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Charlemont ambulance measure part of state Senate health care reform bill

  • MARK

  • ROSENBERG


Combined Sources
Friday, November 10, 2017

A measure to let small town ambulances roll without at two emergency medical technicians on board was included in a sweeping package of health care reforms that overwhelmingly passed the state Senate this week.

The change is one the Charlemont Ambulance Service and some local officials have advocated for years to overcome the difficulty small towns sometimes have finding enough EMTs to staff around the clock.

Sen. Adam Hinds, D-Pittsfield, led a bipartisan effort to secure language updating volunteer ambulance staffing requirements in rural communities as part of the broader health reform package aimed at fixing broken pieces of the state’s health care system while also saving consumers money.

The measure, which passed on a 33-6 vote at midnight Thursday, sets a target for reducing hospital re-admissions and imposes new oversight on the pharmaceutical industry. It aims to cut down on unexpected consumer costs like out-of-network charges and facility fees, and to increase access to telemedicine and mobile integrated health, which involves paramedics performing non-emergency services.

“The bill is really about the consumers and doing everything we can to make health care affordable,” said Sen. James Welch, who led the working group that wrote the measure.

Whether any provisions actually make their way into law depends on action in the House, where Rep. Peter Kocot, Welch’s co-chair on the Health Care Financing Committee, said he hopes to have a bill ready for debate early next year after he wraps up his own meetings and analysis. The Senate bill was developed by a group of senators, outside the traditional joint committee process.

Hinds’ amendment, based on a bill he has sponsored with Rep. Paul Mark, D-Peru, would allow rural volunteer ambulance services to transport a patient receiving care at the nonparamedic level of basic life support to staff the ambulance with one emergency medical technician and one first responder. Current regulations require an ambulance to be staffed with two EMTS when transporting a patient receiving care at either the paramedic level of advanced life support or the non-paramedic level of basic life support.

“This is a critical policy update for rural communities,” said Hinds. “It is also a glaring example of how state laws, often passed and implemented with the best intentions, do not always apply fairly across the state. Small, rural towns often have difficulty mobilizing two EMTs in time to help someone in dire need of medical attention. My amendment allows them to move more efficiently, respond to calls more effectively, and hopefully, when implemented, will save lives.”

Mark said his stand-alone measure has passed last year in the Committee on Public Health, with support from the state Department of Public Health Committee, but it stalled in the House with DPH commenting that the provision would be unsafe, “which was completely contrary to what we were hearing.”

When the health reform package reaches the House, as early as next week, Mark said he plans to add the ambulance measure as an amendment if it is not already included, either on the floor or in conference committee. Even if it the package fails, said Mark, he can still try to push forward on the stand-alone bill, which “would have even more traction now.”

The small-town ambulance waiver, which Marks said originated in the Berkshire County town of Hinsdale and was then championed by Charlemont, winning the backing of the Small Town Summit, is needed by rural towns that have trouble finding enough volunteers with EMT training to respond to less medically urgent calls, said Charlemont Ambulance Director Dana Johnson.

“We’re running out of volunteers,” Johnson said. “This is not unique to Charlemont. It won’t cure the problem, but it will give some relief.”

An ambulance responding with a first responder or even an EMT to someone who needs medical attention has to wait around for a second ambulance to arrive with a second EMT before they can transport the person to a hospital, Johnson said. “We want to do what’s in the best interests of the patient.”

Johnson, who said he’d been working on the issue for nearly 15 years, explained that EMT training is a 150-hour commitment beyond the reach of many rural towns.

But in Colrain, Fire Chief Nick Anzuoni said, “It’s unbelievable anyone would say that we need to lower the standard of care for patients because we live in the middle of nowhere. That is absurd. We’re not that far out. This is an administrative issue; not a health care crisis. Folks just need to look outside the box” and look at other solutions, including explore ways to regionalize.

Larger bill

Gov. Charlie Baker on Thursday said the bill “doesn’t save the state any money” and the Senate was “not trying to chase reforms that are going to make” MassHealth more affordable, one of the goals that punctuated the health care debate earlier this year.

“What they’re doing are chasing a variety of initiatives they believe will make the system better,” Baker told reporters.

Senate Ways and Means Chairwoman Karen Spilka, who has said the health reform bill could yield $114 million in savings from MassHealth reforms and $475 million to $525 million from its commercial market reforms by 2020, said after the bill passed that she was “very surprised” and “dumbfounded” by Baker’s characterization.

“I understand the governor’s concerns,” Welch said. “He comes from the health care industry, comes from the insurance industry, and I’m sure obviously still has relationships in the health care industry that would make him concerned or that members of the health care industry might be concerned about. But I think the way we approached this bill is really to focus on the consumer.”

Debate began on Wednesday, and behind-the-scenes discussions both days involved negotiations around contentious measures proposing to automatically enroll MassHealth-eligible consumers participating in the home care program into Senior Care Options, a managed care program that covers services normally paid for through Medicare and MassHealth, with no copays. Senior advocacy groups opposed the plan.

Just before midnight, the Senate adopted an amendment that Spilka said preserved the passive enrollment while adding extra protections and spelling out specifics of the opt-out process.

“We remain fundamentally of a different mind that older people are smart enough to pick their own plans, but the Senate, I give them credit for working hard to come up with language that would protect older people from any kind of dislocation of service and to make sure that the people who arrange their care are not financially at risk,” Mass. Home Care executive director Al Norman of Greenfield told State House News Service.

Some of the most heated moments in the two days of debate came as Republicans tried unsuccessfully to beat back an element of the bill they dubbed the “name and shame” list — an annual public report identifying the 50 Massachusetts employers with the highest number of employees who receive medical assistance, medical benefits or assistance through the Health Safety Net Trust Fund.

Before passing the bill, senators agreed to modify the way it attempts to shrink the gap between rates paid to the most expensive, larger hospitals and lower-paid community hospitals.

“We view that this is a market failure, and we’re asking the market to correct itself, and if it is unable to do so, then and only then would you turn to government regulation,” said Senate President Stanley Rosenberg of Amherst.

The bill would raise rates for lower-paid hospitals to 90 percent of the statewide average for the previous year, and set a target rate of growth for total hospital spending.

While senators stopped short of imposing a rate cap at the upper level, they adopted a Sen. Jamie Eldridge amendment specifying that efforts to meet the target “do not directly contribute to increased consumer health care costs.”

The Senate overwhelmingly endorsed studying how the costs of a single-payer health care model would compare to the state’s current health care spending, which the Center for Health Information and Analysis tallied at $59 billion in 2016.

The Senate adopted, 35-3, an amendment calling for measuring health spending against the estimated costs of providing health care to all residents through a single-payer system. If the single-payer projections prove to be less costly, the Health Policy Commission would need to submit “a proposed single payer health care implementation plan” to the Legislature for potential action.

In 2012, a similar single-payer benchmark proposal failed 22-15 in the Senate.