Opposition to government-mandated nurse-to-patient staffing ratios knows no geographic boundaries. Last week the New Jersey State Nurses Association (NJSNA) – representing about 125,000 RNs in the Garden State – came out solidly against proposed state legislation that would establish minimum nurse-to-patient ratios.

Judith Schmidt, NJSNA’s CEO, said, “Ratios are rigid and dictate a set number of staff, which is not the best model for optimal patient care, which constantly changes. We need to give the nurses at the bedside the authority and the accountability for staffing their units as needed.”

In Massachusetts, the nursing union representing less than 25% of the RNs in the state is proposing a ballot question for the 2018 election that would impose government mandated registered nurse staffing ratios on every hospital in Massachusetts at all times.  Interestingly, the ratios proposed in Massachusetts are different than the ratios contained in the New Jersey proposed bill, which are different from what the only state with mandated ratios (California) passed. The proposals differ because no existing scientific study has determined a conclusive nurse-to-patient ratio.

“Staffing is not about a specific number, but the appropriate mix of how sick the patients are, which dictates how much care they need, plus the level of experience of the nurse,” said New Jersey’s Schmidt in a statement.

Leading healthcare organizations – representing nurses and hospitals – are united in their opposition to government-mandated nurse staffing ratios. The Coalition to Protect Patient Safety was created to oppose the 2018 statewide ballot question. It currently consists of: MHA, The Organization of Nurse Leaders, American Nurses Association -- Massachusetts, Massachusetts Council of Community Hospitals, and the Conference of Boston Teaching Hospitals. Other healthcare leaders, business groups, and those concerned about maintaining and improving the Massachusetts healthcare system are expected to join the Coalition in the coming months. You can follow the Coalition to Protect Patient Safety on Facebook and Twitter.

While the shortage of drug products manufactured in Puerto Rico has eased a bit in recent weeks, hospitals are still reporting that they are low on IV bags, saline and emergency products. The shortages are so destabilizing that last week the entire Massachusetts Congressional delegation led by Senator Elizabeth Warren signed a letter to FDA Commissioner Scott Gottlieb, M.D., seeking a briefing on the issue.

When Hurricane Maria struck on September 20, 2017, manufacturing in Puerto Rico took a massive hit as power was lost to most of the island. Almost 10% of U.S. pharmaceutical expenditures are for more than 1,000 drug products manufactured in Puerto Rico, the delegation noted in its letter.

Since last September, after a series of miscues, recovery began in Puerto Rico and the FDA recently took a number of steps to mitigate the shortage, such as extending product expiration dates. But the challenges continue, especially around access to intravenous solutions. The delegation letter to the FDA Commissioner outlined the drastic measures Massachusetts hospitals are taking to alleviate the shortages; IVs are now being administered – at greater cost and staff time – by the “IV push” method, and hospitals are compounding solutions in-house.

“Hospitals are reporting shortfalls of potassium chloride, lorazepam, and anesthetics like lidocaine or bupivacaine,” wrote both of the commonwealth’s U.S. Senators along with all nine U.S. Representatives. “While our state’s hospitals continue to provide the highest-quality medical care to patients, addressing these shortages is costly and time-consuming.”

The letter cites reports it received from MHA President & CEO Steve Walsh, who traveled to D.C. last month to meet with the delegation on the supply shortages and other federal-state issues.

Walsh said of the letter, which asked for an FDA briefing by February 23, “Our delegation ‘gets’ healthcare. They understand the strong foundation that hospitals provide to the Massachusetts economy and to the health and well-being of its citizens. When that foundation is threatened – whether through supply shortages or attacks against Medicare funding or healthcare access – the delegation is incredibly responsive.”

A second, similar letter to the FDA’s Gottlieb was signed by 30 Senators and 63 Representatives. That letter called on the FDA to detail, among other items, the steps it is taking to prevent new shortages from Puerto Rico, and to ensure manufacturers are creating contingency strategies to avoid future shortfalls. Massachusetts Representatives Stephen Lynch, Bill Keating, Jim McGovern, Seth Moulton and Niki Tsongas signed that letter.

The federal budget package which passed last week after an hours-long government shutdown includes many important healthcare provisions, such as four additional years of funding for the Children's Health Insurance Program (providing a full 10-year reauthorization), the elimination of the scheduled Medicaid DSH cuts for FY 2018 and 2019, funding for community health centers, extensions of several Medicare rural health programs, and $6 billion for the opioid crisis and mental health.

The Medicare cap on therapy payment is permanently repealed.  The package also includes funding for several public health programs, including the National Health Service Corps. The package repeals the Independent Payment Advisory Board and also includes offsets to pay for the funding expansions, including a 1.5% update reduction for home health. It will also require that biologic manufacturer discounts for Medicare “donut hole” beneficiaries be expanded to generic manufacturers; currently only branded biologics are required to offer discounts. 
The new law lifts the budget caps for two years preventing any additional sequestration cuts. (The current 2% sequester remains in place.)

The president signed the bill on Friday.

A statewide initiative to address emergency department boarding of patients needing inpatient psychiatric care went into effect on Thursday, February 1.  ED boarding of behavioral health patients has been a long-standing problem., but under the leadership of EOHHS Secretary Marylou Sudders, the Department of Mental Health (DMH) developed an escalation process to secure appropriate placement for individuals boarding in EDs who require inpatient psychiatric hospital level of care. The system was designed in consultation with MassHealth, the Department of Public Health, the Division of Insurance (DOI), and several stakeholder groups, including MHA.

For escalating cases where placement has not been achieved in a reasonable period of time, the new policy establishes clear steps and responsibility for senior clinical leadership at insurance carriers, inpatient psychiatric units, and ultimately at DMH, with the goal of identifying and resolving barriers to admission. As part of revised DMH regulations expected in the next few weeks, inpatient psychiatric facilities will follow new licensing requirements to ensure they have the range of inpatient resources necessary to address the clinical needs of patients.  DOI has instructed insurance carriers that they are expected to facilitate admission of difficult cases seven days a week, to provide authorization for specific needs as soon as the need is known, and to maintain adequate networks of inpatient psychiatric facilities.

As this policy is rolled out, MHA is holding bi-weekly implementation calls through April to hear from members about what is and is not working.

Detailed information on the policy can be found both on Patient CareLink and on DMH’s website.

Massachusetts Attorney General Maura Healey last Wednesday issued new community benefits guidelines for hospitals and HMOs.

Community benefits are programs that hospitals offer at no cost to communities to assist in, among other items, targeting obesity, nutrition education, and diabetes management; fighting substance use disorder; providing transportation to assist with accessing primary care and mental health services; hosting community-based support programs for domestic violence prevention and support, maternal and newborn services, and tobacco – among many other programs.

In 2016, Massachusetts hospitals provided $648 million in community benefits. That figure does not include the losses hospitals incurred in providing care to enrollees in government programs such as MassHealth, which reimburses well below the cost of care. In the news release announcing the guideline changes, AG Healey noted that hospitals and HMOs collectively reported between $749 million and $921 million in community benefits each year between 2010 and 2016.

“Massachusetts’s continued leadership on community benefits provides valuable direction to hospitals as they plan for continued investment in their communities,” said Steve Walsh, MHA president and CEO. “We appreciate the collaborative work by the Attorney General to ensure that the new guidelines align federal and state standards, as well as her work with providers and advocates to develop appropriate methods for community engagement.”

The task force that Healey assembled to craft the new guidelines has been meeting since April 2017. Among the participants on that task force were Michael Botticelli, the executive director of the Grayken Center for Addiction Medicine at Boston Medical Center; Douglas Brown, the president of community hospitals and chief administrative officer for the UMass Memorial Health Care System; Joan Quinlan, vice president for community health at Massachusetts General Hospital; Frank Robinson, vice president, community relations & public health for Baystate Health; and Jody White, the CEO of Lowell General Hospital and Circle Health.

The Massachusetts Lung Cancer Screening Learning Collaborative is holding a kickoff meeting on Wednesday, March 14, from morning through afternoon at the Sheraton Tara in Framingham.  Details and registration information will be available later, but the Collaborative plans to offer CMEs and the event will be free.

This meeting will be an opportunity for hospitals across Massachusetts to send staff members currently involved in a lung cancer screening program or looking to start a lung cancer screening program. The Learning Collaborative is being run through the Massachusetts Department of Public Health. More details to follow, but please have interested staff Save the Date today.

A new healthcare policy/advocacy group – United States of Care – launched last week to ensure that “every single American has access to quality, affordable healthcare regardless of health status, social need, or income.” The non-partisan, non-profit group listed its core principles as: “Every American should have an affordable regular source of care for themselves and their families ... All Americans should be protected from financial devastation because of illness or injury ... Policies to achieve these aims must be fiscally responsible and win the political support needed to ensure long-term stability.”

The ambitious group is led by a Board of Directors & Founder’s Council with members ranging from former Republican U.S. Senator Bill Frist, M.D. to Saturday Night Live cast member Pete Davidson, who is a mental health advocate. MHA Member Dr. David Torchiana, the CEO of Partners HealthCare is a Founder’s Council member.  Learn more here.

Project Management for Healthcare

Friday, March 16; 8:30 a.m. to 3 p.m.
MHA Conference Center, Burlington, Mass.

The fundamental purpose of project management is to be one step ahead of potential risk that could show itself during project planning and execution. The trick is to plan, organize, and control as many of the steps as possible to mitigate unnecessary consequences. This seminar is designed to do just that. It will provide participants with strategies that they can use right now, wherever they are in a project timeline. Whether it’s starting with the project plan or building the right team for the task, key strategies on time management, effective communication, and maintaining motivation will be presented. A “how to” related to workflow diagrams will be a significant takeaway as it’s the ultimate preparation tool to identify where current process breakdowns are occurring and to highlight areas that require more attention before implementation begins. Key tactics covering these critical topics and more will all be addressed in this one-day program.  Learn more by clicking here.