The hearing (agenda, pdf) will examine how increasing drug shortages are impacting patient safety and quality of care in Massachusetts.  The committee has invited testimony from hospital administrators, physicians, patients and pharmaceutical representatives, who will discuss the national perspective on drug shortages, the impact of shortages on hospitals and health systems, and industry strategies to address drug shortages.  The proceedings are open to the public and will address how best to mitigate the impact of shortages on patients and families in the Commonwealth.
-Kaitlyn Rhodes

The report that you can find on-line today gives a wealth of information about infections, the work taking place across the state to reduce infections, the process of gathering the infection data, and more. This report also provides aggregate data about infections in Massachusetts and does list some specific hospitals that are outliers for surgical site infections.

How can consumers use this data? Now that we have a few years’ worth of data, it is possible to look at improvement trends both statewide and within individual hospitals, and as each new report is issued that will be something to look at more closely. If you are interested in one or a few specific hospitals,, you can see the data and you can then ask your doctor or your hospital (especially if you have a planned surgery or other reason to plan a hospital visit or if you have a loved one in the hospital or who may be admitted) questions about what they are doing to prevent infections. You can find out more by contacting the Quality Improvement Office or the Patient Advocacy Office of the hospital. You can also ask either of those offices what their Patient and Family Advisory Council (PFAC) is doing to work with the hospital on preventing infections. It is often said that everyone has a role in preventing infections, but if patients and families are expected to have roles in the prevention effort, then the hospitals should get their PFACs involved in figuring out what they are and how to educate about them.

A few comments arose during this morning’s Public Health Council meeting that I want to highlight. One Council member mentioned the PFAC role and stated that the reports should be brought to the PFACs’ attention. A doctor talked about how the infection prevention collaboratives in MA have encouraged a “positive competition” among hospitals to reduce infection rates and also that the public reports have been a driver in making infection prevention a priority. One member asked about disparities, and the DPH representatives said they hope to have enough data to look more closely at that in the next report. And another member of the Council said that DPH was off to a fantastic start and “don’t lose money…keep doing this.”

Which leads us to state the obvious-DPH needs money to do the many fantastic things it does, including all of the work taking place to prevent, track, investigate and report on infections. The Governor’s budget, released two weeks ago, provides $263,646 to the Infection Prevention Program at DPH and $6,318,316 to the Division of Health Care Quality and Improvement. While this is not nearly enough for all of the work that needs to get done, it is imperative that funding not be cut further.

Many kudos to DPH staff, including the Quality Division Director Dr. Madeleine Biondolillo, Iyah Romm, who directed much of the work in putting together the report, and Eileen McHale who coordinates the infection prevention program. Health Care For All and the Consumer Health Quality Council gave many suggestions and comments to DPH following the release of its last report, and our concerns and recommendations were very seriously taken into account as this new report was developed. They have produced a report that is accessible and useful for consumers and hospitals. And they are using this data as well as the data in the recent Serious Reportable Events report to look at areas that may need more work (eg. vaginal hysterectomy infection rates; reporting of medication errors). As MA looks to save money and improve quality through payment and delivery system reform, the infection prevention work at DPH is a great example of an area where this is already happening.

If the continuation of this work is important to you, make sure you mention it to your state senator and representative, as budget season has begun. Also mark March 6, 9:30-10:30am, on your calendar. We are coordinating a State House event in Members Lounge that will highlight the HAI and SRE reports. Speakers will include staff from the DPH Division of Quality and Safety and some of the legislative champions for patient safety-Senator Richard Moore, Representative Jeffrey Sanchez, and Representative Denise Provost. All are welcome, but please RSVP to Deb Wachenheim at dwachenheim@hcfama.org.

Also, the Institute for Healthcare Improvement is hosting another in its series of webinars (called WIHIs) this Thursday at 2:00pm. The featured speakers are Don Berwick, former Administrator of the Centers for Medicare and Medicaid Services and former leader of IHI, and Gerald Shea, Assistant to the President for External Affairs, AFL-CIO. They will be discussing how better care and quality improvements can result in lower costs. The webinar is free but you need to register ahead of time to participate.
-Deb Wachenheim

We invite you to nominate an innovative health care leader in Massachusetts that has contributed to significant improvements in health through community based initiatives. Health Care For All’s Community Leader Award honors individuals, organizations, or groups in Massachusetts that best exemplifie achievements in:

• Outstanding health care leadership or advocacy OR
• Significant improvements in health care for the most vulnerable among us.

The honoree must be present to accept this award at Health Care For All’s annual event, For the People: A Celebration of Health Care Leaders, Tuesday, May 8, 2012 at the Sheraton Boston Hotel. For the People honors health care leaders and raises general operating support for the organization while providing an opportunity for health care advocates to join together. The event includes networking, dinner, and short program recognizing our honorees and highlighting the voices of Massachusetts health care consumers.

Submissions for the Community Leader Award must be received by Monday, February 13, 2012. Click here to nominate your community leader today!

For more information and to sponsor For the People, click here.

After a victory in the Massachusetts Supreme Judicial Court that requires the Commonwealth to restore full Commonwealth Care coverage for eligible legal immigrants, the Connector is began today the process of reintegrating this population into Commonwealth Care. Today, the Connector sent letters to the 13,400 legal immigrants currently enrolled in Commonwealth Care Bridge. This group, who were members of CommCare at the time eligibility ended in fall 2009, will be enrolled in full Commonwealth Care coverage effective March 1. They will have an eleven day period between February 13-24 to choose a plan if they do not want to remain in the CeltiCare Health Plan, which currently provides their Bridge program coverage. Recipients must call the Connector or mail back a response with their selected plan during this time, as web-based services will not be available. If a selection is not made, these members will default to the CeltiCare plan.

The Connector will send out additional letters in batches beginning on March 26 to the 24,000 legal immigrants currently enrolled in the Health Safety Net program. These individuals must select a health plan within ninety days upon receipt of their letter, as they will not be automatically enrolled into a Commonwealth Care plan.

There are several moving parts here, and for more information, we’ve posted the full details on the reinstatement plan.

In addition, the Connector will hold their annual open enrollment period from June 1-22, during which all members have the opportunity to switch to any plan in their service area.

As always, the Health Care For All HelpLine is here to help people navigate this process: 1-800-272-4232.
-Gisela Bryan

The poll itself found modest increases in public support for the components of the ACA, with the exception of the individual mandate. The questions on Massachusetts health reform show that the vast majority of the public is unaware of what’s included in our health reform law:

• 65% are unsure that the Massachusetts reform law requires that everyone has or buys health insurance.
• 69% are unsure that everyone in Massachusetts now has health insurance. Another 10% say this is false.
• 69% are unsure that the health care reform bill is popular with most people in Massachusetts. And 13% think this is false.

We need to tell our story to the country.

And we have an important story to tell. The latest Massachusetts Health Reform Survey, compiled from a large random sample of Bay State adults, shows the state of Massachusetts coverage, access and affordability as of fall, 2010. Lead researcher Sharon Long has been conducting these surveys annually since 2006, tracking the impact of Massachusetts health reform.

Highlights from the report include:

Access and Usage of Care
There were sustained gains in access to and use of health care between 2006 and 2010.

• Gains in Usual Source of Care: Nonelderly adults were more likely to have a usual source of care. They were also more likely to have had a preventive care visit, specialist visit and dental visit.

Health Care Use, Fall 2006 to Fall 2010 - Percent Reporting Type of Care

• Declines in Hospital Use: First-time reductions in emergency department visits and hospital inpatient stays suggested improvements in the effectiveness of health care delivery.
• Declines in Unmet Need for Care: Between 2006 and 2010 there were reductions in unmet need for care for nonelderly adults including reductions in unmet need for doctor care, medical tests, treatment, follow-up care, and preventive care screening.

Affordability of Care
In Massachusetts and nationwide, rising health care costs continue to raise concern about the affordability of care. More than a quarter of adults in Massachusetts reported financial problems due to health care costs.

Still, the study found significant declines in out-of-pocket spending as the share of nonelderly adults in MA who spent 10% or more of family income on out-of-pocket health care costs decreased from 10% in 2006 to 6% in 2010. The study also reported declines in unmet need due to costs.

Unmet Need Due To Cost, Fall 2006 to Fall 2010 - Percent Reporting Unmet Need

Support for Reform

• 66% of nonelderly adults in MA remain supportive of health reform. This level of support has remained steady since the implementation of reform.
• However, among the remaining adults, there has been a marked shift from a neutral position toward opposition (17% opposed to reform in 2006 versus 27% in 2010).

Support for Health Reform in Massachusetts, Fall 2006 to Fall 2010 - Percent Reporting Outcome

Employer Response to Reform
According to the study, there was no evidence that employers of nonelderly adults in MA were dropping or reducing the scope of coverage for their workers.

• The level of nonelderly workers insured by their employer has remained unchanged since before reform.
• The reported satisfaction levels in 2010 (over 70% of workers rated their health plans as very good or excellent) were as good as or better than those reported in 2006.

We have long been involved in letting our colleagues in other states know about the impact of health reform here. The new poll is a challenge to all of us in the Massachusetts health policy community to intensify our efforts.
-Kaitlyn Rhodes and Brian Rosman

Romney gave a cogent, articulate defense of Massachusetts health reform (which of course goes just as well for national health reform under the ACA). Romney offered his standard defense of the individual mandate as reducing the number of “free riders” – “[I]f you don’t want to buy insurance, then you have to help pay for the cost of the state picking up your bill, because under federal law if someone doesn’t have insurance, then we have to care for them in the hospitals, give them free care. So we said, no more, no more free riders.”

But Santorum responded with something that had a lot of us scratching our heads:

SANTORUM:So what is happening in Massachusetts, the people that Governor Romney said he wanted to go after, the people that were free-riding, free ridership has gone up five-fold in Massachusetts. Five times the rate it was before. Why? Because…
ROMNEY: That’s total, complete…
SANTORUM: I’ll be happy to give you the study. Five times the rate it has gone up. Why? Because people are ready to pay a cheaper fine and then be able to sign up to insurance, which are now guaranteed under Romneycare, than pay high cost insurance, which is what has happened as a result of Romneycare.
ROMNEY: First of all, it’s not worth getting angry about. Secondly, 98 percent of the people have insurance. And so the idea that more people are free-riding the system is simply impossible. Half of those people got insurance on their own. Others got help in buying the insurance.

After the debate, policy analysts and fact checkers agreed that Santorum didn’t know what he was talking about. The Washington Post’s Wonkblog explained it well:

Here’s one reason we don’t hear much about free-riding in discussions of Massachusetts health reform: It’s barely happening. About 0.6 percent of Bay State adults under 65 paid a fine for not carrying health insurance in 2009, the most recent year for which data are available from the Massachusetts Department of Revenue. That was back when 96 percent of the population had health insurance, a number that has since risen (as Romney pointed out last night) to 98 percent. The number of free riders would presumably drop as coverage increases, although we’re still waiting for data on 2010 numbers.

But a few days later, the Santorum campaign clarified what he was referring to. Santorum’s “free riders” are different than the “free riders” that most people worry about. He was harking back to the DOI actuarial study (pdf) comparing 2006 and 2008 figures for people buying individual coverage and dropping it within 6 months. The numbers did almost jump five-fold.

Whether or not these people were free riders, in any case it’s not a problem in Massachusetts anymore. Two years ago, the legislature enacted legislation setting up annual enrollment periods for individual coverage. We’ve been critical of some of the details of how this provision is implemented, but this issue that Santorum raised is no longer a concern here.

So groups like FactCheck.org amended their original call, that Santorum was completely wrong, to just point out that he’s behind the times.
-Brian Rosman

First, the Governor’s State of the Commonwealth speech focused on payment and delivery system reforms that will stem the rising costs of health care:

The market is moving in the right direction and that’s very good news. But it is not enough.

Too many small businesses and too many working families still go through an annual ritual that starts with notice of another premium increase, and too often ends with a new plan costing the same or more for less coverage. Slowing the rate of increase is critical, but unless that slowdown is sustained, health care costs will continue to squeeze everything else – including job growth itself.

We need to put an end to the “fee-for-service” model. We need to stop paying for the amount of care, and start paying instead for the quality of care. We need to empower doctors to coordinate patient care and to focus on wellness rather than sickness. And we need medical malpractice reform. All of this is addressed in the bill I filed last year.
…
The Legislature has done considerable work on our proposed reforms, and I want to congratulate your care and thoughtfulness. Now it’s time to act. Before you take up next year’s budget, pass health care cost containment legislation. This is another hard decision. But for the good of the Commonwealth, let’s do this and do it now.

Over the last year and half our Campaign for Better Care has been meeting with legislators, presenting all around the state, and offer public comments regarding the issues of payment and delivery reform. We emphasized that curbing costs must be tied to measures that improve the quality of care and protect the vulnerable as we redesign care. We must make a serious and robust investment in public health and prevention. We need to ensure transparency in all aspects of the health system. The savings must accrue to us, so patients can reap the benefit of a less costly system.

The Campaign for Better Care has offered specific legislative ideas (pdf) around each our patient-centered principles. If you would like to get involved with the Campaign please contact Paul Williams at pwilliams@hcfama.org.

Second, yesterday’s release of the proposed budget for fiscal year 2013 makes progress on health care coverage, public health, and cost control. While $545 million in MassHealth savings are imposed, the budget assumes no further cuts to MassHealth benefits.

The administration’s has posted write-up of their health cost and their public health initiatives on the state’s site. As ususal, the Mass Budget and Policy Center put out their flash analysis last night, with more detailed analysis to come.

The budget proposal fully funds Massachusetts health reform programs, including the re-integration of some 37,000 legal immigrants into the Commonwealth Care program. Full coverage for this group was required by a decision of the Massachusetts Supreme Judicial Court earlier this month, in a case brought by HCFA affiliate Health Law Advocates.

The budget makes major progress in reducing costs through improvements in overall health and wellness. HCFA strongly endorses the proposed increase in the tobacco tax, and the ending of the loophole that exempts sugary soda and candy from the sales tax. These revenue sources will both improve overall health and provide needed funds for health programs. HCFA also supports the expansion of tobacco cessation benefits to Commonwealth Care, as called for in legislation HCFA has actively supported.

The budget includes over $5 million desperately needed by MassHealth to improve customer service and begin implementation of national health reform. Service has deteriorated dramatically as cutbacks have reduced staffing at enrollment centers. Funds are also provided to implement a modern on-line integrated eligibility system for all health programs, scheduled to roll out in 2014.

HCFA calls on the legislature to reverse a budget cut that substantially reduced dental benefits to adults in the MassHealth program. Good oral health is a requirement for good overall health, and we know that the reduction in dental benefits will lead to higher long-term costs. Truly the Commonwealth can afford to end the inexcusable pain and suffering affecting thousands caused by lack of dental care.

We’ll of course have more to say as the budget process continues.
-Paul Williams, Ana Aguilera and Brian Rosman

In order for patients and family members to feel comfortable having these discussions not only with one another but also with their health care providers, it is necessary that providers also learn how to discuss end-of-life care. On that note, we applaud the MA Board of Registration in Medicine for its new requirement, effective February 1, that physicians must take 2 CME credits in end-of-life care.

Most of us have had personal experiences, or know others who have had personal experiences, with end-of-life care for loved ones or friends. Health Care For All would like to start hearing your stories about those experiences as we look at how we can help make a difference in this area. Please contact Deb Wachenheim at dwachenheim@hcfama.org if you have a story to share.
-Deb Wachenheim

The briefing featured a presentation by HCFA’s Children’s Health Policy and Outreach Manager, Dayanne Leal. Leal discussed the recipe for Massachusetts’ success. “Our success came from Massachusetts’ choice to invest in kids, a real commitment to doing the work, and creativity to make it happen,” she said.

The report was prepared by the Kaiser Family Foundation in conjunction with the Georgetown University Center for Children and Families. A video  of the presentations is also available at the Kaiser Foundation website.

At the briefing staff from both institutions presented the main findings and then a panel of experts panelists discuss the survey findings and implications. Panelists included Cindy Mann, Deputy Administrator, Centers for Medicare and Medicaid Services (CMS); John Supra, Chief Information Officer for the South Carolina Department of Human Services; Dayanne Leal, Children’s Health Policy and Outreach Manager, Health Care for All Massachusetts; Tricia Brooks, a Senior Fellow at the Georgetown University Health Policy Institute Center for Children and Families; and Samantha Artiga, an Associate Director at the KCMU. who gave their perspectives. The panel was moderated by Diane Rowland, Executive Vice President, Kaiser Family Foundation.

Federal Medicaid administrator Cindy Mann recognized the work Massachusetts is doing to enroll children and keep them enrolled. “Massachusetts is the clear national leader in covering children,” she said. Leal thanked Mann for approving Massachusetts Express Lane Eligibility waiver to include renewals for parents, which will be crucial as Massachusetts move to the next phase which is improving its coverage retention.