At its September 11 board meeting, the Health Policy Commission (HPC) released preliminary data showing that there has been an increase in high-acuity discharges from Massachusetts hospitals between 2010 and 2017, driven by changing coding practices due to the use of electronic health record systems. According to the HPC, rising acuity contributes to increases in healthcare costs and disparities between hospitals that can invest in more complex EHR systems and those that cannot, and takes clinician time away from direct patient care. 
  
Unfortunately, the HPC reporting does not address the critical factors that may affect the changes in acuity over this time period, nor does it stress the purpose and significance of accurate medical coding. As a result, the conclusions are open to misinterpretation.
  
Documentation is an important aspect of medical care. The increasing complexity of medicine has been met with an increase in complexity of medical documentation; in fact, ICD-10 coding set was developed to reflect these intricacies. ICD-10, which went into effect in 2015, created very granular codes, meaning the level of specificity was greatly improved. These new codes reflect more specific etiologies, comorbidities and complications and improve the ability to demonstrate severity of illness. In addition to clinical documentation, accurate coding provides data to support quality measurement, as well as the acuity and accurate representation of patients’ medical conditions for better population health management. As electronic health systems become more ubiquitous, they have helped to provide accurate, up-to-date and complete information about patients, resulting in legible, complete documentation for streamlined coding and billing.
  
“The Health Policy Commission's coding analysis is very preliminary and we look forward to working with them to provide more context and perspective as they move forward towards findings and recommendations,” MHA said in a media statement. “The expansion of electronic health records and adoption of ICD-10 has enabled healthcare providers to more accurately capture patient acuity and previously under-reported conditions. When coupled with policy-driven efforts to move lower-acuity patients to outpatient settings, and the effect of the aging population, it is likely this preliminary reporting simply reflects the results of improved reporting and data. However, where appropriate, we will always work collaboratively with the HPC on improvements to better serve patients.”

Hebrew SeniorLife and Brown University have received a five-year $53.4 million grant from the National Institute on Aging (NIA) to lead a comprehensive, nationwide effort to address Alzheimer’s disease and related dementias. NIA is a division of the National Institutes for Health.
 
The funding will support the creation of a research incubator or “collaboratory”, bringing together 30 research institutions throughout the United States to conduct pilots to test non-drug, care-based interventions for people living with dementia, and also to develop best practices for implementing and evaluating interventions for Alzheimer’s and dementia care and share them with the research community.
 
Dr. Susan Mitchell, senior scientist at Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research and professor of medicine at Harvard Medical School is co-leader of the collaboration, along with Dr. Vincent Mor, professor of health services, policy and practice at Brown’s School of Public Health.
 
Pilot projects throughout the country will benefit from the collaboratory’s experts, who will assist with ethical concerns (such as how to secure informed consent from people living with dementia); technical support and generation of data on participant populations; statistics and project design; advice on how to measure patient- and caregiver-reported outcomes; dissemination of results and efforts to maximize the likelihood of implementation; partnering with healthcare systems interested in conducting trials; project administration; training for junior researchers; inclusion of and applicability to people of all backgrounds and cultures; and best practices to engage people interested in this work, including people living with dementia and their caregivers.
 
“It’s time for Alzheimer’s and other dementias to receive the same level of research focus and investment as cancer,” said Louis Woolf, HSL president and CEO. “We’re proud to collaborate with Brown University to address this national epidemic that affects not only patients, but their families and caregivers as well.”

Nearly 500 cases of severe lung disease associated with vaping – that is, the use of electronic smoking products – have been reported to the U.S. Centers for Disease Control and Prevention. And there have been at least six deaths across the U.S. related to such products. The American Medical Association has recommended that people stop using e-cigarette products. In response, the Massachusetts Department of Public Health last Wednesday mandated that all healthcare providers report all diagnosed or suspected cases of unexplained vaping-associated pulmonary disease to DPH. Providers are asked to use this specific document to make the reports.
 
Specifically, DPH wants reports on “Persons experiencing otherwise unexplained progressive symptoms of shortness of breath, fatigue, chest pain, cough, and weight loss, of any severity, and an abnormal chest imaging study, associated with vaping in the past 90 days.”
 
In the cases reported across the U.S., some patients reported the use of vaping products containing THC (found in marijuana), but others used only products with nicotine.

Declaring that flavored nicotine vaping products serve little purpose other than to appeal to younger people and start them down the road to addiction, the federal government signaled last week that is moving to ban flavored e-cigarettes from the market.
 
"The data just shows that kids are getting access to these products in spite of our best efforts and enforcement," said U.S. Health and Human Services Secretary Alex Azar. He said that the Food and Drug Administration would have details of the ban plan in the coming weeks. 
 
In Massachusetts, MHA – a member of the Tobacco Free Massachusetts coalition – is strongly supportive of HB1092/SB1279, An Act Regulating Flavored Tobacco Products. That proposed legislation would implement a comprehensive ban on all flavored tobacco, including menthol and mint flavors, and would apply to conventional products, as well as e-cigarettes and other vape products.
 
In its testimony before the Joint Committee on Public Health this summer, MHA said, “According to a report from the CDC and FDA, almost a third of the middle and high school students who used e-cigarettes in 2016 said the availability of flavors was a main reason they did. Eighty percent of Massachusetts high school youth who are current tobacco users reported using a flavored tobacco product in the past 30 days … Mint, wintergreen, and menthol are popular flavors among young people, and they are one of the most popular flavors among youth consumers.”
 
Earlier this month, Michigan became the first state to ban flavored e-cigarettes.

A Massachusetts patient, caregiver, and advocate were among those testifying last Wednesday before the U.S. House Committee on Oversight and Reform about the Trump Administration’s termination of the deferred action program, which allows immigrants to receive medical care without the fear of deportation.
 
In August, the administration announced that it would no longer accept from immigrants renewals of their deferred action applications. Under intense criticism, the United States Citizenship and Immigration Services backtracked on the action and said it would reconsider. But there has not been any definitive announcement on how affected patients and families should proceed.
 
Among those testifying on Wednesday was Jonathan Sanchez, a 16-year-old from Honduras who has been receiving care for his cystic fibrosis at Boston Children’s Hospital. He stated clearly that if he is forced to go back to Honduras for care available in that country, he will die. “It is incredibly unfair to kick out kids who are in hospitals or at home getting treatment to save their lives,” he told the committee.
 
Also testifying was Dr. Fiona S. Danaher, a pediatrician and co-chair of the Immigrant Health Coalition at Massachusetts General Hospital. She told committee members, “Perhaps no intervention is more crucial to minimize the suffering of a severely ill child than maintaining the presence of a loving family member at the bedside. Terminating the medical deferred action program would leave some medically complex US citizen children struggling not only with the physical burden of their disease, but with the emotional trauma of forced separation from their immigrant parents. No child can be expected to heal under such circumstances. This is not just bad medicine; it is unconscionably inhumane.”
 
Anthony Marino, director of Immigration Legal Services at the Boston-based Irish International Immigrant Center, also testified.
  
U.S. Representative Ayanna Pressley (D-Mass.), a member of the committee, was especially critical of the Trump Administration’s action, calling it “appalling.”
 
Representatives from U.S. Immigration and Customs Enforcement and U.S. Citizenship and Immigration Services who testified did not offer many details on the future of the program, citing the lawsuits that had been filed against the government challenging deferred action’s termination.

The Centers for Disease Control and Prevention (CDC) recently issued the 2019-20 influenza vaccine recommendations from the Advisory Committee on Immunization Practices (ACIP). ACIP continues to recommend routine annual influenza vaccination for all persons older than age 6 months who do not have contraindications. Vaccination should be offered by the end of October; however, vaccination should continue to be offered as long as influenza viruses are circulating and unexpired vaccine is available. A summary of the recommendations is here.

Last year’s opioid law (Chapter 208 of the Acts of 2018) requires electronic-only prescribing for controlled substances by all providers in all settings. Since its passage, DPH has been formulating the regulations to implement the law as well as to comply with federal updates to partial fill requirements. Last Wednesday, the Public Health Council signed off on the final e-prescribing regulations, which go into effect on December 27, 2019. However, the regulations do provide a grace period for implementation until January 1, 2021. MHA and the hospital and physician community have been working with DPH this year on issues of concern with the draft regulations. One of the biggest changes DPH accepted was to exclude Schedule VI drugs from the e-prescribing requirement. Schedule VI drugs are those outside of the federally designated schedules and are considered to have a low potential for abuse.

Mark Fulco, the president of Mercy Medical Center since September 2017, has left his post. David Bittner, the CFO of Mercy’s parent company, Trinity Health Of New England, will serve as interim leader until a new president is chosen.
 
Michael Moran, the president of Baystate Wing Hospital and chief administrative officer of Baystate Health’s eastern region since 2016, has resigned effective Nov. 1. VP of Patient Care Services and CNO Molly Gray will replace him.