School openings (in whatever form), the oncoming cooler weather driving people indoors into enclosed spaces, and the unfortunate reduction of social distancing caution all are conspiring to increase the possibility that the pandemic will surge once again in Massachusetts. Among the strategies to stay on top of the surge is the need for increased testing with rapid results.
 
The FDA has already authorized two such rapid point-of-care antigen tests from Becton Dickinson and Quidel. Such tests are different from tests that detect antibodies. While it takes time for a person’s immune system to develop antibodies, a foreign antigen is present almost immediately and the tests that have been developed can ID the antigen with 20 minutes.
 
Maryland Governor Larry Hogan (R), the outgoing chair of the National Governors Association, devised a compact with six other states (to date) and the Rockefeller Foundation to expand the use of rapid point-of-care antigen tests. The six states, which include Massachusetts, are in discussions with the two companies to purchase 500,000 tests per state.
 
In a media release, Massachusetts Governor Charlie Baker (R) said, “Increasing both testing capacity and access to testing is a critical part of stopping the spread of COVID-19. We are pleased to join this interstate compact and look forward to working with this bipartisan group of governors to collectively build on these shared goals.” 
 
The coalition now consists of states with four Democratic governors and three Republicans. Other states, cities, and local governments may join the compact.
 

The state’s Center for Health Information and Analysis (CHIA) in mid-July released a report showing the bleak finances of hospitals in the first quarter of the year (Jan. through March 31) and cautioned that its report did not begin to cover the effects of COVID-19. CHIA last week released its most recent hospital financials overview covering the period from March to May 31, and the picture it paints is very dark.
 
CHIA found that the reporting hospitals (38 representing 74% of all acute care hospital revenue) had a median total margin of negative -28.9% and 34 of 36 hospitals reported overall losses. The big systems (Baystate Health, Beth Israel Lahey Health, Mass General Brigham, and Wellforce) lost money as did smaller systems and independent hospitals. After calculating COVID-19 federal funding that some hospitals received in April and May, Massachusetts hospitals still took massive revenue hits due to the pandemic.
  
“While state and federal COVID-19 relief funds supplemented the operating revenue reported in April and May, in aggregate total operating revenue remained lower than total expenses for the participating hospitals,” CHIA reported.
 
MHA released the following statement after reviewing the CHIA report: “The latest CHIA report paints a clear picture of the serious economic challenges our hospitals are facing. Massachusetts hospitals continue to grapple with the immense losses brought on by COVID-19, which threaten the stability of many healthcare organizations – especially community and safety net providers. Additional relief will be essential in bringing our system back to full strength, especially as we prepare for a second wave and focus on remaining fully accessible to all patients. We appreciate the efforts of our elected leaders to make sure our providers have the resources they need to be there for their patients and communities.”

While most everyone has been destabilized by the pandemic and its effect on society and the economy, caregivers are feeling the stress more than many. A powerful opinion piece from the family of the New York emergency room physician who committed suicide at the height of the COVID-19 outbreak calls on the healthcare system to recognize the problem and address physician burnout.
  
Dr. Lorna Breen was the head of the Emergency Department at New York-Presbyterian Allen Hospital in New York City. She died by suicide after telling her family that she was reluctant to seek help or ask for assistance for overwhelming work-related stress because she feared that she would lose her medical license or be ostracized by her colleagues.
  
This brief commentary in National Academy of Medicine Perspectives calls for an end to the “culture of silence” pervading the medical community around the issue of burnout.
  
“Clinicians are struggling, suffering, and, in some cases, dying while their needs are not being met by employers, educational institutions, professional organizations, and other authorities that shape the culture of health care,” Breen’s family and colleagues write. 
  
The Massachusetts Medical Society – Massachusetts Health & Hospital Association Joint Task Force on Physician Burnout has addressed how electronic health records contribute to the burnout problem, and how stress and anxiety relate to the COVID-19 pandemic. The task force is also addressing how the burden of systemic racism affects both clinicians and patients.

As has been reported, but which is still unclear to some, workers providing “critical infrastructure services” – which includes hospital personnel – must quarantine when returning from an “at-risk” state. Massachusetts last week updated its guidance on the mass.gov website to reinforce this message. It posted the following Q & A:
 
Q: I am a Mass. resident and I provide Critical Infrastructure Services. I plan to go on vacation to Florida with my family. Do I need to quarantine when I return home from Florida?

A Yes. Workers who travel from Massachusetts for personal or leisure reasons cannot rely on the Critical Infrastructure Worker exemption upon return. You must either quarantine or satisfy the testing rule. Your status as a Critical Infrastructure Worker does not allow you to break quarantine — even to do that specialized work — following travel for personal or leisure reasons.

Likewise, a Critical Infrastructure Worker who comes to Massachusetts for personal or leisure reasons cannot rely on the Critical Infrastructure Worker exemption upon arrival and must either quarantine or satisfy the testing rule.

View the state's entire travel order page here.

The Centers for Medicare & Medicaid Services (CMS) has released the calendar year (CY) 2021 outpatient prospective payment system (OPPS) proposed rule. CMS will accept comments on the rule through October 5. The final rule is typically published around Nov. 1, but CMS has waived this timeline so that it may provide as few as 30 days between the publishing of the CY 2021 final rule and its effective date. Therefore, the final rule could be published as late as December 2. The policies and payment rates will take effect Jan. 1, 2021. Highlights include an update to OPPS rates by 2.6% for CY 2021; a potential further reduction in payments for drugs purchased through the 340B program; and significant changes to the controversial hospital “star ratings” methodology. MHA is gathering member reactions to the proposed rule and will submit its comments to CMS.