04.30.2018

A Blog on Ratios, Plus a State House Hearing, and more...

A Point-by-Point Argument Against Mandated Nurse Ratios

Hebrew SeniorLife President & CEO Louis Woolf recently posted a blog on the nurse staffing issue entitled “Massachusetts Nursing Ballot Question is Bad for Our Health.”

Woolf’s blog delivers a series of concise arguments about why government-mandated, one-size-fits-all nurse staffing ratios would be bad for Massachusetts healthcare.

“The American Nurses Association of Massachusetts and the Organization of Nurse Leaders oppose this ballot question because it strips decision-making power from nurses themselves,” Woolf wrote. “Our hospitals vary in size, specialize in different services, and serve different patient populations. Having the same staffing plan at every hospital, for every patient, at all times makes no sense and many nurses agree.”

Woolf said one argument against ratios “hits especially close to home for me.” Noting the past winter’s back-to back nor’easters, Woolf wrote, “Hebrew Rehabilitation Center teams rallied together to make sure our patients were well taken care of during the storms. When blizzard conditions make traveling difficult, we don’t always have full staffing.  Yet as a team, our nurses determined where we needed critical resources and utilized other team members to support the nurses. And the outcome was excellent. With this law we, and other hospitals, could face penalties if enough nurses are unable to report to work under severe weather conditions.”

To read the post, which includes details on the ballot question’s costs, its effect on ED wait times, and more, click here.

Nurse Staffing Debate Turns to Beacon Hill Today

The Massachusetts legislature’s Joint Committee on Public Health holds a hearing today at 1 p.m. on the Massachusetts Nurse Association’s (MNA’s) ballot question to impose mandatory registered nurse staffing ratios.

Since the ballot question process in Massachusetts offers the legislature the opportunity to weigh in, all proposals slated for November are filed as legislation and a public hearing is required.

More than 100 healthcare professionals from throughout the state are expected to attend the hearing to show their strong opposition to the MNA proposal. Those testifying will include staff nurses, hospital leaders, behavioral health professionals, and research experts. The Joint Committee will hear about all the adverse effects of the proposed law, including its threat to patient care, the decision-making ability of nurses, and the stability of Massachusetts hospitals.

Over the years in attempting to make its case at the State House, the MNA has relied on strong photo-op staging. But from a science/fact point of view, the MNA has never been able to present an authentic study that endorses a specific nurse-to-patient ratio for all hospitals at all times. Such a ratio does not exist.

In California, the only state that has imposed mandated ratios, there is no evidence it has improved the quality of care. In fact, Massachusetts hospitals already equal or exceed California hospitals in nearly every meaningful measure of patient care.

Among Proposed Changes to Medicare: Less Reporting

The FY19 Inpatient Prospective Payment System (IPPS) proposed rule – the voluminous document that details the contract between hospitals and the Medicare system – was released last week. Aside from containing the annual rate update, the proposed rule would significantly reduce the number of quality measures hospitals have to report.

CMS said it was eliminating some reporting altogether and would remove duplicative measures across five hospital quality and value-based purchasing programs. “This would result in the removal of a total of 19 measures from the programs and would de-duplicate another 21 measures while still maintaining meaningful measures of hospital quality and patient safety,” CMS wrote in a release, adding that other changes will reduce the number of hours providers spend on paperwork.

Mass. Providers, Insurers, Consumers Unite to Oppose Rule

A federal proposed rule to allow short-term, limited-duration insurance could expose individuals to higher healthcare costs, reduced benefits coverage, and destabilize the Massachusetts healthcare market, according to a coalition of Bay State provider, insurance, and consumer groups.

MHA joined with Blue Cross Blue Shield of Massachusetts, Health Care For All, the Massachusetts Association of Health Plans, and Massachusetts Medical Society in drafting this letter to CMS opposing the rule, which would amend the definition of “short-term, limited duration insurance.”  Currently, such “STLDI” plans are limited to a maximum of three months of coverage; the proposed rule would expand the maximum coverage period to 12 months.

While insurers would have to include disclaimer language with the plans – explaining that the STLDIs may not comply with federal requirements for health insurance, don’t meet minimal coverage requirement of the Affordable Care Act, and may expose individuals to tax penalties – the Massachusetts group wrote that the cautionary notices are insufficient.

 “If this rule is finalized in its current form, it is likely that individuals with younger, healthier risk will move to join STLDI plans, while older and sicker individuals will remain in their traditional policies, leaving the individual market concentrated with unhealthy risk,” the letter states. “As the better risk moves into STLDI plans, premium rates for those individuals that remain will increase, making it more difficult to maintain coverage.”

The Massachusetts groups, in urging the Department of Health & Human Services to retain the existing regulation, wrote: “While STLDI products may provide a limited option in states that have large uninsured populations, Massachusetts has near universal coverage, with multiple programs to assist consumers in finding and affording comprehensive coverage. As such, there is no need in Massachusetts for this type of product, with limited benefits and no protection against tax penalties or high out-of-pocket medical expenses.”

QUALITY CORNER: Brigham and Women’s Hospital & IV Fluids

As has been reported extensively, Hurricane Maria in September 2017 temporarily knocked out production of IV fluid bags in Puerto Rico, which produces 44% of the bags used in the U.S.  While the shortage of 50- and 100-ml bags has abated somewhat, shortages continue for larger 500- to 1000-ml bags.  In fact, U.S. hospitals for the better part of a decade have faced reoccurring shortages of IV fluids for a variety of reasons.

Now, a team at Brigham & Women’s Hospital has developed a series of timed steps that providers can take to ensure that ED patients with mild dehydration can rehydrate by drinking fluids rather than having them injected through an IV catheter.  The oral rehydration protocol is included in the hospital’ electronic medical record and order-entry system, streamlining the process.

In this New England Journal of Medicine article describing the protocol, the authors wrote, “To ensure implementation of our protocol, providers were sent an email message by hospital leadership detailing the IV-fluid shortage and the oral rehydration protocol. ED nursing leaders trained nurses and ED technicians and posted flyers throughout the ED. We also provided additional training and reminders about the oral rehydration protocol to our faculty and residents.”

Like traditional IV use, the oral hydration strategy relies heavily on clinical judgment to determine which patients will benefit from its use. And, the authors note, “Patient and family participation is key to success” since patients are required to consume set amounts of fluids at periodic intervals, and usually rely on family members to time them.

“We share this protocol as a replicable model for other U.S. hospitals looking for strategies during the IV-fluid shortage,” the authors write. “Experience in low-resource settings worldwide has proven the efficacy of oral rehydration therapy, and vulnerabilities of the U.S. IV-fluid supply chain are expected to continue. We believe that widespread use of oral rehydration protocols would therefore be a rational practice change and a mainstream model for use in the United States even after the current IV-fluid shortage crisis ends.”

Book Your Next Conference or Meeting Here

Need a good meeting space? Flexible room options? One with food options? In a convenient location surrounded by shopping and restaurants? The MHA Conference Center at 500 District Ave. in Burlington, Mass. offers very competitive prices and personalized service. Last week, the MHA Conference Center updated its website to offer potential customers clear views of each room option, plus a list of amenities, food options, and more.  Click the link above or call (781) 262-6028 to learn more.

Transition

Ron Bryant, who had been serving as interim president of Baystate Franklin Medical Center, last week was appointed to the position on a permanent basis. He now will be president of both Baystate Noble Hospital in Westfield and Baystate Franklin in Greenfield.  Bryant had been serving as Baystate Franklin’s interim chief since December 2017 when the previous president, Cindy Russo, resigned.

Governor Baker to Speak at MHA Annual Meeting in June

MHA 82nd Annual Meeting: June 6 to 8
Doubletree by Hilton Boston North Shore, Danvers, Mass.

Governor Charlie Baker will address the MHA 82nd Annual Meeting on Friday morning, June 8 during a state of the state speech on the opioid crisis. Also appearing on Friday will be Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center. Botticelli was director of the White House Office of National Drug Control Policy – the nation’s “Drug Czar” – during the Obama Administration. The three-day annual gathering takes place this year in Danvers, Mass. and features, in addition to the governor, Admiral Peter Neffenger, who was the deputy national incident commander for the 2010 Deepwater Horizon oil spill, and Elise Wilson, RN, who survived a stabbing attack in a Massachusetts hospital ED where she was working. The MHA Annual Meeting is always a great opportunity for healthcare community peers to come together for solid educational programming and enjoyable networking. Please visit here to register and for updated information on the program.

John LoDico, Editor