Place story copy here.The state’s Public Health Council last Wednesday voted to approve an emergency regulation (105 CMR 316.000) that requires face masks or coverings to be worn at all times in public where a person cannot social distance, except: if the person is under age two; the covering affects the person’s ability to breathe safely; the person has a disability that prevents them from wearing a face mask or covering; the person depends on supplemental oxygen; or the person is engaged in outdoor exercise and is able to do so in a manner that complies with social distancing. (Parents will have discretion about whether children age 2 to 5 should wear a mask or covering, but children over age 5 are required to wear one.)
  
People who cite an exception relating to medical disability or condition don’t have to verify their claim; businesses can ban people without masks if they don’t cite an exception.
  
Also, last Tuesday, Governor Baker’s enhanced COVID-19 restrictions went into effect. As it relates to masks, his Executive Order #46 states: “For gatherings of more than 10 people, all persons over the age of two must wear a face covering when they attend indoor and outdoor gatherings where participants other than those in the same household will be in attendance, unless they are prevented from wearing a face covering by a medical or disabling condition. This restriction applies to gatherings in all venues and locations, including private homes, backyards, parks, athletic fields, and parking lots.”
  
Also last week, Health & Human Services Secretary Marylou Sudders suggested that people should consider wearing a mask inside their homes if they live with people who are at high risk for COVID-19.
  
As for what kind of masks or covering to use, the CDC issued guidance saying people should avoid masks with one-way valves or vents allowing air to be exhaled through a hole in the material. “This type of mask does not prevent the person wearing the mask from transmitting COVID-19 to others,” the CDC wrote. “Therefore, CDC does not recommend using masks for source control if they have an exhalation valve or vent.”
  
And a Duke University study that gained notice last week advised against the use of “gaiters” or neck cloths. These thin coverings, the researchers wrote, break up air droplets into even smaller droplets and, in effect, exacerbate the spread of COVID-19 rather than decreasing it. 

As the U.S. House, Senate, and White House continue to discuss COVID-19 relief bills, the issue of surprise medical billing – that is, unexpected charges to patients who show up to emergency rooms or who are treated by an out-of-network provider – remains unresolved.
  
Last week, U.S. Representatives Thomas R. Suozzi (D-N.Y.) and Donna E. Shalala (D-Fla.) weighed in on the issue with a guest commentary in The Republican newspaper in Springfield, Mass.
  
“Over the past year, various congressional committees have proposed different legislative solutions to protect patients from unexpected medical bills,” Suozzi and Shalala wrote. “Several of the proposals provide greater advantage to insurers, the one sector of the healthcare industry that has not been decimated by COVID-19. In fact, the most prominent of these proposals puts insurance companies squarely in the driver’s seat, allowing them to lowball providers and exclude key doctors and hospitals from people’s networks. This would decimate the hospitals that play such a central role in our communities.”
  
The two favor what they call “a smart approach” proposed by Ways and Means Committee Chairman Richard E. Neal (D-Mass.), which calls for negotiations over payment rates as opposed to setting a payment benchmark. “We believe this solution is the right path forward because it requires insurers and doctors to come to the table to prevent patients from receiving surprise bills,” they wrote.
  
MHA also has been a strong supporter of Neal’s approach. Said MHA President & CEO Steve Walsh, “It protects patients from receiving surprise bills and requires providers and insurers to negotiate out-of-network cases, with an objective arbitrator responsible for making the final ruling. It’s a process supported by our state’s hospitals and physician community.” The alternative proposal, Walsh said, “would tilt the scales in favor of insurers by setting one-size-fits-all rates, threatening our community hospitals and patients’ access to medical specialists.”

Earlier this month, the U.S. Census Bureau announced that 2020 Census field collection and self-response options will end on September 30 – one month earlier than the previous October 31 deadline. While Massachusetts’ self-response rate is 65.7% – ahead of the national average – the commonwealth is still below the state’s 2010 self-response rate of 68.8%. And less than 55% of Boston’s households have responded to date. The loss of time and social distancing due to COVID-19 could lead to a significant undercount – especially for immigrant communities and persons of color. This could have a notable effect on the state’s Congressional representation, redistricting, and critical federal funding for communities over the next 10 years. As much as $16 billion in federal dollars for Massachusetts lies in the balance, with much of this funding devoted healthcare programs like Medicare, Medicaid, Children’s Health Insurance Program (CHIP), and substance use and prevention grants.
  
Over the next six-plus weeks, hospitals will play a key role in their communities to ensure a fair and accurate count in the census. Hospitals should consult this toolkit that MHA developed for ideas about how to continue outreach virtually and safely during the COVID-19 pandemic. This map shows the towns in Massachusetts that need a targeted effort to increase census responses.

“It isn’t the Spanish Flu.”
  
That’s the argument that anti-mask, anti-social-distancing, COVID-19-downplaying people make. But a new study in the online Journal of the American Medical Association (JAMA), authored by a physician at Brigham and Women’s Hospital indicates that the COVID-19 pandemic is worse than the 1918 Spanish Flu.
  
Jeremy Samuel Faust, M.D. studied deaths in New York City during the 1918 H1N1 influenza pandemic and during the coronavirus pandemic, as well as the deaths in the preceding years of both pandemics. He then determined “excess mortality” – that is, deaths over baseline deaths of previous years that occurred at the peak of both pandemics. There were more excess deaths per 100,000 in 1918, but the baseline was higher. That is, all-cause deaths in New York city in the years before the pandemic were about 100 per 100,000. And during the height of the 1918 pandemic the deaths rose to 280 per 100,000 or 2.8 times normal.
  
But during the years before COVID-19, there were about 50 all-cause deaths in NYC per 100,000 – or half as much as a century before. That’s due to improvements in public health, sanitation, medical advances, etc. Working from that baseline, the 202 per 100,000 all-cause deaths during the height of the COVID-19 pandemic is four times what would be expected. That is, COVID-19 quadrupled the expected death rate while the 1918 flu nearly tripled the rate.

Michael Apkon, M.D., the president and CEO of Tufts Medical Center since the fall of 2018, will leave his job next month to work in a healthcare policy position. Michael Tarnoff, M.D., surgeon-in-chief, will serve as interim president.

Healthcare Project Management—Virtual Webcast

Tuesday, September 15 & Thursday, September 17; 2 to 4:30 p.m. each day

Healthcare organizations are facing major challenges with changes in payment systems and increased emphasis on quality, patient safety, and patient/employee experience/satisfaction. Faced with these challenges, organizations are launching major performance improvement projects, including (a) revenue cycle improvements (billing and collections); (b) implementation of electronic medical records and information systems; (c) supply chain cost reductions; (d) operations improvements, including patient flow and resource utilization; (e) quality and patient safety improvements; and (f) patient/employee experience/satisfaction improvements.
 
This session provides participants with an overview of project management and an opportunity to practice some of the skills needed to successfully manage a project. In addition, participants will explore project management through the lens of audiences affected by their work and learn how to engage and sustain the involvement and participation from project sponsors and key stakeholders. Experiential activities allow the time to practice both the skills and the language of project management. The keynote speaker is Karen Curley, MSW, MPH, director of learning & organizational development at Dana-Farber Cancer Institute. Learn more and register by clicking here.