Health Care Reform – Part 2

1. Health Care Reform – Part 2 Cost Containment Legislation and its impact on the Department of Public Health August 13, 2008

2. Overview An Act to promote cost containment, transparency and efficiency in the delivery of quality health care (S2863) • Legislative Process • Outcome • DPH impact

3. Legislative Process • Senate President Murray introduced the first iteration of this legislation in March 2008. • Although it was broad scope and complexity, it passed quickly in the Senate (mid-April). • The House released its version in mid-July, putting out a bill that was significantly different than the one passed by the Senate.

4. Outcome • The result of this process is a 55 page piece of legislation which addresses: • Health care cost containment • Reform and efficiency • Access to care • Enhanced transparency • Adoption of Health Information Technology

5. DPH Impact • Legislation mandates 3 types of response from the Department of Public Health • Regulatory Change • Programmatic & Policy Development & Implementation • Collaboration, Assessment, Reporting

6. Regulations to be Promulgated by Public Health Council • Category 1 – Health care facility quality • Requires regulations for hospitals to establish patient and family advisory councils • Requires regulations for acute care hospitals to develop a method for requesting immediate assistance for deteriorating patients

7. Regulations to be Promulgated by Public Health Council • Category 1 - continued • Requires regulations for the reporting of HAIs and SREs (including serious adverse drug events) • Requires regulations prohibiting a health care facility from charging for services provided as the result of the occurrence of an SRE

8. Regulations to be Promulgated by Public Health Council • Category 1 (continued) -Changes process by which hospitals and clinics may destroy medical records and time period for retention

9. Regulations to be Promulgated by Public Health Council • Category 2 – Hospital/CHC electronic records/modernization • mandates DPH to promulgate regulations by October 2012 that will require hospitals/CHCs to implement Computerized Physician Order Entry systems (CPOE) • mandates DPH to promulgate regulations by October 2015 that will require hospitals/CHCs to implement interoperable electronic health record systems

10. Regulations to be Promulgated by Public Health Council • Category 3 –Determination of Need (DoN) • Mandates regulations requiring the licensure and subsequent Determination of Need for physician based ambulatory surgery • Mandates regulations requiring a DoN filing for outpatient capital projects exceeding $25 million

11. “Gift Ban” – Action Steps and Regulations • The department has been mandated to adopt a “standard marketing code of conduct for all pharmaceutical or medical device manufacturing companies that employ a person to sell or market prescription drugs or medical devices in the commonwealth.”

12. “Gift Ban” (2) • This standard shall be no less restrictive than the most recent version of the standards laid out by the Pharmaceutical Research and Manufactures of America and Advanced Medical Technology Association.

13. “Gift Ban” (3) • Bans certain meals, recreational events, sponsorship, travel, lodging, grants • Requires submission of report of any benefit above $50 to anyone in health care – publicly released • Requires pharmaceutical/medical device manufacturing companies to submit training program, investigation policies, compliance contact and proof of compliance with marketing code.

14. “Gift Ban” (4) • These regulations are to be promulgated by January 1, 2009. • They are enforceable by the attorney general, the district attorney, or the department of public health. • There are no funds appropriated to develop, promulgate, or enforce these regulations.

15. Regulatory Changes by Professional Boards • Allows physicians to supervise four physician assistants instead of two • Requires MD licensure requirements to demonstrate that applicants are competent in electronic medical records/prescribing • Pharmacies/stores must report improper dispensing resulting in injuries/death

16. Programmatic Mandates with DPH as the Lead Agency • Pharmacy Drug Detailing Program • Health Care Workforce Center

17. Drug Detailing Program • The department is charged with developing, implementing and promoting “an evidence-based outreach and education program about therapeutic and cost-effective utilization of prescription drugs for physicians, pharmacists and other health care professionals.”

18. Drug Detailing Program (2) • The department shall arrange for face-to-face visits with prescribers for education and outreach with a specific mandate to “inform prescribers about drug marketing intended to circumvent competition from generics” and other alternatives.

19. Drug Detailing Program (3) • The department has been asked to incorporate into its program other independent educational resources or models from around the country • The FY09 budget has appropriated $500,000 for this project

20. Health Care Workforce Center • The department has been mandated to establish a health care workforce center to improve access to health care services and work in consultation with the commissioner on labor and workforce development.

21. Health Care Workforce Center (2) • This center shall: • Monitor trends in access to primary care providers • Review laws and regs on contracting and reimbursement practices for impact on recruitment and retention of physicians and nurses

22. Health Care Workforce Center (3) • Establish criteria to identify underserved areas for setting up a loan repayment program administered by the center • Support appointed 16 member Advisory Council

23. Health Care Workforce Center (4) • The Legislature has appropriated $850,000 for this center with $500,000 of that earmarked for the loan repayment program in FY09.

24. Other Components of Law with other Lead Agencies • A Special Commission on Health Payment Reform to investigate restructuring the current payment system to provide incentives for efficient and effective care. • Co-chaired by DHCFP and ANF • The 15-member Commission shall make its recommendations no later than April 1, 2009.

25. Other (2) 2. End of Life Care Initiative to be Led by EOHHS • Calls for regulations and activities including expert panel, public awareness campaign, pilot programs, etc. with involvement of QCC and Betsy Lehman Center

26. Other (3) • Action steps to address primary care shortages -UMass is mandated to expand the size of its medical school enrollment, increase residencies for those in primary care and waive tuition at Medical School for commitment to practice in underserved areas -Special Trust Fund developed to increase faculty and students in nursing/allied professions

27. Other (4) • MassHealth to promote medical home efforts -Establishes medical home demonstration project with payment that supports mutli-disciplinary teams and services including telephone communication, home-based care and group care

28. Conclusion • All in all, this is a comprehensive piece of legislation that addresses much of what the first iteration of health care reform was unable to address. • The Department’s share of the workload is significant. We are hopeful the General Court will continue to provide support to the Department as we endeavor to fulfill our mandates.