Health Policy Commission Looks At Grant Program

Community Hospital Acceleration, Revitalization, and Transformation (CHART) grant program

The Health Policy Commission met on Thursday July 25th for its seventh full meeting. The Commission is moving ahead with important work set to occur in the fall, which will include awarding grants to support hospital investment and conducting the annual Cost Trends hearing. Read on for a full report of the meeting’s happenings.

Paul Hattis guided the Commission through the Community Health Care Investment and Consumer Involvement Committee’s work. The committee explained that the Distressed Hospital Fund, which has $39.9 million to distribute in its first year, has been recast as the Community Hospital Acceleration, Revitalization, and Transformation (CHART) grant program. This name better reflects the grant’s purpose: promoting sustainable innovations, rather than bailing out hospitals that are struggling financially (slides 9-10).

The Commission was presented with draft regulations governing CHART grant administration. Commission member Marylou Sudders initiated discussion about the need to define the purposes of this fund in the regulation, rather than only detailing this information in the RFP (Request for Proposals). Lois Johnson, general counsel, replied that defining the priorities in the RFPs was a strategic move and allowed for a more flexible process, as some policy decisions regarding the grant’s goals had not yet been made. Commissioner Wendy Everett questioned how involved commissioners would be in selection of the awardees, as HPC staff is set to do the bulk of the work reviewing applications and selecting finalists. HPC Chair Stuart Altman noted that Commission members want to be involved in the selection process beyond just the final approval stage, and that allowing the subcommittee to work on reviewing candidate applications is a way to accomplish this.

Time was also spent discussing the statutory criteria that defined eligibility for CHART grants (slides 14-15). Ineligible are major teaching hospitals (defined as having a resident to bed ratio greater than 4:1), for-profit institutions, and those hospitals that have a relative price above the median. The relative pricing determination is based on information calculated by CHIA. Although Counsel Lois Johnson clarified that the CHIA data was adjusted for case mix, there remained concern because Medicaid Fee- for-Service is not included in the payer mix that comprises this calculation.

In the coming weeks, the HPC will continue working on the regulations, a draft of which the Commission approved at the meeting. A public hearing on the regulations will be held at the end of August, and public comments will be incorporated into the final regulations before they are presented to the HPC Board for a vote on September 11th. Shortly thereafter, the HPC will issue its first RFP, with the hopes of distributing at least some of the grant funding before the end of 2013.

The next committee to report was the Care Delivery and Payment System Reform committee. The committee had not met since the last HPC board meeting, but assembled for a committee meeting later that afternoon. The afternoon subcommittee meeting focused on the HPC’s development of standards for certifying PCMHs and ACOs. In the upcoming months, the committee will have to decide to what extent they want to work off of a subset of existing national standards and how to supplement those national standards to make up for their weaknesses. Stuart Altman expressed concern about the scale of this undertaking, as being responsible for the administration of a certification program for PCMHs and ACOs is a potentially tremendous and time-intensive responsibility.

Next to report was the Quality Improvement and Patient Protection subcommittee. Jen Bosco, OPP director, gave a condensed summary of internal and external review processes under the OPP, the topic of the QIPP subcommittee meeting and listening session on Tuesday, July 23rd. A thorough summary of this subcommittee meeting is available here.

Last on the agenda for the day was an update from the Cost Trends and Market Performance committee. Since the HPC’s June board meeting, the committee has decided not to proceed with a Cost and Market Impact Review (CMIR) for three material changes that had come to its attention (slide 42). The CMIR that has been initiated, a look into the Partners/South Shore hospital merger, was described as moving forward productively.

The Board also discussed preparations for this year’s Cost Trends Hearing, to take place October 1st and 2nd at UMass Boston. The committee will begin to identify witness in the next month or so, and will determine which witnesses will provide written testimony and which witnesses will be asked to appear in person to give oral testimony under oath (slides 46-49). Four panels have tentatively been scheduled to address the following topics:

  • High-value care for high-need patients
  • Addressing system barriers to efficiency
  • Evolving market structure-impact on cost and quality
  • Empowering purchasers through information, incentives, and choice

The HPC commission also unanimously approved the Lewin Group as the contractor that will provide analytical data support for the All Payer Claims Database (APCD). Not only did the Lewin Group demonstrate an understanding of the unique issues that arise when working with an APCD, it was also a high-value bidder, offering the second-lowest price of the seven applicants.

The next HPC commission meeting will take place at noon on September 11th, 2013, location TBA.
-Claudia Kraft

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