Breakthrough Massachusetts Law Expands Access to Healthcare

Massachusetts passed new legislation on January 1st, 2021, expanding patient accessibility and the scope of practice of several healthcare professions.

On January 1st, 2021 Massachusetts Governor Charlie Baker enacted new healthcare legislation, fittingly titled, “An Act promoting a resilient health care system that puts patients first.” The MCPHS Community, especially members of the pharmacy, optometry, and nursing programs, have cause to celebrate this legislation, as it means the elimination of inefficiencies within the healthcare system and an increase in patients’ access to quality and affordable healthcare.

What this law means for pharmacists

The bill acknowledges that the COVID-19 pandemic has made clear the integral role that pharmacists play in healthcare teams. It “recognizes pharmacists as healthcare providers, enabling them to integrate more fully into coordinated care teams and work with patients to review medications to identify areas for care improvement.” This paves the way for pharmacist services to be covered by health insurance and is a significant advancement for pharmacists in Massachusetts, one that has long been fought for on Beacon Hill by the pharmacy profession. MCPHS applauds this occasion on behalf of its pharmacy students, alumni, and faculty.

As stated by Anna Morin, MCPHS Dean of the School of Pharmacy and Interim Chief Academic Officer for the Worcester/Manchester campuses, “Pharmacists have long been recognized as valued and integral members of the health care team. Serving as the medication experts and providing guidance to their patients and advocating on their behalf, the ability for pharmacists to improve patient outcomes and improve the efficiency and cost of care is well documented. In addition, pharmacists have played a critical role in the COVID-19 response, including testing and vaccination efforts. The healthcare bill signed by Governor Baker on January 1, 2021 recognizes pharmacists as healthcare providers in the Commonwealth of Massachusetts. Provider status will help to remove barriers when seeking reimbursement for clinical services, enabling pharmacists to integrate more fully into patient care and provide an expanded set of services.”

Likewise, Stephen Kerr, MCPHS Interim Dean of the School of Pharmacy in Boston, noted that, “Pharmacists have always served on the frontlines of community health and during this COVID-19 pandemic have been on the forefront of testing, counselling, and now actively engaged in vaccination efforts. Governor Baker’s recent legislation recognizes pharmacists as healthcare providers and acknowledges both the expanding and vital role that pharmacists play in public health. It will go a long way in ensuring that pharmacists continue to be recognized for their important contributions to the community, always seeking better outcomes and putting their patients first.”

MCPHS School of Pharmacy Boston faculty Matt Machado, Professor of Pharmacy Practice; Trisha LaPointe, Associate Professor of Pharmacy Practice; and Tim Hudd, Professor of Pharmacy Practice, have served the Massachusetts Pharmacists Association (MPhA) as members of the Board of Directors and have advocated for this bill for many years and helped Massachusetts pharmacists advance healthcare legislation.

Other important changes

The legislation also benefits several other MCPHS programs as it expands the scope of practice for MCPHS optometry, family nurse practitioner, and psychiatric mental health nurse practitioner students, faculty, and alumni throughout the state. It will also provide for the expanded use of telehealth services that are covered by health insurance across multiple professions.

Changes for optometrists

This legislation has expanded the definition of “practice of optometry” to include not only the management of optical deficiencies, but also the treatment, prescription, and application of devices for ocular diseases and abnormalities, visual and muscular anomalies, and removal of foreign bodies in eye tissue. Crucially, the law will allow optometrists to “utilize and prescribe therapeutic pharmaceutical agents for treating glaucoma and other ocular abnormalities of the human eye.” According to Bridget Hendricks, OD, MS, FAAO, Associate Professor, Chief of Glaucoma Service, The Eye & Vision Center, School of Optometry, MCPHS, this law brings comprehensive improvements to optometric care in Massachusetts, such as permission for optometrists to “use and [prescribe] topical and oral therapeutical agents (including those in schedules III, IV, V, and VI) for the diagnosing, preventing, and treating or managing glaucoma, as well as the prescription of all necessary eye medications, including oral anti-infectives.” New authorizations such as these can encourage and motivate MCPHS optometry students and alumni in their practice of clinical treatments beyond vision correction.

Maryke Neiberg, Dean of the University’s School of Optometry, adds, “Approximately 1,600 optometrists in Massachusetts will now be able to provide enhanced care to their patients. MCPHS’s School of Optometry already trains students to the highest standards and full scope of the profession so that our graduates will be able to practice successfully in all other states. Starting this year, they will also be able to practice to the level of their training in Massachusetts too.”

Changes for advanced-practice nurse practitioners

For advanced-practice nurse practitioners, the principal advantage of this law is that it grants them full practice authority. This means that nurse practitioners (with over two years of qualified experience) can issue written prescriptions and medication orders and order tests and therapeutics independent of a supervising physician. Despite being a healthcare hub with some of the top hospitals in the world, Massachusetts is the 23rd state in the U.S. to give nurse practitioners full practice authority. The autonomy of advanced-practice nurse practitioners to manage patients without a supervising physician creates more access to care for patients and allows for more flexibility in their schedules, which in turn gives patients more of their time and care. In the words of Patricia Murray DHS, MSN, APRN, FNP-BC, Associate Professor, FNP Track Coordinator, School of Nursing, MCPHS: “Full practice authority will shine a light on the role that nurse practitioners' play in direct patient care, and the contributions we make toward improving healthcare overall. Through this legislation, in addition to filling the primary care gaps in our community, we will be able to demonstrate the impact that NPs have on the specific population they serve. This is key to advancing our profession and to safeguarding our role as primary care providers.”

The law emphasizes primary and behavioral healthcare. The authorization of qualified advanced-practice nurse practitioners to perform psychiatric examinations also supports a critical need within a shortage of mental health services. This law allows for more attention to psychiatric patients by giving psychiatric mental health nurse practitioners the ability to perform examinations, hospitalizations, and restraints. These new capabilities, in conjunction with permanent insurance coverage of behavioral telehealth visits at the same rate as in-person visits, promise positive changes and accessibility for psychiatric patients and powerful treatment opportunities for practitioners. As observed by Lorraine MacDonald, MCPHS Assistant Professor and Coordinator for the Psychiatric Mental Health Nurse Practitioner program, “The requirement of insurance coverage for telehealth visits is instrumental in caring for patients with mental illness. The Psychiatric Mental Health Nurse Practitioner track has been training students for the past three years in telehealth and using simulation for simulated patient visits. In a response to the growing need for telehealth, the School of Nursing has implemented a required telehealth course for FNPs and PMHNPs beginning January 2021. These changes to our curriculum are ahead of the curve and were implemented prior to Governor Baker's announcement of expanded telehealth coverage.”

Changes for telehealth services

• An important focus of this law is the coverage of telehealth visits by medical insurance at the same rate as in-person visits. Providing parity of reimbursement for behavioral health services, primary care services, and chronic care management allows providers the comfort and incentive to offer telehealth services to their patients. In addition, by lifting the restriction on settings where telehealth services can be provided, the law allows patients the opportunity to seek patient-centered care in their own homes. Telehealth services also create increased access to care, particularly in rural areas and areas with shortages of qualified sub-specialists. Additionally, the provision enables more frequent monitoring of patient health, particularly for those with chronic conditions, and it can lead to improved health outcomes and increased patient engagement. Kristy Altongy-Magee, MCPHS Program Director for the Worcester/Manchester Physician Assistant Studies program, explains, “Telehealth is one tool used to influence the changing landscape of healthcare, which includes the 5 P’s: Personalized, Precise, Predictive, Preventive, and Participatory. It improves health outcomes by facilitating a shift from reactive sick care to preventive and predictive care; from episodic, intermittent, and siloed care to continuous, collaborative care; and from one-size-fits-all care to personalized, precise, and proactive care.”
• MCPHS values and advocates for the continued expansion of the scope of practice across all healthcare professions. MCPHS faculty and alumni have always been at the forefront of their fields, and their efforts have been a guiding light in helping to further the University’s mission of educating healthcare practitioners in support of the changing needs of society.