More than 500 behavioral health patients, including 74 children, were “boarded” in Massachusetts hospital emergency rooms at the beginning of last week.
  
Behavioral health boarding occurs when a patient remains in an emergency department (ED) or medical/surgical unit because an inpatient psychiatric bed is unavailable. 
  
Last Tuesday, MHA’s Senior Director of Healthcare Policy Leigh Simons Youmans discussed the 500-plus boarders in her testimony on MHA’s priority behavioral health legislation, H.1061, before the Joint Committee on Financial Services. That bill, An Act to Strengthen and Expand Access to Behavioral Healthcare, was filed by Representative Marjorie Decker (D-Cambridge) and would, among other provisions help address the pressing workforce shortages that prevent facilities from staffing available psychiatric beds.
  
“MHA has recently begun to collect weekly psychiatric boarding data from health systems across the commonwealth,” Youmans told the committee. “Over the past two weeks that data has shown more than 500 patients waiting in EDs or on medical surgical units for an inpatient psychiatric placement. I would note that in the last two months, hospitals have seen a marked reduction in pediatric boarding, consistent with the longstanding trend of decreased pediatric boarding during the summer when kids are away from the stressors of school. As a result, we may well see the 500-boarder number increase as the summer ends and as children go back to school in the fall.”
  
The administration and legislature to date have been very responsive to the boarding crisis, which Youmans called “the epidemic within the pandemic.” Funding in the FY21 budget and additional investment from MassHealth will bring 300 beds online this calendar year, and MassHealth has made supplemental payments to support psychiatric units. In July, the administration announced funds dedicated toward immediate workforce needs to attract and retain staff at inpatient psychiatric units and facilities.
  
“These incredible financial commitments by the state will help to address the current acute crisis,” Youmans said. “Addressing the longstanding systemic challenges of the behavioral health system will take additional steps.” She said H. 1061’s Behavioral Health Investment Trust Fund would support behavioral health pipeline initiatives to expand the behavioral health workforce in the long-term, and in a culturally competent way. The bill would also create, among other initiatives, a Behavioral Health Rate Task Force and require coverage for all medically necessary mental health services across MassHealth, the Group Insurance Commission, and commercial insurers.

MassHire will be holding a five-day virtual job fair August 16 to 20. This job fair – the largest in Massachusetts – will be completely free to all employers. Hospitals are encouraged to post for the event their behavioral health positions, including direct care and clinical positions. Hospital employers should e-mail Dawn Beati (Dawn.Beati@detma.org) with their interest and the following information: job title and number of open positions; job description, and compensation.

The MHA Board of Trustees voted last Thursday to adopt a statewide consensus policy requiring mandatory COVID-19 vaccination for all Massachusetts hospital and health system employees.
  
MHA member hospitals and health systems in recent weeks have begun to issue their own individual vaccine mandates and, nationally, healthcare-worker mandates have increased, including the recent decision by the Veterans Health Administration to enforce vaccinations for all frontline workers.
  
The MHA Board, which had not met since May, last Thursday unanimously endorsed the following policy:
  
Each hospital and health system will establish its own policy and timeline for mandatory vaccination, exercising their independent judgment, based on their workforce and the needs of the communities they serve and will comply with all federal and state laws in granting appropriate medical and religious exemptions. 
  
Since December 2020, Massachusetts hospitals have administered more than 2 million doses of the COVID-19 vaccine and continue to play critical roles educating their communities about the safety, efficacy, and importance of COVID-19 vaccination. Massachusetts ranks second in the nation for the highest rate of fully vaccinated people, and hospitals and healthcare workers have played an essential role in achieving that position.
 

After weeks of back and forth, a bipartisan group of Senators reached agreement on an infrastructure package last Wednesday and within hours the Senate proceeded to end debate through a cloture vote. The 67-32 cloture vote included Massachusetts Senators Elizabeth Warren and Ed Markey voting in favor. 
  
The agreement includes nearly $600 billion in new spending for roads, rail, public transit, bridges, broadband, and water/power systems. Healthcare was not included under investments, but the offsets to pay for the package include limitations on Medicare drug rebates, some unobligated funds from last year’s COVID-19 CARES Act, and a one year extension of the Medicare 2% payment sequester cut. Provider Relief Fund dollars were not included in the offsets, a relief for the hospital community. 
  
The American Hospital Association had expressed its opposition to funding infrastructure by using funds that were authorized for providers to offset pandemic-related costs, and MHA shared that message with the Massachusetts congressional delegation during the past few months. However, the continuation of the Medicare sequester in order to finance non-healthcare programs is problematic as healthcare providers cannot sustain additional cuts to the Medicare program.
  
The Senate passed a key vote to proceed on the bill late last Friday but full passage of the bill and amendments was expected to occur after Monday Report's deadline. With the August congressional recess underway, action in the House may be delayed.

What’s the best way to determine at which hospital you should receive care? Should you use Leapfrog rankings or those from U.S. News & World Report or Newsweek? Is Medicare’s Hospital Compare website the best, or should you rely mainly on the experiences of your friends and family, or solely on the recommendations of your primary care physician?
  
MHA has always endorsed the use of Hospital Compare, as the federal site is based on evidence-based measures endorsed by the National Quality Forum. But as the site states, it should not be one's only factor in choosing a facility; patients should “talk to your doctor, social worker, or other healthcare providers when choosing a provider,” according to the site. (Hospital Compare, it should also be noted, has instituted a 1-to-5 star rating system that has been roundly criticized as inaccurately simplifying a hospital’s quality of care.)
  
U.S. News & World Report released its very popular hospital rankings last week. Part of the U.S. News score of hospitals relies on “an annual expert-opinion survey of specialized physicians” that has drawn criticism from some for relying too much on opinion and reputation as opposed to hard data. However, other parts of the U.S. News rankings rely on the same measures that Hospital Compare uses. Last week, the magazine rated Massachusetts General Hospital as number 5 in its top 20 hospitals nationally, and Brigham and Women’s Hospital number 14. It ranked Boston Children’s Hospital as the best children’s hospital in the U.S. Other Massachusetts hospitals ranked highly in specific specialty areas.
  
Of note, U.S. News and World Report ranked Saint Vincent Hospital at number 9 in the state, and highly in several specialty categories: chronic obstructive pulmonary disease (COPD), diabetes, heart attack, heart failure, kidney failure and knee replacements. 
  
The U.S. News study also examined nurse staffing in each specialty and rated Saint Vincent as “Very High” – a distinction shared with other top institutions in the state. The Massachusetts Nurses Association strike against Saint Vincent has featured several very inaccurate charges from the union about alleged substandard staffing, which is belied by the data in the U.S. News rankings. The union’s strike, which began on March 8, has resulted in St. Vincent being forced to take 80 inpatient beds offline and reducing other services to the communities it serves, effective today.

Chapter 220 of the Acts of 2018 requires hospitals to complete and implement by October 1, 2021, an operational plan for the recognition and management of patients with dementia or delirium in acute-care settings. The Department of Public Health last week notified hospitals that due to delays the pandemic has caused, the recently passed FY22 state budget contains a provision extending the due date for these operational plans to October 1, 2022. Since passage of Chapter 220, hospitals have been implementing the required plans, as well as abiding by the law’s requirement that all of their licensed physicians, physician assistants, registered nurses, and practical nurses must complete a 1-time course on the diagnosis, treatment, and care of patients with cognitive impairments. 

Massachusetts and Federal Surprise Billing Laws: A Status Update

Thursday, August 5; 12 - 1 p.m.

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