April 16 was National Healthcare Decisions Day, which this year passed with little fanfare given the healthcare community’s focus on COVID-19. But the day’s focus on advance care planning – that is, making sure you can receive the medical care you want even if you are not in a position to articulate it yourself – has never been more important.

Throughout this month and beyond, providers are encouraging patients and families to focus on the process that they want their loved ones and caregivers to follow if they become seriously ill. One of the easiest ways to start this process is to designate someone as a healthcare agent and make sure that agent knows the person’s wishes by filling out a simple healthcare proxy.

Lots of information exists to start people down the advance care planning path. Visit PatientCareLink and then click on “Healthcare Planning Throughout Your Life” under the For Patients & Families tab, or “Serious Illness Care” under Improving Patient Care.

Hospitals suspended elective surgeries and most non-COVID-19 care to free up beds, personnel and resources to fight the pandemic. But eventually, when the COVID-19 crisis abates, the elective surgeries will come back for the benefit of patients who have been deferring care and for the financial health of the healthcare sector. On Friday, the American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses, and American Hospital Association released a roadmap as to how to resume elective surgeries.

The groups’ joint statement says that a facility can begin thinking of resuming the surgeries when there is a “sustained reduction in the rate of new COVID-19 cases in the relevant geographic area for at least 14 days,” and if the facility has an appropriate number of ICU and non-ICU beds, personal protective equipment, ventilators and staff “to treat all non-elective patients without resorting to a crisis standard of care.”

Other recommendations call for increased testing; development of a hospital committee to develop a surgery prioritization policy; and creating and implementing a social distancing policy for staff, patients and visitors in non-restricted areas in anticipation of a second wave of COVID-19 activity.

MHA current estimates show approximately $1.4 billion in losses per month for acute hospitals and affiliated physician groups. Specifically, acute hospital revenue losses are approximately $1.1 billion per month; hospital-affiliated physician organization revenue losses are estimated to be more than $280 million per month. This does not take into account the added costs hospitals are shouldering related to COVID-19, including purchases of new equipment, supplies, and resources to expand capacity. MHA estimates that through July of this year, hospitals and affiliated physician groups will have lost more than $5 billion dollars. Although the federal government and the state have recently provided some financial relief, funding received to date leaves hospitals facing untenable losses. MHA is continuing to pursue additional funding support at both the state and federal levels to address this gap.

Governor Charlie Baker has signed legislation, Chapter 64 of the Acts of 2020, to strengthen liability protections for caregivers and certain healthcare organizations during the COVID-19 outbreak. The Massachusetts House and Senate last week quickly enacted the MHA-supported bill, sending it to the governor's desk on Friday. Baker filed the legislation to minimize the threat of lawsuits in relation to work conducted in good faith under the unprecedented COVID-19 circumstances. The proposed protections are especially important for clinicians practicing at unique field hospitals.

 

The bill was originally heard by the Joint Committee on Financial Services on Monday, before being sent to the Senate Committee on Ways and Means. MHA submitted testimony stating, “It is essential that this legislation be enacted into law immediately to ensure that Massachusetts healthcare professionals are confident as they work through overwhelming challenges and patient surges.”

In this letter to U.S. Health & Human Services, the American Hospital Association thanked the government for recently distributing $30 billion in CARES Act funding, but added the amount is not enough. “Therefore, we urge the department to release substantial additional emergency funds to all hospitals in an expedited manner," AHA wrote. “The initial round of funding began to provide hospitals and health systems with some much-needed relief, but simply was not of the magnitude necessary. In addition to this second wave of funding to all hospitals, targeted relief is necessary for hospitals in hot spots, hospitals with a high percentage of payments under Medicare Advantage, hospitals caring for high numbers of Medicaid patients, and rural hospitals.”

The first round of the $100 billion appropriated through the CARES Act went to all providers that bill Medicare; hospitals received only a portion funding although they are hemorrhaging revenue from curtailing most non-COVID-19 care while investing in resources to fight the pandemic.

The AHA added that hot spots should receive additional funding “to help offset the significant costs incurred by hospitals testing, diagnosing and treating COVID-19 cases. HHS could identify these geographic areas based on a variety of measures, such as COVID-19 admissions or ‘persons under investigation.’ An equitable distribution, such as by bed size, total net patient revenue, or adjusted admissions, could be used to distribute funds to hospitals in these targeted areas of the country.” Massachusetts is the state with the third-highest number of COVID-19 positive patients in the country.

Attorney General Maura Healey’s office has launched a new website for frontline workers – FrontlineMA.org. It’s meant to be an accessible, one-stop shop for healthcare workers and first responders to get up-to-date information and resources on things such as PPE, priority testing, free/discounted meals, and housing options. Also take a moment to review the Hero Wall – a page where frontline workers can view messages of thanks, and also submit their own stories in picture, video, or text form.

Insights from the Frontlines: Caring for the Caregiver During COVID-19

Thursday, April 23, from 12 - 12:30 p.m. EST

Please join us for this webinar to hear from the COVID-19 frontlines at UMass Memorial Health Care. Caregiver fatigue and burnout were a concern for hospitals before the COVID-19 pandemic. Responding to the current crisis and planning for a surge of patients, while not knowing what the future holds are factors that only add to the strain on staff. The ability to care for caregivers will be critical for hospitals to continue to respond to a sustained high-level operations tempo through the surge and well into recovery efforts, while ensuring the long-term capacity to care for communities. This webinar will feature insights and strategies for caring for the caregiver during COVID-19. We will be joined by Thomas Ward, Wellness Program Manager at UMass Memorial Health Care. The discussion, moderated by Valerie Fleishman, Senior Vice President and Chief Innovation Officer at MHA, will include specific tools and resources for supporting staff wellbeing. Visit here to register.