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Massachusetts isn’t using a tool that could help tackle its shortage of primary care doctors – The Boston Globe

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Massachusetts isn’t using a tool that could help tackle its shortage of primary care doctors – The Boston Globe


When Massachusetts is a national outlier in any policy, it’s worth asking why and whether that policy still makes sense.

Massachusetts today is one of only seven states that does not use Medicaid money to fund medical residencies, which provide the clinical training of new doctors after they complete medical school. Among the 10 states with the most teaching hospitals and physician residents, it is the only one that does not use Medicaid money to support graduate medical education, or GME, according to the Association of American Medical Colleges.

The main reason appears to be cost: Massachusetts did have a program, but policy makers cut it in 2010, according to the Executive Office of Health and Human Services, amid budget shortfalls due to the 2008 recession and as state officials prioritized implementing universal health insurance coverage.

Today, cost remains a barrier to reinstating the program. Yet given the shortage of primary care physicians, lawmakers should consider reinstating Medicaid GME in a targeted way that shores up needed services like primary care, behavioral health care, and community health centers.

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Without the Medicaid money, residencies are mostly paid for by Medicare, which gave $16.2 billion in fiscal 2020 to GME programs nationwide.

Although it may seem like an arcane distinction, there are two good reasons to use Medicaid money to fund residencies beyond those funded by Medicare. One is that the federal government would match the state contribution, drawing new federal money. The second is that the state can narrowly tailor a Medicaid program to decide how much money to spend — and how to spend it.

This flexibility means state lawmakers could target money for residencies in specific specialties that Massachusetts needs more of.

There is a dire need to train more primary care physicians and keep them in Massachusetts. People are struggling to find doctors. Wait times at community health centers, which see many Medicaid patients, have recently been as long as 80 days for a new patient and up to 40 days for an existing patient, according to Michael Curry, president and CEO of the Massachusetts League of Community Health Centers.

According to the Milbank Memorial Fund’s primary care scorecard, 16.7 percent of adults in Massachusetts and 5.4 percent of children in 2021 lacked a usual source of health care, numbers that had grown since 2011. According to survey data from Massachusetts Health Quality Partners and the Center for Health Information and Analysis, adults were having a harder time accessing primary care in 2022 than in 2019. Massachusetts has a higher rate of doctors leaving primary care than the nation overall. One-third of Massachusetts doctors in 2020 were over 60 and fewer than one-quarter of Massachusetts medical school graduates are entering primary care, according to MHQP.

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When someone cannot get an appointment with a primary care physician, they are more likely to become seriously ill and go to the emergency department, at a time when hospitals are experiencing capacity crunches.

Funding more residency training slots through Medicaid would not magically solve the problem. Seriously addressing the primary care shortage will require paying primary care doctors more and addressing the administrative burden that makes primary care such a hard job. Massachusetts officials are taking other steps to address the problem, like establishing student loan repayment programs.

But reestablishing Medicaid GME could allow hospitals and community health centers to train more doctors to work in badly needed fields. Because specialty care is more lucrative, without the added Medicaid incentive, hospitals are more likely to create residencies in specialty fields than primary care.

Multiple bills to reestablish Medicaid GME payments are pending in legislative committees, with advocacy by the League of Community Health Centers and the Massachusetts Health and Hospital Association. The details differ, but the basic idea is to pay for residencies in fields with shortages, including primary care and behavioral health care, in hospitals and community health centers. (Like primary care, behavioral health care is a field where worker shortages are severely impacting people’s ability to get timely care.) A program could also potentially fund training for non-physician clinicians, like nursing students.

The League of Community Health Centers is asking for $50 million in Medicaid funding over three years, half of which would be reimbursed by the federal government. According to the organization, that level of funding would pay to graduate 23 new family medicine doctors annually (with funding for three years of residency) and to fund 69 residency slots each year for nurse practitioners, assuming a cost of $185,000 per physician resident and $120,000 per nursing resident.

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Most states use general fund money to pay for Medicaid GME, though some rely on municipal tax money or taxes on hospitals. Lawmakers will have to determine the best funding source.

But the money is likely to be a smart investment, and it will draw in federal money that the state is leaving on the table now. And if increased funding for residencies means more doctors go into primary or behavioral health care in Massachusetts, patients will be seen sooner and will get the care they need to remain healthy, lowering costs in the long term.


Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.





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Massachusetts

‘That comes with a price tag’: How snow removal is busting town budgets – The Boston Globe

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‘That comes with a price tag’: How snow removal is busting town budgets – The Boston Globe


“The way we experience climate change is through extremes,” said Shel Winkley, a meteorologist at Climate Central. “All of that comes with a price tag.”

Across the region, officials are trying to figure out how to pay that price. The Massachusetts Department of Transportation has already spent more than $185 million on snow and ice removal this winter — about $20 million beyond what was spent during the “Snowmageddon” winter of 2015. State officials are weighing whether to seek aid from the Trump administration.

Providence has had to cap spending for the rest of the fiscal year after record-setting snowfall. In Boston, where officials have trimmed the snow removal budget, the city was on track to spend nearly double what it had set aside for winter cleanup — even before the February blizzard hit. Cambridge has spent $6 million, more than 10 times the placeholder amount it budgeted for winter cleanup.

“This is an additional pressure point on an already pressurized budget situation,” said Adam Chapdelaine, executive director of the Massachusetts Municipal Association. “In some communities, it’s likely going to force some hard decisions.”

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In Edgartown, officials want to tap into budget reserves to make up the cost, a step that requires voter approval. If voters don’t support that move, it could mean raising taxes, said James Hagerty, the town administrator.

A boardwalk at the Seaport District in Boston still has some salt and ice melt deposits on the wooden boards along with some snow, on Mar. 2.David L. Ryan/ Globe Staff

Local officials said federal funding would help, but they’re not counting on it. Some worried that partisan disparities in which states have received disaster funding under the Trump administration would put Massachusetts at a disadvantage.

“We are hopeful that the state and federal government might step in to assist, but it’s just waiting at this point,” said Gregory Berman, Chatham’s director of natural resources.

The skyrocketing costs are yet another reminder that winters here don’t feel the same. New England is largely trending toward shorter and milder winters. Massachusetts has lost about 30 days of snow cover each year over the last few decades.

However, experts say the relationship between climate change and total annual snowfall is more complicated. Think of it as two competing forces. On one hand, global warming increases the amount of moisture in the atmosphere; when conditions are cold enough, this added moisture can fuel heavier snowstorms. On the other hand, rising temperatures mean that winter precipitation falls more frequently as rain than snow.

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The data reflect this mixed picture. An analysis of historic snowfall totals by Climate Central, a nonprofit that conducts climate change research, found that annual snowfall has actually increased over the past 50 years in Boston and parts of coastal Massachusetts, while inland areas have seen declines.

Looking ahead, researchers project that the most intense storms may become even heavier, producing more snow than blizzards past. This shift may already be underway. In the past 40 years, Boston has recorded 10 snowstorms that produced at least 20 inches of snow. In the eight decades prior to that, there were just three.

These massive storms can trigger extra expenses, as municipalities have to pay for equipment rentals, contractors, and overtime for cleanup around the clock.

Julie Wormser, chief climate officer in Cambridge, said that total snowfall data surprised her.

“Based on how quickly the ocean is heating up off New England, my bet is that the next 50 years of data will reverse that snowfall trend,” she said.

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Cities and towns in Western Massachusetts, Cape Cod, and the North Shore were hit especially hard. This winter, they received more than two feet of snow above their average.

Snowfall totals were higher compared to the seasonal average across Massachusetts from Dec. 1 to March 15.Iowa Environmental Mesonet (IEM)

On Cape Cod, Sandwich officials overspent their snow budget by $250,000, driven largely by the February blizzard. Town Manager George “Bud” Dunham said a day of minor plowing and treating roads can cost about $10,000, but major storms push that figure past $50,000. The town is still cleaning up downed brush and tree limbs.

If not for the storm, Dunham said, the town might have invested in new snow equipment or set aside funds for retired employees’ health insurance costs.

Mattapoisett, a coastal community on Buzzards Bay, also blew through its budget, spending nearly triple what officials had set aside. Still, Michael Lorenco, the administrator, said the town should be able to absorb the hit within its $37 million budget without raising taxes.

“I’m not a scientist, but towns near the coast seem to be getting more snow than they normally would in the past,” Lorenco said.

That doesn’t change the city’s responsibilities.

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“Climate change or not,” he added, “we have to clean up the roads.”

Ken Mahan of the Globe staff contributed reporting.


Kate Selig can be reached at kate.selig@globe.com. Follow her on X @kate_selig.





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Massachusetts bakery that made signature pizza trays for more than 100 years closes for good

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Massachusetts bakery that made signature pizza trays for more than 100 years closes for good



A Framingham institution that has been in business for more than a century closed its doors for the final time on Sunday.

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Framingham Baking Company, known for its signature pizza trays, has officially shut down permanently. Crowds have been lining up around the block in the shop’s final days, with Sunday serving as their last day in business.

“That’s a wrap! Special thanks to all of our loyal customers! It was a great run. We love you!” Framingham Baking Company posted on Facebook Sunday after selling its final slices of pizza.

Founded in 1917, the bakery on Waverly Street became known for the square pizza slices.

The third-generation owners say they couldn’t find anyone to take over the business.

“We’re closing today after 109 years in business,” owner Joan Thomas said. “My grandparents, my parents, and my siblings – three generations have run this bakery.”

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Customers explained why they were willing to wait in long lines to get their hands on some treats one more time.

“So many years of eating this pizza, and the bread, and the cookies. You had to be there for the end,” one woman said.

“My grandfather was a delivery guy for a long time. My first job was riding around with him in the van delivering to all the local restaurants. It’s tough to see it close, but it’s had an amazing run. Here for my last delivery. Bring some pizza home to my family,” another man added.

One customer waiting in line said it wasn’t just pizza the Framingham Baking Company provided, it was memories.

“Brought it to the cousins’ every birthday party, every gathering. Any time there was family there was pizza,” he said. 

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Massachusetts’ middle-class income range is highest in US., topping out at over $200K

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Massachusetts’ middle-class income range is highest in US., topping out at over 0K


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Your household can earn more than $200,000 a year and still be considered part of the “middle class” in Massachusetts, according to a recent study by SmartAsset.

Massachusetts ranks as the top state with the highest income range for households to be considered middle class, based on SmartAsset’s analysis using 2024 income data from the U.S. Census Bureau. The Pew Research Center defines the middle class as households earning roughly two-thirds to twice the national median household income.

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According to a 2022 Gallup survey, about half of U.S. adults consider themselves middle class, with 38% identifying as “middle class” and 14% as “upper-middle class.” Higher-income Americans and college graduates were most likely to identify with the “middle class” or “upper-middle class,” while lower-income Americans and those without a college education generally identified as “working class” or “lower class.”

Here’s how much money your household would need to bring in annually to be considered middle class in Massachusetts.

How much money would you need to make to be considered middle class in MA?

In Massachusetts, households would need to earn between $69,900 and $209,656 annually to be considered middle class, according to SmartAsset. The Bay State has the highest income range in the country for middle-class households. The state’s median household income is $104,828.

In Boston, the range is slightly lower. Households need to earn between $65,194 and $195,582 annually to qualify as middle class, giving the city the 19th-highest income range among the 100 largest U.S. cities. Boston’s median household income is $97,791.

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How do other New England states compare?

Massachusetts has the highest income range for middle-class households in New England. Here’s what households would have to earn in neighboring states:

  1. Massachusetts (#1 nationally) – $69,885 to $209,656 annually; median household income of $104,828
  2. New Hampshire (#6 nationally) – $66,521 to $199,564 annually; median household income of $99,782
  3. Connecticut (#10 nationally) – $64,033 to $192,098 annually; median household income of $96,049
  4. Rhode Island (#17 nationally) – $55,669 to $167,008 annually; median household income of $83,504
  5. Vermont (#19 nationally) – $55,153 to $165,460 annually; median household income of $82,730
  6. Maine (#30 nationally) – $50,961 to $152,884 annually; median household income of $76,442

Which state has the lowest middle-class income range?

Mississippi ranks last for the income range needed to be considered middle class, according to SmartAsset. Households there would need to earn between $39,418 and $118,254 annually. The state’s median household income is $59,127.



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