Massachusetts hospitals have taken a large financial hit due to the COVID-19 pandemic, according to a new study from the Center for Health Information and Analysis (CHIA).
  
Hospitals suffered traumatic losses in March and April when elective procedures were cancelled and facilities expended large amounts of funds buying scarce personal protective equipment (PPE), creating surge beds, performing increased testing, and more. The federal CARES Act helped mitigate the losses, but CHIA found that even with federal relief, hospitals still lost money.
  
The 38 of 61 hospitals that participated in the CHIA survey represent approximately 74% of acute hospital operating revenues. Reporting shows median total margins plunging significantly in March across all hospital cohorts, ranging from negative 50.1% at teaching hospitals to negative 19.4% at academic medical centers. Community hospital margins decreased by one third – 33.2% – in March.
  
“Federal CARES Act payments improved profitability in April and May, but overall total margins remained mostly unfavorable compared to the base period,” CHIA found. Without CARES Act funding in April, community hospital total margins decreased 69%. With the CARES Act money, those community facilities experienced median total margins of negative 26.4%. 
  
While expenses rose, operating revenue decreased. CHIA found that in aggregate, total operating revenue was lower than total expenses for all three months. As a result, hospitals and hospitals systems have faced challenging decisions on services and personnel in order to remain financially stable.
  

Last Thursday morning, the president signed a short-term spending bill, H.R. 8337 to support federal programs through December 11. The Senate passed the measure on September 30 by a vote of 84-10 and the House passed it two weeks ago by a vote of 359-57.
  
On healthcare, the bill extends to December 11 several provisions due to expire on November 30, including funding for the Community Health Center program, National Health Service Corps, Teaching Health Center GME program, and the Special Diabetes programs. In addition, the bill made important revisions to the Medicare Accelerated and Advance Payment Program by delaying repayment for one year, reducing the interest rate to 4% on the unpaid balance, and limiting claim offsets to 25% of the full Medicare payment for 11 months followed by six months with claim offsets limited to 50% of the full amount. The package also extends the delay for the scheduled Medicaid disproportionate share hospital reduction. 
 
The continuing resolution will allow Congress time to complete action on the 12 agency appropriations bills and those which cannot be enacted by December 11 will likely be addressed in a December omnibus package to provide appropriations for the remainder of fiscal 2021.
 

Telemedicine works. The telehealth flexibilities enacted during the pandemic have allowed patients to keep appointments while limiting their exposure (and that of caregivers) to COVID-19, reduced the stress and costs of travelling to appointments, filled coverage gaps to underserved communities, and even preserved personal protective equipment, among many other benefits. But what will telemedicine look like when the pandemic and the flexibilities end?
  
Currently, a House-Senate conference committee is meeting to resolve the differences between two competing healthcare bills, each of which address telemedicine. Last week, the tMED coalition, representing more than 40 healthcare and telecommunication associations, consumer advocates, and technology companies, wrote to the conferees outlining specific steps to preserve telemedicine in Massachusetts.
  
“As the commonwealth continues its phased reopening and encourages the use of telehealth to the maximum extent feasible, the tMED Coalition urges our state elected leaders to make the establishment of sustainable and equitable telehealth policies for both synchronous and asynchronous technologies a top priority,” tMED wrote. The letter addresses payment for telehealth, prior authorization suggestions, reporting requirements, and more.
  

DPH has issued a clinical notice about a troubling neurological disorder in children that has been tracked across the U.S. since 2014, with two suspected cases in Massachusetts this year.
 
Acute flaccid myelitis (AFM) is a serious neurologic condition that affects mostly children and typically presents with sudden limb weakness that can lead to permanent paralysis. DPH notes that the affliction has occurred in the U.S. usually during late summer and early fall. Since January 1, 2014, DPH has received 40 reports of suspected AFM; 19 were classified as confirmed cases, four as probable, and 17 as not cases. This year, there have been four reports; two have been classified as probable cases and two as not cases.
 
Clinicians should immediately report suspected cases of AFM to DPH by calling (617) 983-6800. This graphic chart explains the ailment and reporting procedure.

While the state and healthcare system devote needed attention to the pandemic, another insidious affliction – substance use disorder – continues to harm lives in Massachusetts. Recent state data show that while the mortality rate from opioids has bent downward slightly, opioid-related acute inpatient hospital stays increased, driven by an uptick in secondary admissions.
  
Now a new six-month addiction nursing fellowship from Boston Medical Center’s Grayken Center will train registered nurses on the specifics of caring for those with SUD. RNs chosen for the fellowship will still work at the bedside, but will dedicate 12 hours a week to take part in clinical and educational activities focused on the treatment and care of individuals with substance use disorder across the care continuum. In particular, they will learn about medication treatment, harm reduction techniques, and using trauma-informed care strategies when caring for patients. They will also be responsible for developing a project in an area of their choosing during the course of their fellowship, which they will present to BMC’s Substance Use Disorder Nursing Council. The 35-plus members of the council, who represent all of the nursing care areas in the hospital, developed the fellowship, which BMC believes is the first of its kind in the U.S. 
  
The six-month fellowship will be offered twice a year, with two BMC nurses in each cohort. At the completion of the fellowship, the fellows will be prepared to sit for the Certified Addictions Registered Nurse (CARN) exam.
  

MHQP is initiating “Wave 3” of its physician surveys on telehealth. In July, 130 clinicians responded to the first survey, which was followed up in August with what MHQP is calling “Wave 2” to find out physicians’ ideas on practical solutions, useful ideas, tips and tricks for how to make telehealth better. MHQP has posted the results of those two surveys here.
 
Now, MHQP’s "Wave 3" survey focuses on telehealth technological challenges; involvement of the team; time effectiveness; privacy, and language barriers. Clinicians are urged to take the survey via the link above.

MHA is co-sponsoring a program that helps building engineers, maintenance supervisors, and others in the skilled trades advance their skills and careers in energy efficient operation of commercial buildings.
 
Building Operator Certification (BOC) Level 1 is designed for individuals with two or more years of experience in building operation and maintenance, who wish to broaden their knowledge of the total building system. Completion of Level I requires a time commitment of 74 hours, which includes seven classes, work-site projects, and open-book tests.
 
The program is especially relevant for the hospital community, which is why MHA is co-sponsoring it along with Health Care Without Harm, MassSave, National Grid, and Eversource. Massachusetts healthcare energy managers can attend BOC Level 1 via zoom.
 
The registration deadline is October 22. Online orientation begins October 29. Full details, including costs (some of which may be reimbursable), and registration are available here.

A challenge to the Affordable Care Act is before the U.S. Supreme Court, which recently lost Ruth Bader Ginsburg and could very soon have Amy Coney Barrett as its newest justice.
 
For many people, the future of the Supreme Court is the deciding factor in their vote for president. And for many people in healthcare, the fate of the Affordable Care Act has profound implications not only on access and coverage but on healthcare financing models and more.
 
The American Hospital Association has released a concise 23-minute video featuring AHA General Counsel Melinda Reid Hatten and Cate Stetson, a partner at Hogan and Lovells, who was a former law firm partner of Chief Justice John Roberts before his appointment to the court. The two lay out their thoughts on the ACA case and other legal challenges that could affect hospitals and health systems.

Massachusetts Rep. Dan Cullinane (D-Dorchester), who is currently serving as Acting Chair of the Joint Committee on Health Care Financing, has announced that he will join the lobbying form of Kearney, Donovan & McGee. He had previously announced that he would not seek re-election. Cullinane was a member of the House-Senate conference committee negotiating a new healthcare reform bill; last week, he resigned from the committee due to his announcement. Rep. John Mahoney (D-Worcester), the current Chair of the Joint Committee on Public Health, will replace Cullinane as conferee.

COVID-19 & The Joint Commission: Key Updates/What to Expect

Tuesday October 27; 11:30 a.m. to 2:15 p.m.

Patient safety, quality and Joint Commission compliance are always top priorities for hospitals. The COVID-19 pandemic has added many new challenges to these efforts. Join us for this program where we’ll hear an update directly from Joint Commission leaders about what to expect with surveys due to COVID-19, such as allowance or exceptions to standards, how surveys are performed in high-risk areas, and key areas of focus. Of particular concern is infection prevention and we will have an expert in this area talk about strategies to incorporate during the pandemic. We will also feature local hospital leaders sharing their experiences and tactics within their hospitals during this difficult time. Register by visiting here.