A missed healthcare opportunity

Legislature's failure to pass reform endangers survival of smaller hospitals and facilities

MASSACHUSETTS MISSED AN opportunity to address some of the most crucial healthcare challenges facing the state when the Legislature failed to reach agreement on a sweeping reform bill this session. It’s disappointing, particularly because the reforms thoughtfully formulated over the past several months are vital to many of our local communities, hospitals, workers, and patients.

Across the state, too many community and safety-net hospitals are struggling financially, forced to make tough decisions about whether to scale back operations, or in some cases, whether to close altogether. These struggles have real consequences, threatening healthcare jobs, hurting patients who rely on these institutions for care, increasing healthcare costs, and ultimately destabilizing the entire healthcare system in Massachusetts.

At the same time, hospitals are facing pressures from varying – and fundamentally unfair – reimbursement rates that favor larger, urban medical centers over community and safety-net hospitals. It’s not uncommon for community and safety-net hospitals to receive lower reimbursement rates even as they care for relatively higher percentages of Medicaid and Medicare patients.

It’s not only hospitals that are struggling and need legislative help. Massachusetts’ nursing home industry is facing a host of challenges that have destabilized the market. Since 2000, more than 200 of Massachusetts’ skilled nursing facilities have closed. The pace of facility sales has rapidly accelerated and too many facilities have been plagued by mismanagement and ownership changes that have negatively impacted patient care and hurt frontline caregivers.

The healthcare bill would have addressed these challenges. We can’t just go back to the status quo. These issues are vital to Massachusetts communities, hospitals, patients, and workers and to an economy where for many regions, that threatened community hospital is the largest employer. We need to get back to work to pass a reform bill with four crucial components.

First, we must make immediate investments in our community hospitals and health centers. These institutions are not only critical economic engines, they are the primary source of quality and affordable care for patients in our state, many of them elderly or low income. Abandoning these institutions to financially uncertain futures is quite simply abandoning those patients.

Second, we should ensure that all hospitals receive minimum payments from commercial insurers that are at least 90 percent of the statewide minimum. And we should implement regulations and create additional state oversight to ensure the lowest-paid hospitals are brought up to that target within a reasonable period of time. These changes and investments will allow community hospitals to receive a fair share of the pie for they work they do.  In some cases – particularly for some our most financially challenged community hospitals – it means millions of dollars more each year in commercial rate payments.

Third, the state must act now to stabilize Massachusetts’s struggling nursing home industry and to ensure that these facilities are properly staffed, reimbursed and managed. Nursing homes must be held more accountable to residents, their families, and their employees when they change management or ownership teams. Government, industry, labor, and resident stakeholders should develop the policy reforms needed to guarantee quality nursing home care and fair reimbursement that will support good jobs for caregivers.

Finally, we must do better in engaging the entire healthcare workforce, and especially frontline healthcare workers, so that they have a stronger voice in reforms that impact their patients and their jobs. There are opportunities to increase transparency around healthcare workforce changes and to promote greater collaboration to improve care and lower costs. Engaging frontline caregivers in our hospitals and nursing homes will keep these institutions strong and economically viable. At a minimum, the state should ask larger health systems to submit information on provider initiatives that demonstrate planning and investment in worker readiness.

It’s no secret that our healthcare system is facing enormous pressures resulting from the rising costs of care, damaging actions by the Trump administration that are undermining care, changing demographics, and a host of other factors. By making meaningful healthcare reforms that benefit those that need them most – our community hospitals, nursing homes, patients and workers – Massachusetts can remain the nation’s leader in healthcare.

Meet the Author
Let’s not wait until it’s too late to take these steps that will ensure our Commonwealth can continue to deliver affordable, accessible care now and far into the future.

Tim Foley is the executive vice president of 1199SEIU United Healthcare Workers East and a member of the Massachusetts Health Policy Commission.