HB1184, HB2434/SB1244, HB578/SB549, HB2439, HB3230, HB2436, HB3236/SB1221, HB3227, HB3515, SB1246
Patient Safety and Quality; Workforce Development

The Massachusetts Health & Hospital Association (MHA), on behalf of our member hospitals, health systems, physician organizations, and allied health care providers, appreciates this opportunity to offer comments on bills that seek to address patient safety, quality and workforce development.

MHA supports HB1184. This bill facilitates the development of a comprehensive, long-range plan, including the development of a nursing research agenda, to advance the practice of nursing and to address the current and future nursing shortage. HB1184 creates a nursing advisory board to advise the Governor and the Legislature and to recommend policy initiatives regarding nursing practice and the nursing shortage across the health care and education continuum.

While MHA supports the intent of HB2434 / SB1244 to put in place a framework that encourages the widespread adoption of telemedicine services in Massachusetts, MHA encourages the Committee to instead support HB578/SB549, promoted by the Massachusetts Telemedicine Coalition (tMED), which is far more comprehensive and will: ensure parity in insurance coverage for telemedicine services at the same payment rate as in-person treatment; streamline the credentialing process for Massachusetts licensed clinicians using telemedicine services within the state; and ensure a uniform and consistent approach that fosters innovation when defining telemedicine services. As the need for healthcare services grows, telemedicine will improve access to care and increase the efficiency of care delivery, while decreasing the overall cost of healthcare in the state.

MHA opposes HB2439, which would amend the medical peer review law to allow any group or individual provider to be considered as an official medical peer review committee. MHA supports the efforts of a peer review committee to ensure that providers are practicing following their applicable scope of practice. However, such committees should be operating within the structure of a formal group, hospital, clinic, or professional society which will ensure that the work of the committee meets applicable codes of ethics, law, and professionalism. HB2439 would allow any group to be designated a peer review committee and would exempt such group from meeting the specific standards and requirements that are in existence today. This bill would undermine the benefits of formal committees which are essential to reviewing and developing provider best practices.

MHA is strongly opposed to HB3230. This bill would eliminate an important component of the mandatory overtime law that was enacted in section 103 of Chapter 224 of the Acts of 2012, which inserted a new section 226 into Chapter 111 of the General Laws. Chapter 224 included new restrictions related to the use of mandatory overtime for registered nurses. Massachusetts hospitals do not use mandatory overtime as a standard staffing practice. Our nurse leaders have worked hard to develop internal procedures and best practices for all hospitals to avoid the use of mandatory overtime and regularly share those best practices with their colleagues. Because of these efforts, the use of mandatory overtime is rarely required. The language in Chapter 224 carefully balances the new restrictions with the care and safety requirements of all patients by ensuring appropriate exceptions in emergency situations where the safety of a patient requires its use and there is no reasonable alternative. As directed by Chapter 224, the Health Policy Commission approved further guidelines and procedures related to the new law that have been in effect and working successfully for almost 5 years.

MHA is strongly opposed to HB2436 as it would prevent the immediate care and treatment of patients who may be suffering from an acute medical condition. HB2436 was drafted to prevent a healthcare facility (hospital, nursing home, or other mental health facility) from transferring a patient suffering from Alzheimer’s or dementia for medication adjustment without approval of the patient or guardian. It is important to note that MHA and the Alzheimer’s Association, in coordination with DPH and Elder Affairs, have developed a joint workgroup to develop clinical and operational best practices on the treatment and care coordination for patients suffering from Alzheimer’s and other related dementia care issues. While our goal is to improve the diagnosis and treatment for patients with Alzheimer’s or related dementia, there is also recognition that any such treatment must take into consideration that patients may need immediate treatment (including an immediate transfer to a facility that can treat certain critical acute level conditions). In HB2436, if a patient with Alzheimer’s is suffering from an immediate acute condition that may need immediate treatment that is not available at the current facility, then the healthcare provider would be forced to delay potentially life-saving treatment. While we support the general principles of HB2436 to ensure that patients who are suffering from Alzheimer’s are not moved if receiving general medical care and treatment as that will disrupt their mental state, the Committee should be aware of the potential problems in care for patients without any recognition of the need for immediate care based on the determination of the treating clinician. To that end, we urge this Committee to consider alternative ways to address this concern and MHA would be happy to work with the committee on ways to achieve this goal.

MHA is also opposed to HB3236/SB1221, as drafted. The hospital community fully supports the intention of HB3236/SB1221, to develop a rapid response team to work with patients who are diagnosed with Autism within a hospital setting. MHA’s concern is that this bill may potentially delay care and treatment for autistic patients. Potentially, should such an autism team be established within a hospital, only those staff who are trained by DPH to provide autistic care would be able to care for an autistic patient who arrives in a hospital for emergency or general medical care. If that staff is caring for other patients or not working a particular shift, our concern is that the autistic patient could be left to wait for a longer period until such certified person arrives to begin care/treatment. MHA agrees with the intention of the first sentence of the legislation and would encourage DPH to work with providers to train staff who may interact with and treat patients with autism on how to interact with, diagnose and care for these patients as part of the overall care and treatment in a specific hospital department. We would instead encourage the Committee to focus on the development of a general education curriculum for the provider community (similar to what is currently being developed for Alzheimer’s patients) to ensure all medical staff have the skills and knowledge needed to care for autistic patients whenever they arrive in a hospital setting.

MHA opposes both HB3227 and HB3515. These bills set forth new requirements for the use and adoption of a “do not resuscitate” (also called a DNR) order for all patients in HB3227 and specifically, for individuals with a disability in HB2515. While every hospital and healthcare facility has policies and procedures for their employees to recognize and follow DNR orders, we support the intent of HB3227 as it seeks to create uniformity and standardization of such orders and forms for healthcare providers in the Commonwealth. However, HB3227 does not take into consideration the specific clinical perspective and requirements that healthcare providers must follow under various state laws that may make it difficult, if not impossible, to follow the provisions of the bill. Since we applaud the intent of the sponsors and agree that there should be standardization and uniformity in this area, we would strongly urge the Committee to consider developing a study for a representative group of providers and state officials to meet over a time-limited period to develop a consensus approach for DNR orders that takes into consideration existing state and federal laws, clinical requirements, and then develop a uniform approach to utilizing and recording known DNR orders.

MHA is concerned with the provisions of SB1246. This bill seeks to amend current law that was adopted as part of the state’s payment and delivery reform law to establish model checklists of care. Currently, hospitals are already required to include pulse oximetry testing for newborns as part of the newborn testing regimen at every birth center. It is unclear whether pulse oximetry testing is intended to apply to neonates or to any patient under SB1246. Pulse oximetry testing is a standard intervention for some patients given their clinical condition, but it is not standard for all patients. The determination to conduct pulse oximetry testing should remain at the discretion of the clinician based upon a patient’s clinical presentation. As a result, we urge this committee to reject this bill as currently drafted as it would create confusion with application of existing law and potentially require unnecessary medical services for patients.

Thank you for the opportunity to offer testimony on these issues. If you have any questions or require further information, please contact MHA’s Vice President of Government Advocacy, Michael Sroczynski, at (781) 262-6055 or msroczynski@mhalink.org.