10.15.2018

ER Wait Times, a Safety Summit, and more...

ED Doctors and Nurses and EMTs Slam Question 1

Emergency Department (ED) wait times will go up and care will be compromised if Question 1 passes – that’s the collective conclusion of ED doctors and nurses, as well as the EMTs who treat and transport patients.

Last Thursday, the emergency caregivers came together at Pro EMS, which provides emergency medical services and advanced life support to Cambridge and eight surrounding communities.

“In California, the only state in the nation that has imposed nurse staffing ratios, there’s a term – it’s known as holding the wall,” said Lisa Nasuti, the paramedic field supervisor for South Shore Health System. “This is when emergency medical personnel sit with their patients in a hall, in an ambulance, in a parking lot until a nurse is free to care for them. That is what we will face if Question 1 passes – EMTs waiting long periods with patients on stretchers. And just think of the trickle-down effect; that ambulance can’t turn around and go back to the community it serves as a 911 provider, or transfer critical patients to Boston or other areas.”

Question 1 mandates four different ratios for a hospital ED, depending on the acuity of the patient. That means that the ratio – and the number of nurses required to fill it – can change minute by minute.

Nicole Arnold, R.N., a bedside nurse and a member of the Emergency Nurses Association – Massachusetts Chapter, detailed how an ED nurse faces an ever-changing population seeking urgent care.

“All flexibility and decision-making will no longer be ours as nurses,” she said. “Who will care for that cancer patient if me and my team are already at our legally binding ratio? Who will care for that stroke patient? The sexual assault victim, the tragic car accident, the overdose, or suicide attempt? These are the realities we face; all things in the ER are unknown. These are your family members and mine and they do not fit into a rigid, cookie cutter plan. They fit into a demographic that requires my professional decision-making as the need arises.”

The reccurring theme from the ED personnel was that if there is one area of a hospital that requires caregivers to be nimble, it’s the ED.

Scott Weiner, M.D., president of the Massachusetts College of Emergency Physicians, said, “My biggest fear is for disaster situations. We need the flexibility to take as many patients as we can possible care for the next time a gas line explodes or a bus crashes or we are again victims of terrorism – or it is simply an unplanned, crazy-busy day. If you are a patient in any of these situations, how would you like to hear that your hospital emergency department stands ready with doctors, technicians, labs and x-rays all ready to care for you, but we can’t let you through the door because the nurses have met their arbitrary ratio – even when the nurses’ own expert clinical judgement says that they too have the bandwidth to safely care for you?”

The state’s Health Policy Commission recently released a study showing that Question 1 will cost up to $950 million annually. But in reaching that figure, the HPC did not factor in the additional costs to hospital EDs. At the cost trend hearings this week, the HPC is expected to have the ED cost number available and that additional cost should push the annual cost of government-mandated ratios contained in Question 1 past $1 billion, which Dr. Weiner noted last Thursday would most likely result in community hospital closures.

Ali Raja, M.D., the executive vice chair of Massachusetts General Hospital’s department of emergency medicine, cautioned that Question 1 will harm access and lead to increased boarding.

“When we’re full [at MGH’s ED], our nurses – who are professionals in every sense of the word, and have the judgment to care for our patients exceptionally well – will be limited in the real-time decisions they can make on the fly to move patients around and equalize the work load. This proposition will take that ability away from them.”

The ballot question is opposed by the American Nurses Association - Massachusetts, Emergency Nurses Association - Massachusetts Chapter, Organization of Nurse Leaders, Infusion Nurses Society, Massachusetts Association of Colleges of Nursing, Academy of Medical-Surgical Nurses’ Greater Boston Chapter, the Western Massachusetts Nursing Collaborative, the Massachusetts College of Emergency Physicians, the Massachusetts Medical Society, the Massachusetts Health and Hospital Association, the Massachusetts Council of Community Hospitals, the Conference of Boston Teaching Hospitals, and other healthcare and business leaders across the state.  You can watch the entire press conference here.

The List of Question 1 Opponents Grows

The list of important healthcare entities opposing Question 1 continues to grow as the November 6 Election Day nears.

The Providers’ Council – a statewide association of primarily non-profit, community-based organizations that provide human services, health, education and vocational supports to one-in-10 residents of the commonwealth – last week voiced its opposition to the ballot question, saying that mandated ratios would require thousands of new nurses “who just don’t exist in our state.” What will happen when you combine a mandated demand for nurses with a non-existent supply of RNs? The Providers' Council wrote: “What that means for human services providers, behavioral health and substance abuse providers (all in need of nurses), is that they will likely lose them to hospitals, leading them to reduce beds, increase wait times and/or close programs. That is an intolerable situation for clients, patients, and consumers that need services now. It is estimated that 1,000 behavioral beds and many addiction treatment beds needed during this opioid crises could be lost.”

The Massachusetts Health Council also has announced that it is joining the Coalition to Protect Patient Safety, as did the Brain Injury Association of Massachusetts. See a full list of Coalition supporters here.

Save the Date: MHA Healthcare Safety Summit

MHA’s Statewide Quality Forum Steering Committee, Workplace Violence Prevention and Planning Workgroup, and the Promoting Employee Wellbeing Committee are holding an all-day Healthcare Safety Summit on Tuesday, December 4 from 8 a.m. to 3 p.m. at MHA’s Burlington offices. The program is geared towards hospital personnel from security and safety, risk management, quality improvement, human resources, nursing and other clinical professions, as well as public affairs and employee assistance programs. Summit topics include: overview of trends and types of healthcare violence and conflict; preventive methodologies; employee engagement; and programs focusing on recognition, wellness and resilience.  Mark your calendars. More details to follow.

Health Council Sets Further Conditions on BIDMC-Lahey Deal

The Massachusetts Public Health Council last week weighed in on the proposed Beth Israel Deaconess-Lahey merger, imposing a series of conditions on the deal before it can go forward.  The conditions call on the proposed entity – Beth Israel Lahey Health – to, among other things, attempt to reduce inpatient volume at its academic medical centers and expand the percentage of MassHealth in its payer mix.  The Public Health Council wants to ensure that any Beth Israel Lahey Health provider authorized to participate in MassHealth, has, in fact, applied to participate in the state program.

Beth Israel Deaconess CEO Kevin Tabb, M.D., who will lead the new system, was quoted in the State House News Service as saying of the council’s conditions: “Yes, this is something that we can and must do, but it is approaching the outer limits of what's doable, and I need to further remind people that while I agree completely with many of the concerns that have been raised about the woes of healthcare in Massachusetts and in this country, we can't solve all of that on the backs of this single transaction.”  Attorney General Maura Healey’s office is currently reviewing the proposed deal.

Delegation Members Sign on to Protect Hospital Payments

Members of the Massachusetts congressional delegation have signed on to a letter from Rep. Peter Roskam (R-Ill.) and Mike Thompson (D-Cal.) asking CMS to rescind its proposed payment reductions to certain hospital outpatient departments.

Under the Outpatient Prospective Payment System (OPPS), CMS is proposing to cut payments for Evaluation and Management services and expand certain site-neutral payment policies to grandfathered hospital provider-based departments.

The new site-neutral payments are inadequate because the large number of patients presenting at these clinics require more specialized services than those generally provided in physicians’ offices. Because physicians’ offices are available for only certain hours of the day, site-neutral payments do not include the additional costs of 24/7 operation available in hospital departments. 

The hit to Massachusetts hospitals could exceed $25 million. As of last Friday, the following Massachusetts Democratic Representatives signed the Roskam-Thompson letter: Katherine Clark, Bill Keating, Joe Kennedy, and James McGovern.

Opioids & Substance Use Disorders: Connecting Patients to the Right Care at the Right Time

As the battle against opioid use disorder continues, the behavioral healthcare system and other medical professionals are mobilizing to provide the most effective care for patients. To ensure patients are triaged with careful planning and post-treatment plans, we will focus on care across the continuum. On Friday, Oct. 26 from 8:30 a.m. to 3 p.m. in Burlington, we’ll look at current best practices to get patients into treatment, featuring experts from hospital, post-acute, community, and criminal justice perspectives. In addition to the patient care sessions, we will also provide a comprehensive update of recently passed legislation affecting treatment regarding opioids and substance use disorders.  This is a timely, don’t-miss conference. Learn more by clicking here.

John LoDico, Editor