Press Release  HPC ISSUES FINDINGS ON COVID-19 HEALTH CARE SYSTEM IMPACTS; PLANS TO WEIGH IN ON MASS GENERAL BRIGHAM EXPANSION

BOSTON — Today, the Massachusetts Health Policy Commission (HPC) released results from the COVID-19 Impacts on the Massachusetts Health Care System: Interim Report. The findings focus on calendar year 2020, examining trends in health care utilization, service delivery, and market and financial impacts.

In January 2021, the Legislature tasked the HPC with studying the impact of the COVID-19 pandemic on the health care delivery system in Massachusetts, including short-term and long-term implications. This interim report provides an overview of the pandemic’s impact on the utilization of health care services in Massachusetts in calendar year 2020 and outlines the questions that the HPC aims to address in the future as it continues to track the pandemic’s effects.

Key Findings:

• Total hospital inpatient volume dropped 32% from January to April 2020. At the same time, hospitals were converting clinical capacity to care for patients with COVID-19. The number of COVID-19-related admissions peaked in April, totaling 20% of all admissions that month. Non-COVID-19 volume increased after April but totals did not reach pre-pandemic levels by the end of 2020. Overall, the number of admissions was 9% lower in 2020 than in 2019.

• While the total number of inpatient admissions dropped in April, the number of patient days in intensive care units/critical care units (ICU/CCU) increased dramatically, spiking 63% over April 2019 levels. While ICU/CCU use dropped after the initial surge, ICU/CCU days remained higher than 2019 levels through 2020. Overall, the number of ICU/CCU days increased 10% from 2019 to 2020, even as the number of admissions was lower.
• Patients of color represented a larger share of COVID-19-related inpatient hospital admissions, compared to their share of overall inpatient admissions. COVID-19-related hospital admissions were particularly disproportionate for Black and Hispanic patients. Among patients age 65+, the share of COVID-19 related admissions among Black patients was double their share of all hospital admissions. Among Hispanic patients 18 to 64 and age 65+, the share of COVID-19-related admissions was more than twice their share of all hospital admissions.
• ED visits fell sharply in spring 2020, decreasing 55% between January and April 2020. Overall, the number of ED visits in January to September 2020 was 23% lower than the total from the same months in 2019. While all categories of ED visits declined during the pandemic, potentially avoidable ED visits declined most. From April – September 2020, the total number of potentially avoidable ED visits was 38% lower than in the same months in 2019, compared to declines of 34% for injuries, 22% for behavioral health, and 31% for all other ED visits. Potentially avoidable ED visits decreased most for children compared to other age groups.
• Federal and state COVID-19 relief funding helped keep median margins positive for all hospital cohorts in FY 2020. However, some hospitals, particularly community hospitals and community high public payer hospitals, had negative margins in FY 2020 even with relief funding preventing greater losses. Of Massachusetts’ 22 larger health systems that encompass most of these hospitals and their affiliated physician organizations, 8 had negative overall margins in FY 2020 even including COVID-19 relief funds, a higher number of systems than in 2019. 7 of the 8 were community-hospital based systems.
• The total number of behavioral health (BH)-related ED visits was 16% lower in January to September 2020. However, the percentage of these visits resulting in ED boarding (waiting over 12 hours in the ED) increased, from 27% of BH-related visits over those months in 2019 to 29% in 2020. The percentage of BH-related ED visits resulting in ED boarding increased throughout the pandemic, reaching 31% in September.
• The rate of ED boarding was highest among pediatric patients. From March to September 2020, 39% of pediatric BH ED visits resulted in ED boarding compared to 28% of adult BH visits. At 29% in 2020, pediatric BH patients were also more likely to experience boarding that lasted over 48 hours.
• Use of telehealth as a share of all healthcare services peaked in April 2020 in Massachusetts. Among commercially-insured Massachusetts residents, approximately 70% of primary care, specialist, and BH visits were provided via telehealth in April. Starting in May, primary care and specialist visits began returning to in-person care but use of telehealth still represented 20-30% of visits in September. Use of telehealth for BH remained consistently high, remaining near 70% through September 2020. Among pediatric patients who were receiving psychotherapy services before the pandemic, most patients converted entirely to telehealth or a mix of in-person and telehealth (72%), but almost a quarter of these patients discontinued care.
• Massachusetts-based commercial insurers retained a greater amount of their premium income in 2020 than in the previous two years. Across Massachusetts-based insurers, fully-insured premium revenue increased by 2.3% ($10.7 to $10.9 billion) from 2019 to 2020, while medical claims expenditures decreased by 1.9% ($9.5 to $9.3 billion).

The full chartpack is available on the HPC’s website.

HPC Comment on Mass. General Brigham (MGB) Determination of Need (DoN) Filings

The HPC announced at the meeting that it will submit comment to the Massachusetts Department of Public Health’s DoN process regarding the Mass. General Brigham’s DoN applications for three substantial capital expenditures, totaling $2.3 billion. Recently, DPH notified MGB that an independent cost analysis (ICA) must be done for each application. The HPC has previously commented to the DoN program where the project was likely to have a significant impact on health care spending and health care market structure and where the HPC had developed analyses that could support DPH in its review.

The size and nature of the projects proposed by MGB suggest that they may have a significant impact on health care spending and health care market structure. Providing comment after the ICAs are conducted allows the HPC to objectively analyze all potential aspects of MGB’s plans that could impact the Commonwealth’s efforts to meet its cost-containment priorities and identify areas of potential concern. The HPC will provide input to DoN program staff for consideration well in advance of their staff report and final decision by the Public Health Council.

FY 2022 Health Care Cost Growth Benchmark

At today’s meeting, commissioners voted to set the Massachusetts Health Care Cost Growth Benchmark for calendar year 2022 at 3.1%. The HPC held a public hearing regarding the potential modification of the benchmark on March 25, 2021, in conjunction with the Joint Committee on Health Care Financing to examine recent data around cost growth and hear public testimony. In total, 16 organizations submitted testimony for consideration, which is available on the HPC’s website.

The benchmark is a target for controlling the growth of total health care expenditures across all payers based on the state’s long-term economic growth rate as measured by potential gross state product, or 3.6%. This is the HPC’s fifth year setting the benchmark.

Cost-Effective, Coordinated Care for Caregivers and Substance Exposed Newborns (C4SEN) Investment Program Awards

Commissioners also voted to approve awards for the Cost-Effective, Coordinated Care for Caregivers and Substance Exposed Newborns (C4SEN) Investment Program, a new grant opportunity which aims to develop innovative care models that promote collaboration among appropriate providers to better coordinate care delivery to ensure access to high-quality, efficient, and culturally sensitive care – including addiction treatment – for both substance exposed newborns (SEN) and their caregivers during their period of highest risk. Five hospitals across Massachusetts will receive grants.

“Through the C4SEN program, the HPC is targeting much needed resources for the most at need patients, communities, and health care providers,” said David Seltz, HPC Executive Director. “The COVID-19 pandemic has further highlighted the need to invest in behavioral health care services and through this funding, we are supporting these five community hospitals as they provide culturally competent care for substance exposed newborns and their caregivers. The HPC is thrilled to work with our awardees to expand access to comprehensive postpartum and newborn care across the Commonwealth.”

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