The Betsy Lehman Center for Patient Safety released a new report Thursday offering recommendations to aid and bolster safety improvement efforts in Massachusetts emergency departments (EDs). In “Urgent Matters: Improving Safety in Massachusetts Emergency Departments,” an expert panel of emergency department physicians, nurses and patients from across the state focuses on three areas of risk: crowding, cognitive overload and post-ED care coordination. MHA representatives were part of the workgroup and participated in the report’s development. You can access the report and accompanying toolkit here.

Last week, the Trump Administration released a final rule pertaining to immigration that will ultimately make it more difficult for many immigrants to access healthcare. MHA, along with healthcare providers and other advocates across the country, has strongly opposed the revised rule from the outset, and remains opposed despite several modifications to the initial proposed rule in the final version. Thirteen states, including Massachusetts, have already filed suit in US District Court to challenge the changes.
  
At issue is how the rule re-defines who could be determined a “public charge” of the government and therefore potentially ruled inadmissible for immigration into the United States. A public charge is an individual who is likely to become “primarily dependent on the government for subsistence.” For the past 20 years, this definition has been limited to individuals who receive cash assistance and/or use long-term care at the government’s expense.
  
When making immigration determinations under the new rules, the federal government will now consider past use of numerous new programs – including non-emergency Medicaid benefits – in determining whether a person seeking to change their immigration status can support themselves financially or if they are at risk of becoming a public charge. While the determination is prospective, use of certain public benefits within the past 36 months will be factored into the “totality of circumstances” including age, health, family status, resources, education, etc. The final rule exempts children up to age 21 and pregnant women (including 60 days after pregnancy) from the provision that negatively considers use of non-emergency Medicaid. Medicare Part D benefits are also exempt in the final version. Use of other public benefits, however, including Supplemental Nutrition Assistance Program (SNAP) and many federal housing programs, will still be considered under the final rule.
  
These expanded considerations remain very concerning and are expected to have a detrimental effect on healthcare access for immigrants and severely hamper the providers that care for them. 
  
In December, MHA President and CEO Steve Walsh wrote to the Department of Homeland Security opposing the proposed rule, stating “an expansion of [the public charge] definition to include healthcare benefits such as Medicaid will likely mean many immigrants will withdraw or forgo applying for health coverage programs. Worse, many may also forgo even seeking medical care if they believe it will be a potential negative factor in their future immigration status.” MHA further noted that the new rule will create a “chilling effect” that will extend beyond those directly affected by the rule. Given the complexity of immigration rules and healthcare programs, many immigrants will fear participating in federal and state programs.
  
The rule is currently set to become effective October 15, 2019, and will apply prospectively to those seeking a change in their immigration status. MHA will be working with its members, the commonwealth, the Congressional delegation, and other healthcare stakeholders during the coming months to address implications for Massachusetts healthcare programs.

Boston Medical Center’s Grayken Center for Addiction, through funding from the state Bureau of Substance Addiction Services, is holding a series of trainings across the state for emergency department (ED) nurses on treating opioid use disorder in ED settings. These 3.5 hour trainings are designed to assist ED nurses with the assessment and treatment of patients with opioid use disorder, outline tools to initiate and refer patients to engage in Medication for Opioid Use Disorder (MOUD), and address concerns for the treatment of addiction in specialized urgent care and emergency room settings.
 
The trainings will take place on select dates in September, October, and November. Training venues include locations on the North Shore, South Shore, Cape Cod, and in Eastern, Central, and Western Massachusetts. More information can be found on the BMC Office Based Addiction Treatment Training and Technical Assistance website at https://www.bmcobat.org/. 

Harvard Pilgrim Health Care and Tufts Health Plan, the second- and third-largest health insurers in Massachusetts, respectively, on Wednesday announced plans to merge. The combined organization would have nearly 2.4 million members in Massachusetts, Maine, Connecticut, New Hampshire and Rhode Island. The announced agreement is subject to multiple state and federal reviews and approvals.
  
“MHA looks forward to learning more about the proposed merger between Tufts Health Plan and Harvard Pilgrim Health Care,” said MHA president & CEO Steve Walsh. “We anticipate that state regulators will be reviewing the planned affiliation closely to determine whether it will ensure improved health insurance coverage, access, and affordability for Massachusetts patients.” 
  
The two health insurers had sought to merge once before, in 2011, but ultimately called off the deal. Both organizations will remain independent companies during the review and approval process, the announcement said.

The Division of Insurance (DOI) issued a communication on August 2nd to fully insured health plans providing guidance on coding and billing for additional services (“specialing”) that may be necessary for admissions to inpatient psychiatric units as part of the commonwealth’s Expedited Psychiatric Inpatient Admissions (EPIA) policy.
  
Last year, the Executive Office of Health and Human Services, the Department of Mental Health, MassHealth, the Department of Public Health, and DOI, issued a joint EPIA policy that established an escalation protocol for securing appropriate placement for patients boarding in EDs who require inpatient psychiatric hospital level of care. Part of that policy included expectations for health plans as part of the EPIA process. This month’s DOI guidance clarifies a number of definitions and health plan requirements in order to address MHA member concerns about difficulties in operationalizing specialing.

The Massachusetts Health & Hospital Association, in collaboration with the Massachusetts Department of Public Health and the Massachusetts Nurses Association, is pleased to host an all-day, hospital-based safe patient handling program on Friday, September 20th. The program, entitled Pathways to Safe Patient Handling in the Modern Hospital Setting, will run from 8 a.m. to 4 p.m. at the MHA Conference Center, 500 District Ave., Burlington, Mass.
 
The conference will examine the importance of engaging hospital leadership, operational best practices, the skills that practitioners/staff need to sustain a safe patient handling program, and how to evaluate lessons learned. The conference will also provide a forum to foster networking among attendees so that ongoing relationships and learning between and among hospitals and staff can continue.
 
The event’s keynote speaker/moderator is Guy Fragala, Ph.D., an occupational safety and health professional and national expert in the application of ergonomics to the healthcare setting. Other confirmed speakers include Kim Hollon, FACHE, President & CEO, Signature Healthcare Brockton Hospital and Signature Healthcare; Suzanne Nobrega, MS, Outreach Director, Center for the Promotion of Health in the New England Workplace, UMass Lowell; Tim Quigley, DNP, MBA, RN, Senior Vice President, Chief Nursing Officer, South Shore Health; and Sandra Wettergreen, Safe Patient Handling Coordinator, VA Boston Healthcare System.

The Organization of Nurse Leaders - MA, RI, NH, CT, VT (ONL) has released a special report highlighting key findings from the organization’s 2019 Nursing Summit. ONL held the summit in January, bringing together hundreds of nurses from across New England. One innovative tactic used at the summit to equalize the voices of the attendees was to identify each participant by name and “RN,” rather than including any advanced degrees or titles.
  
Attendees spent time discussing what makes a care team effective, the characteristics of strong nurse leadership - including charge nurses, elements of a healthy work environment, and the importance of recognition and gratitude for all that nurses do. Participants were also asked to identify and brainstorm ideas for each of these elements of professional nursing practice. 
  
Top recommendations identified at the ONL Nursing Summit included elevating the voice of the nurse, increasing recognition and appreciation, ensuring safe and positive work environments, and practicing at the top of one’s license. These overarching themes were expanded upon with endorsed best practices to achieve each recommendation, as well as possible action items to bring these ideas into existence at attendees’ workplaces.

To read the 2019 ONL Nursing Summit Report, click here.

MHA will host a webinar, “Telemedicine in Massachusetts: Opportunities and the Current Regulatory Landscape,” on Friday, September 27th from 10-11:30 a.m. This online program will highlight the applicable laws and regulations of the practice of telemedicine, with a focus on Massachusetts. In the current regulatory environment, telemedicine opportunities differ from state to state.
  
There will also be a brief highlight on the Massachusetts Telemedicine Coalition (tMED), an advocacy group of which MHA is a founding member. The webinar is free, though registration is required. To register, click here.