It is undeniable that Massachusetts hospitals suffered a financial drubbing due to COVID-19 at the beginning of the year, and then received substantial funding from the federal government and the state in the spring and summer. What is less clear to some is how the losses and subsequent gains balance out.
  
Last week, the state’s Center for Health Information and Analysis (CHIA) issued its quarterly report of hospital and health system finances using data from October 1, 2019 through June 30, 2020. The state agency found that the median total margin for acute hospitals – which is a measure of profitability – was negative 0.7%. Last year by June’s end, the median total margin was positive 3.6%.
  
All cohorts of hospitals showed a significant decline in median total margin compared to the same reporting period last year and community hospitals had a negative median total margin of 4.8% for the year. CHIA’s report found that if hospitals had not received substantial federal and state relief funding, the statewide median total margin would have been negative 6.7%. 
  
While the CHIA report shows the financial results through June with and without government relief, there are some further issues to consider that are not reflected in these bottom-line figures. Hospitals often subsidize home health operations, physician practices, and other entities, and are currently permitted to transfer some of their federal Provider Relief Funding to its affiliates. Another fact is that relief funding received to date can be used to fund continuing COVID-fighting hospital operations well into 2021.
  
“With the second wave upon us and uncertainty lingering over the future of financial support, we are bracing for what could be another difficult year ahead,” MHA’s President & CEO Steve Walsh said of the CHIA report. “As providers treat an influx of COVID-positive patients and make the investments necessary to deliver safe care, it’s crucial that they can remain financially viable and fully accessible to their communities. We are incredibly grateful to our state and federal elected officials for helping secure the support our providers have needed to survive, and we will continue to count on their support.”
  

As of the end of last week, four out of the five regions of the state (as organized by the Executive Office of Health and Human Services) had entered Tier 2 as defined by the state’s resurgence planning document. In making the designation, the state said the affected regions faced “widespread capacity constraints, diminishing ability to support patient transfer, and accelerating disease indicators.” Only Region 1 (Western Mass.) has so far avoided the higher tier designation.

While all data submitted to the state and then the federal government show that there still enough beds to contain the influx of patients, many hospitals are reporting that they are facing workforce problems in staffing the beds. Many of the retired providers that were allowed to re-enter the workforce, along with travelling nurses (whose fees have been rising exponentially), and other temporary caregivers that rushed into the fray in the spring have left, leaving the ever-increasing workload to already stretched hospital caregivers. The steadily increasing COVID-19 cases are causing great concern mainly because of the steadily diminishing workforce to treat them. The issue caused the state to send an alert last week, asking hospitals to ensure that their daily reporting “reflects current staffing capabilities and takes into account all constraints resulting from staff absences or other resource shortages."

Governor Charlie Baker toured the field hospital that has been set up at the DCU Center in Worcester and that is being managed by UMass Memorial Health Care. The DCU hospital operated during the spring, was decommissioned when cases declined, and now has been quickly re-opened by the National Guard and MEMA. The facility can treat up to 220 patients when at full capacity, according to the governor.
  
During his remarks, UMass Memorial Health Care President & CEO Dr. Eric Dickson made a direct appeal to the general public, stating, “We don’t want this to be the second surge, we want this to be the final surge. It will only be the final surge if everyone follows the rules every day. This is about being a good citizen.”
  
The governor announced that another field hospital would open shortly in Lowell and receive medical guidance from Lowell General Hospital.
  
Said MHA President & CEO Steve Walsh, “The availability of field hospitals, such as the ones overseen by UMass Memorial Health Care and Lowell General Hospital, further ensures that acute care beds can always be available to the sickest patients. Even with this readiness in place, our providers still need the help of every resident in order to avoid being overwhelmed. It’s no exaggeration to say that mask wearing and social distancing have a direct effect on the strength of our healthcare system.”

The Health Policy Commission issued a Request for Proposals (RFP) for interested organizations to apply for a new $1.2 million investment program – the Cost-Effective, Coordinated Care for Caregivers and Substance Exposed Newborns (C4SEN). The program is funded through a $300,000 legislative appropriation with an additional allocation of $900,000 by the HPC from the Distressed Hospital Trust Fund (DHTF). C4SEN covers the care period of at least 12 months post-partum and focuses on improving outcomes for both mothers and infants, as well as adding to the knowledge base of clinical best practices for substance-exposed newborns and their caregivers. 
  
The state anticipates funding up to three awards of approximately $300,000 each to DHTF-eligible hospitals and roughly $300,000 to another eligible entity. 
  
The RFP and its attachments are available on the state's procurement website, COMMBUYS. The HPC may issue RFP amendments, FAQs, and other information during the procurement period. Responses to the RFP must be submitted by 3 p.m. on Friday, January 22, 2021. Submit all questions about the C4SEN RFP to HPC-C4SEN@mass.gov by 3 p.m. on Tuesday, January 8.

Nationwide, hospitals are struggling to provide services to people who are experiencing a mental health or substance use emergency. In response to this crisis, NAMI Massachusetts developed an emergency department education initiative that contains a curriculum augmented by personal accounts and skills gained through first-hand experience. NAMI (National Alliance on Mental Illness) says adding a deeply personal perspective to its program curricula “adds a means of teaching both the emotional aspects and practical consequences of living with a mental health or substance use condition.” 
 
The training will help ED staff to: decrease stigma and increase empathy when interacting with people experiencing crises due to mental health or substance use; gain a better understanding of trauma and its effect on both patients and staff; understand the importance of language choices; learn practical tools and strategies; and become familiar with mental health and substance use disorder resources. 
 
NAMI Mass is holding a Zoom webinar on the ED initiative on Friday, December 18 at noon. Register in advance for the webinar by clicking here.

An American Hospital Association white paper released last week focuses on how some commercial insurers are increasing prior authorization requests and payment delays. 
 
“Insurers use prior authorization to ensure that providers order care that is consistent with clinical guidelines and protocols, as well as to confirm that such care is covered by the patient’s plan,” AHA writes. “This tool was designed to primarily help guide (and monitor) providers’ decision-making around treatments that are new, particularly high cost, or that have a history of questionable use. However, some plans are now applying prior authorization to a wide range of services, including those for which the treatment protocol has remained the same for decades and there is no evidence of abuse.”
 
While the findings pre-date the COVID-19 public health emergency, the report underscores the urgency to address these concerns as hospitals care for COVID-19 patients. 
 

Essentials of Facility Reimbursement for ED and Observation Services: 2021 Updates

Thursday, December 17; 1 – 2 p.m.

Successful emergency department financial performance requires identifying opportunities and avoiding common pitfalls. Join us and position your ED for optimized performance by taking a focused look at the critical areas of ED documentation, revenue capture, and compliance. Learn about the most important and hot-off-the-presses 2021 OPPS changes affecting ED facility reimbursement and the evolving observation comprehensive APC. Topics covered in this webinar will include correct E/M level assignment, procedure charge capture, and observation services. Register today.