Transcript Health Care Workforce Center (2)

Health Care Reform – Part 2
Cost Containment Legislation and its
impact on the Department of Public
Health
August 13, 2008
Overview
An Act to promote cost containment,
transparency and efficiency in the
delivery of quality health care (S2863)
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Legislative Process
Outcome
DPH impact
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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.
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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
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DPH Impact
• Legislation mandates 3 types of
response from the Department of
Public Health
1. Regulatory Change
2. Programmatic & Policy Development
& Implementation
3. Collaboration, Assessment,
Reporting
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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
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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
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Regulations to be Promulgated
by Public Health Council
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Category 1 (continued)
-Changes process by which hospitals and
clinics may destroy medical records and time
period for retention
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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
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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
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“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.”
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“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.
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“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.
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“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.
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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
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Programmatic Mandates with DPH as the
Lead Agency
1. Pharmacy Drug Detailing Program
2. Health Care Workforce Center
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Drug Detailing Program
• The department is charged with
developing, implementing and promoting
“an evidence-based outreach and education
program about therapeutic and costeffective utilization of prescription drugs
for physicians, pharmacists and other
health care professionals.”
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Drug Detailing Program (2)
• The department shall arrange for face-toface 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.
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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
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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.
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Health Care Workforce Center (2)
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This center shall:
1. Monitor trends in access to primary
care providers
2. Review laws and regs on contracting
and reimbursement practices for
impact on recruitment and retention of
physicians and nurses
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Health Care Workforce Center (3)
3. Establish criteria to identify
underserved areas for setting up a
loan repayment program administered
by the center
4. Support appointed 16 member
Advisory Council
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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.
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Other Components of Law with other
Lead Agencies
1. 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.
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Other (2)
2. End of Life Care Initiative to be Led by
EOHHS
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Calls for regulations and activities including
expert panel, public awareness campaign,
pilot programs, etc. with involvement of QCC
and Betsy Lehman Center
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Other (3)
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
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Other (4)
4. MassHealth to promote medical home
efforts
-Establishes medical home demonstration
project with payment that supports mutlidisciplinary teams and services including
telephone communication, home-based care
and group care
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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.
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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.
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