around their work. While there is still a long way to go, were are pleased to see substantial advances being reported today.

February 20, 2014

The Health Policy Commission (HPC) answered this question in its full commission meeting this week on Wednesday, February 19, 2014.  As David Seltz stated in his Executive Director report, the agenda for Wednesday’s meeting was short, but very important.  According to the final report from the HPC regarding Partners Health Care System’s proposed acquisition of South Shore Hospital and Harbor Medical Associates, the answer to this question is written in the data or, more accurately, in the lack of data.  Without abstention, The HPC voted to approve the final report recommending that Partners’ proposed acquisition should not proceed.  Also up for a vote were the final regulations from the Office of Patient Protection (OPP) on health insurance consumer protection. Materials from today’s meeting can be found here, and our full report on details from the meeting is on the backside.