Stabilizing Community Hospitals
The 2009-2010 Agenda

Community hospitals received important support during the recently concluded two-year session ending in January 2009. Our objective is to continue to argue for a rebalancing of the acute care health delivery system, believing that an increased investment in community medicine is one of the most important components to creating a sustainable near-universal health insurance coverage program for our citizens as mandated by Chapter 58.

Our proposals recognize the extreme economic conditions that we all face due to the current economic meltdown. As such we are proposing no new spending to community hospitals, unless such funding is available either through the existence of surplus in the Health Care Safety Net Trust Fund or as a result of federal stimulus dollars.

There are four areas of concern to community hospitals which we believe require action:

Supporting Primary Care Recruitment - SB532, SB569
APrimary Care Development Fund shall be established via existing funding sources for grants to community hospitals to aid in physician recruitment and retention activities and ensure primary care physician access in their communities.

Addressing the Unfunded Computerized Physician Order Entry (“CPOE”) Mandate - HB1064, HB1097, HB2020
Legislation will ensure that community hospitals receive priority assistance for CPOE projects, an unfunded mandate of last sessions cost containment legislation.  Community hospitals have tremendous infrastructure needs and less access to capital. Lower reimbursement rates and new requirements imposed by payers (including with respect to CPOE) further increase the strain on community hospitals – and particularly in the current economy. In addition, other hospital systems either already have made significant investment and progress in these areas and/or have more access to funding sources going forward. CPOE is necessary for health care providers - to be able to provide quality health care, and function in the most efficient and cost effective manner. Community hospitals need assistance to be able to implement what has become a necessary part of operating in today’s health care environment.

Leveling the Playing Field -- Reducing Inequities Among Health Care Providers – SB576, SB577, SB578, SB581, SB586, SB587, SB884, SB885, SB892, SB893, SB900, SB904
Our proposals would help ensure that all providers of services traditionally provided in the outpatient hospital setting (e.g. ambulatory surgicenters (ASCs), clinical labs and physician practices providing services provided by hospitals, ASCs and/or labs, hereinafter “non-hospital providers”) are subject to the same or comparable requirements as community hospitals, thereby helping to prevent the further weakening and destabilization of community hospitals. Non-hospital providers are duplicating many of the services provided by community hospitals, and are able to do so at lower expenses in large part because they are not subject to the same regulatory requirements as community hospitals. Non-hospital providers are able to operate so successfully in large part because they attract better paying patients because they do not have to provide care to the indigent or uninsured. Non-hospital providers are able to attract more patients through aggressive expansion efforts made possible in part by funds made available by Boston teaching hospitals with higher reimbursement rates. If these inequities are not addressed in the near future, the Commonwealth’s health care system will develop two standards of care: One for MassHealth enrollees, the underinsured and the sickest patients who would continue to receive care in community hospitals struggling to remain open and operate emergency rooms in the face of lower reimbursement rates; and one for higher reimbursed Boston teaching hospitals and their affiliated health care providers, serving the bulk of private pay patients in the community hospitals primary service areas. Historically, the Commonwealth has prided itself on having a unified standard of care, and to maintain that, inequities that have developed through lack of regulation should be addressed at this time.

Access to Capital – SB554, SB555, SB579
Establish a Community Hospital Capital Reserve Fund (Moral Obligation Bonds). The purpose of this Fund would be to provide community hospitals with the lowest available cost of capital for expansion and renovation projects.