DPH has posted updated guidance on diagnostic COVID-19 testing. The memo incorporates a variety of changes, including: expanding testing of asymptomatic individuals at the discretion of their healthcare provider (with the caution that “asymptomatic individuals are strongly encouraged to contact their insurer to confirm coverage”); recommending testing of children with multisystem inflammatory syndrome; testing of all individuals for COVID-19 upon admission to a healthcare facility “including but not limited to, a hospital operated or licensed by the Department of Public Health or Mental Health, long-term acute care hospital, or skilled nursing facility”; and information on re-testing of previously COVID-19 positive individuals, who have been cleared from isolation.
 
MHA has formed a workgroup to look into healthcare workforce surveillance testing practices. Many facilities are facing increasing demands to conduct testing for schools, universities, and businesses that are re-opening. Such demands are being made during a period when testing materials and PPE are still in short supply.
 
Last week, the Division of Insurance cleared up one area of uncertainty when it issued a bulletin reminding health insurance companies that they are expected to cover polymerase chain reaction (PCR) and antigen testing for symptomatic and asymptomatic cases, and for close contacts of confirmed or clinically diagnosed COVID-19 cases.

The state’s Center for Health Information and Analysis (CHIA) last week released the latest report on hospital finances for the first quarter of the calendar year (Jan. through March 31), and the document paints an extraordinarily bleak picture that will almost certainly become darker when reporting for the second quarter is tabulated.
  
Hospitals were only two weeks into dealing with the pandemic in the period covered by the report, yet CHIA’s data shows that overall acute hospital profitability, as measured by the median total margin was – (negative) 2.7%, a decrease of 6.9 percentage points in comparison to the same period of the prior year. The median operating margin was negative 1.3%. Seventeen of 21 reporting systems had negative total margins; 43 out of 45 hospital/health system-affiliated physician organizations reported a net loss for the period ending March 31, 2020.
  
The COVID-19 surge hit Massachusetts hard in April and May with a massive amount of non-COVID-19 care evaporating at hospitals, and with it a loss of revenue. Hospitals also spent greatly on expanding capacity to meet the surge and to purchase PPE at inflated costs.
  
“The latest CHIA report shows the early, yet swift impact the COVID-19 emergency had on hospital finances,” said MHA President & CEO Steve Walsh. “The analysis covers the first two weeks of canceled elective procedures at Massachusetts hospitals, which was only the beginning of a financial free-fall that has grown increasingly dire in the months since. Even as care services are restored, severe revenue challenges persist. These early findings underscore the need for substantial and ongoing financial support so our hospitals can weather this storm and continue to treat every patient in need of care.”

tMED – the Massachusetts Telemedicine Coalition – has sent a letter to the Massachusetts Congressional delegation asking support for a series of legislative and regulatory steps that can be taken to preserve and expand on the telemedicine gains that have occurred during the pandemic. 

“There is significant anxiety among providers and patients alike that there will be a retrenchment of the federal policies, creating clinical, operational and financial challenges for the healthcare landscape that will prevent providers from continuing to use telehealth as a much needed modality for service delivery,” the coalition wrote. “ …. To support the continued utilization of telemedicine once the Public Health Emergency (PHE) expires, the tMED Coalition would strongly urge you to pursue the following legislative actions. This letter also outlines critical regulatory actions the administration must take and for which we would request your support.”

MHA has joined a coalition of business groups in signing a letter committing the entities to address systemic racism and discrimination. The groups acknowledge “the systemic oppression and racism of our country’s history,” and state that “racism has no place in business or anywhere in our society – it is a stain on our history and our identities both across the country and here in Massachusetts.” Thirty-one groups signed the letter, which stated: “We will listen. We will hear. We will learn. We will act. We will hold ourselves accountable.”

A new study led by researchers at Boston Medical Center, in collaboration with Harvard Pilgrim Health Care Institute, shows that value-based incentive programs aimed at reducing healthcare-associated infections did not improve infection rates in either safety-net or non-safety-net hospitals. The study, published in JAMA Network Open also shows that there are higher rates of healthcare-associated infections in safety-net hospitals. The study notes that many safety-net hospitals are under more financial stress than non-safety-net hospitals and rely on supplemental funding from both the state and the federal government to remain operational. “Right now, the programs are not leading to any meaningful improvements in patient safety and are contributing to inequity in our healthcare system by disproportionately penalizing safety-net hospitals,” said Heather Hsu, M.D., the study’s first author who is a pediatrician at Boston Medical Center. “We hope that these results can serve as a starting point to re-evaluate and re-design value-based incentive programs.”

MCSTAP – the Massachusetts Consultation Service for the Treatment of Addiction and Pain – is holding a “Case Discussion Call-in Hour” on the third Wednesday of each month from 12 to 1 p.m. MCSTAP’s Medical Director Dr. Christopher Shanahan will discuss real, anonymous cases concerning management of chronic pain, substance use disorder, or both. The next call is Wednesday, July 15. Click here to register for the call, to review past cases that have been discussed, and to access other MCSTAP offerings, such as buprenorphine waiver training. 
 
As a reminder, MCSTAP maintains a phone line Monday through Friday, from 9 a.m. – 5 p.m., which providers can use to access a resource and referral specialist. That specialist will collect some information about the provider’s practice and the patient he or she is calling about and will then triage the information to the physician consultant on call.

In 2017, the American Hospital Association (AHA) released Stem the Tide: Addressing the Opioid Epidemic, a toolkit that advised caregivers on how they could partner with patients, clinicians and communities to address the opioid epidemic. Last week, AHA released a companion resource, Stem the Tide: Opioid Stewardship Measurement Implementation Guide, which offers hospitals and health systems actionable ideas for program development and implementation. It presents monitoring and measurement standards, supported by evidence-based protocols, for prescribing responsible amounts of opioids to patients and safeguarding prescription drugs from diversion.
 
MHA has been a national leader in the opioid fight, creating guidelines for the use of opioids within hospitals, for developing Medication for Opioid Use Disorder (MOUD) programs, and for preventing opioid misuse within facilities, among other initiatives. These guidelines have been used by other states to craft their own responses to the crisis. Visit PatientCareLink for more information on the Massachusetts OUD response.

WEBINAR: CMS' New Price Transparency Rule; What Hospitals Need to Know

Thursday, July 16, 2020 from 1 - 2 p.m. EDT

In November 2019, CMS released a price transparency final rule, effective January 1, 2021. AHA and others challenged the rule and learned on June 23 that they did not prevail. Although AHA will appeal, it is now a critical time for hospitals and health systems to consider preparing to publish pricing for items and services, and to understand how this will affect organizations going forward. This webinar will review hospitals' obligations for posting standard charges in a machine-readable format and for posting 300 "shoppable services" in a consumer-friendly format. We will also provide an update on the next steps following the unsuccessful lawsuit filed against the U.S. Department of Health and Human Services to block the final rule from going into effect in January. Click here for more information.