10.19.2020

Budgets, MOUD in LTC, and more...

Governor Refiles 2021 State Budget, Discusses COVID Readiness

Governor Baker last Wednesday refiled his state budget proposal – a $45.5 billion balanced plan that relies on federal pandemic relief funding and a $1.35 billion withdrawal from the state’s rainy day fund to cover revenue shortfalls due to the state’s COVID-19-hobbled economy. The rare budget refiling is necessary because the state, confronting the pandemic, never passed a FY2021 spending plan; a series of supplemental spending bills has kept the state afloat through 2020.
  
In the overview document accompanying the budget, the Baker Administration praised healthcare providers across the commonwealth who “stepped up in historic ways while experiencing a significant impact on their revenue and operations.”
  
Earlier in the week, Baker held a press conference to again acknowledge the work of the healthcare community in preparing the state for a resurgence of COVID-19. The governor said that the state’s response since the coronavirus first hit the state in March has been “transformational” and that Massachusetts is well positioned to handle an expected uptick in the virus this fall and winter.
  
“The cooperation and ingenuity of healthcare leaders have made a huge difference in fighting this virus,” Baker said, noting that he and EOHHS Secretary Marylou Sudders, who runs the state’s COVID-19 Command Center, have been in constant contact with hospitals. 
  
“Early on and working very closely with the Mass. Health & Hospital Association, we enacted strict policies to ensure sufficient inpatient capacity,” Sudders said. “[T]hese expectations remain in place as a protective measure should Massachusetts experience another surge.”
  
 

After Massive Losses, Hospitals Start to Rebound, Prepare for Next Wave

Following three months (March—May) of devastating financial losses due to COVID-19, Massachusetts hospitals bounced back a bit in June and July, according to a new report from the state’s Center for Health Information and Analysis (CHIA).
  
Thirty-seven of 61 acute hospitals and 11 of 25 hospital health systems submitted monthly data through July and are included in the CHIA report. The federal CARES Act funding that flowed to the state, as well as the restoration of in-person services, helped temper the losses that hospitals experienced from March through May. A CHIA report issued in September showed that median total margins plunged 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.
  
The new data shows 29 of 37 hospitals reporting a positive margin in June and 35 of 37 hospitals reporting a positive margin in July. The cohort of community hospitals continued to show negative operating margins in June, although all four cohorts – community hospitals, academic medical centers, teaching hospitals, and high public payer hospitals – showed positive margins in July.
  
MHA President & CEO Steve Walsh said of the new CHIA report, “We are certainly grateful for the relief provided to hospitals thus far, and for the ongoing support from Governor Baker, Congressman Richard Neal, and all our state and federal legislators. This support has helped hospitals stabilize and survive, and it will be more vital than ever as providers continue to navigate precarious financial circumstances and brace for a COVID-19 resurgence. Unfortunately, this will prove to be a very challenging season for our healthcare system yet again.”
  
 

MHA Helps Un-clog the PPE Pipeline

As Governor Baker noted in his press conference last Tuesday, the state has been stockpiling personal protective equipment (PPE) by whatever means it can ever since the outset of the pandemic demonstrated that the nation was woefully under-supplied in PPE.
  
MHA also addressed the issue on behalf of its membership, helping to vet PPE suppliers early on, serving as a clearinghouse for donations from companies and the public, and most recently entering into a partnership with PPE Exchange, an online marketplace of suppliers.
  
This week MHA is coordinating the distribution of 40,000 16-ounce bottles of hand sanitizer that was donated to the healthcare community by The Faber Foundation through SLH Medical Supply.
  
 

HPC Hearing to Focus on Past and Future Response to COVID-19

The Health Policy Commission’s annual cost-trend hearing is scheduled to take place tomorrow, October 20 from 9 a.m. to 12:30 p.m. The theme is “COVID-19 and the Massachusetts Healthcare System – Assessing Impact, Advancing Equity.”
 
Two panels are expected to discuss how the pandemic has affected physical and mental health of the commonwealth’s residents, how some communities and populations have disproportionately borne the brunt of COVID-19, how the healthcare system has been affected and has endured, and what risks lie ahead.
 
Among those participating will be Dr. Damian Archer, CMO of North Shore Community Health; Dr. Thea James, VP of Mission and Associate CMO, Boston Medical Center; Dr. Steven Strongwater, president and CEO, Atrius Health; Deborah Wilson, president and CEO, Lawrence General Hospital; Dr. Shari Nethersole, Executive Director for Community Health, Boston Children's Hospital; and Dr. Thomas Sequist, Chief Patient Experience and Equity Officer, Mass General Brigham.
 
David Williams from the Harvard T.H. Chan School of Public Health will deliver the keynote presentation; Williams is an expert on the social determinants of health.

MOUD in Long-Term Facilities 

The Department of Public Health’s Bureau of Healthcare Safety & Quality has released a new toolkit to provide guidance on medication for opioid use disorder (MOUD) in long-term care facilities. The resources on the page serve to support the staff in facilities that provide care for residents diagnosed with an opioid use disorder who are on MOUD. The resources are free to access, print, and share.
  
In 2019, MHA worked with the Massachusetts College of Emergency Physicians and an MHA member workgroup to develop MOUD guidelines for use in hospital emergency departments. Chapter 208 of the Acts of 2018 requires acute care hospitals that provide emergency services within an emergency department and satellite emergency facilities to have the capacity to initiate opioid agonist therapy to patients that present after an opioid-related overdose. 
 

Hospital, M.D., and Nursing Groups Join to Denounce White House Order

Two weeks ago, MHA issued a strong statement denouncing an executive order from the White House that could limit the ability of organizations receiving federal funding, such as hospitals, to hold anti-racism and anti-discrimination training. Now, the American Hospital Association, American Medical Association, and American Nurses Association has sent a letter to the president calling on him to immediately rescind the order.
 
“On the front lines of healthcare every day, our members strive to provide the highest quality care to all patients and improve the overall health of the communities we serve,” the healthcare leaders wrote on October 14. “We embrace diversity, inclusion and equity in our workplaces and believe that these values make our organizations stronger and better equipped to provide optimal, culturally sensitive care to every patient. We recognize that myriad factors influence patients’ health status and health outcomes, including the social determinants of health, implicit bias, and historical systems that have led to unequal access to care. To further the goal of health equity, we must fully understand and address these factors.
 
“We are, therefore, dismayed by [Executive Order] 13950, which would stifle attempts at open, honest discussion of these issues in the public and private sectors. Prohibiting federal agencies from conducting and funding trainings that promote racial reconciliation is counterproductive to addressing racism.”
 
 

Transition

The Board of Trustees of Boston Children’s Hospital has named Kevin B. Churchwell, M.D., the hospital’s next CEO, effective March 31, 2021, on which date current CEO Sandra L. Fenwick will retire. Churchwell is currently president and COO of the hospital. Churchwell joined Boston Children’s Hospital in 2013 as Executive Vice President for Health Affairs and COO. He is also an Associate Professor of Anesthesia at Harvard Medical School. Churchwell is a graduate of the Massachusetts Institute of Technology and Vanderbilt University Medical School. He completed his pediatric residency and a clinical fellowship in Anesthesia and Pediatric Critical Care at Boston Children’s Hospital. The current treasurer of the MHA Board of Trustees, Churchwell also chairs the association’s Diversity, Health Equity & Inclusion Committee.

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

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

 

Patient safety, high-quality care, 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 allowances or exceptions to standards, how surveys are performed in high-risk areas, most cited standards, 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 in this difficult time. Please register here.

John LoDico, Editor