Redlining, Racial Bias in Medical Tests, and more ...

Eliminating Bias From Kidney Tests; AG Urges Review of Other Tests

MHA “strongly supports” the recent recommendation from the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) that calls for eliminating the current method of measuring kidney function due to the fact that it introduces racial bias into who may receive critical care, including transplants, to fight kidney disease.
At issue is the long-standing use of estimated glomerular filtration rate (eGFR) equations to determine the health of a kidney. Factoring in a patient’s age, height, weight, and gender to a basic serum creatine test creates a number to assess kidney health; the higher the number the healthier the kidney. But based on a series of now discredited tests on a small population of Black patients, the medical community began factoring race into the eGFR equation. That resulted in Blacks automatically receiving a higher eGFR number, which indicated that their kidneys were healthier than they actually were. That, in turn, means that specialty nephrology care, including kidney transplants, is often deferred for Blacks because the racially biased eGFR test does not a give a true indication of their health.
NKF and ASN put together a task force in 2020 to study the issue, but even before the results were released last month, some hospitals and health systems – notably Mass General Brigham and Beth Israel Lahey Health in Massachusetts – removed race as a factor in kidney tests.
“MHA strongly supports the recent recommendations by the KNF and ASN taskforce regarding the removal of race as a factor for estimating kidney function,” said MHA’s Director of Health Equity Akriti Bhambi. “As our healthcare community is committed to equity and anti-racism, it is essential that racial bias be eliminated from clinical guidelines and practice.”
Massachusetts Attorney General Maura Healey also applauded the work of the taskforce and called on the healthcare system to immediately adopt its recommendations. But AG Healey went further, adding, “Beyond this kidney test, we need to take a hard look at other clinical tools that take patient race into account, as some may inappropriately steer patients of color away from needed care. We need the medical community to work together to quickly identify these tools, develop and vet appropriate alternatives, and ensure that no patient faces discrimination because of structural racism.” MHA supports Healey’s comments on this issue.

Past Redlining Still Affecting Public Health Today 

The “redlining” of neighborhoods that began in the 1930s has resulted in those affected areas experiencing greater rates of gun violence and much worse outcomes for Black women during pregnancy and childbirth, according to recent studies.
The U.S. government’s mortgage underwriting standards and its labeling of certain neighborhoods as “desirable” or in “decline” through mapping led to many urban neighborhoods with predominately Black residents being encircled with the undesirable red line. Home loans were refused to residents in those neighborhoods (even to returning veterans through mortgage programs from the Department of Veterans Affairs), leading to the areas declining further and its residents (and their families) being prohibited from participating in the wealth-building aspect of home ownership. Redlining was ostensibly eliminated in 1968 through the Fair Housing Act. 
A new study from researchers at Boston Medical Center has found that neighborhoods that were initially redlined decades ago currently have higher rates of firearm violence compared to areas that were not redlined. The researchers overlayed violence data from the Boston Police Department with color coded maps showing how neighborhoods were labeled in the 1930s and 1940s. Neighborhoods labeled yellow and red – or “definitely declining” or “hazardous”, respectively – had much higher rates of gun violence than areas labeled green and blue “in large part due to high rates of poverty, low educational attainment, and low homeownership rates.”
“It is important for researchers and policy makers to understand the downstream impacts of structural racism and how they affect firearm violence in devalued, redlined communities,” said Michael Poulson, M.D., the study’s first author and a surgical resident at BMC. “Our study results show that considering neighborhood factors such as poverty, educational attainment, and segregation are important when interventions are being developed to help decrease firearm violence in communities still feeling the effects of redlining.” 
Also last week, researchers from the University of Rochester issued a study of more than 64,000 births and found that historically redlined zip codes were associated with increased risk of preterm birth and periviable birth. Racial and ethnic disparities in outcomes are well documented, with Black women carrying a disproportionate burden of increased morbidity and mortality due to a range of obstetric outcomes. The Rochester study linked modern and historic data sets to find that modern obstetric disparities are associated with a system of historic inequity.
“The observation that racially discriminatory home lending patterns of the 1940s were associated with contemporary preterm birth rates can inform us that the legacy of government-sanctioned discrimination persists today,” the researchers wrote.

Hospitals that Lost Billions Seek Relief from the State

According to an MHA analysis of hospital and health system financial data from the Center for Health Information and Analysis, hospitals that experienced a decline in their operating margins during the pandemic had an aggregate $1.36 billion decline in FY2020 and Q2 FY2021 margins compared with the same periods in FY2019 – even with government COVID-19 financial relief. At the hospital health system level, which includes physician practices that also sustained deep financial losses, that decline grows to $1.71 billion in the aggregate even after factoring in financial assistance. 
Citing these “staggering losses,” MHA President & CEO Steve Walsh submitted testimony to legislators in which he asked that $500 million of available American Rescue Plan Act funding that Massachusetts controls be used to establish a trust fund for hospitals and their affiliated healthcare providers to support unfunded expenses and lost revenues due to the pandemic.
“Since the beginning of the pandemic, hospitals and health systems did whatever it took to remain open and accessible to every patient,” Walsh said. “They spared no expense to rapidly increase bed capacity, secure personal protective equipment, and oversee the operation of field hospitals and vaccination sites – all while treating a relentless disease. The response of our hospitals and healthcare organizations is what kept Massachusetts from looking like many other states in the country. We were no longer separate hospitals or health systems. We were the commonwealth’s hospital system – rounding daily as an entire state while sharing resources, staff, beds, ventilators, and expertise. Our shared response for the common good ultimately saved lives. And, during this time, we never asked the legislature for funding.”
Walsh said the available ARPA funding is “a pivotal – and perhaps last – chance to restabilize Massachusetts hospitals and health systems, which have been there for the commonwealth and its residents during our darkest hours.”

Staffing Shortages, Behavioral Health Boarding, and More Plague Hospitals

At last Wednesday’s Health Policy Commission Advisory Council meeting, several MHA members delivered important updates about the challenges providers are currently facing.
Christine Schuster, president & CEO of Emerson Hospital, Dr. Steven Strongwater, president & CEO of Atrius Health, and Deborah Wilson, president & CEO of Lawrence General Hospital briefed the advisory council about the influx of non-COVID patients, staffing shortages, and the behavioral health crisis with which they are grappling. The health leaders spoke about their commitment to ensuring staff are vaccinated against COVID-19 even if such mandates, which became official for several hospitals and health systems last Friday, result in workers leaving their jobs. In any given week, there are more than 600 behavioral health patients boarding in hospitals as they await a bed.
"As of today, I have three adolescents in my emergency department that have been there for more than four days, which as you know, it's not the greatest place when you have mental health issues to be in a short-stay, acute environment," Schuster said.

Care After the Hospital: A New Tool to Finding the Right Post Acute Care

Join MHA for a webinar on Wednesday, October 13, as the association releases its new “Care After the Hospital” guide for patients and caregivers. Identifying the next step for care medical event or hospitalization can be daunting– both for patients and providers alike. To help address this challenge, healthcare professionals from across the Massachusetts care continuum constructed a first-of-its-kind post-acute care guide to counsel healthcare professionals, and those in their care, on which options are best for their unique needs. The webinar will run from 11 to 11:45 a.m., and will feature leaders from Hebrew Senior Life, Lawrence General Hospital, and the Spaulding Rehabilitation Network. Register today.

Mark Your Calendars for CARe/MACRMI Forum

The 9th annual communication, apology, and resolution (CARe) forum, hosted by the Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI), takes place this year on Tuesday, October 26 from 10 to 11:15 a.m. Registration is required for the free, virtual presentation. (MACRMI hopes to hold a follow-up, in-person event with simulations and discussions at a to-be-announced date in the spring.)
This year’s virtual forum keynote speaker is Dr. Alice Coombs, the current chair of the Department of Anesthesia at Virginia Commonwealth University, and former president of the Massachusetts Medical Society. She will discuss the role that society and personal biases play in the delivery of healthcare, and the importance of that awareness in implementing CARe programs. 
In the CARe program, patients and families who experience adverse medical events are provided full communication about the facts of the event, and have the opportunity to ask questions and receive timely, honest answers. In cases of preventable injury, providers and healthcare organizations apologize, discuss with patients what will be done to prevent the error from recurring, and work with their insurers to give patients a fair and timely resolution and, if appropriate, compensation, without the patient having to resort to litigation.
Attendees can earn CME credit. For more information, please contact Melinda Van Niel at mvanniel@bidmc.harvard.edu.

Federal Government Says More Relief Funding is Available 

A much-needed tranche of federal relief money for fighting the pandemic became available last week. The federal Health Resources & Services Administration (HRSA) said $17 billion is available from Phase 4 of Provider Relief Fund distributions and $8.5 billion is being distributed from the American Rescue Plan Act funding for rural providers. The application portal will close at 11:59 p.m. ET on Tuesday, October 26. Because a number of verification steps must be met, HRSA encouraged providers to begin the application process as soon as possible. HRSA said it hopes to distribute the PRF funds in mid-December and the ARPA money in mid- to late-November. Seventy-five percent of the $17 billion Phase 4 PRF distribution will be based on providers’ COVID-19 lost revenues and expenditures from July 1, 2020, through March 31, 2021. Smaller providers will be reimbursed at a higher rate compared to larger providers, HRSA said. The remaining 25% of the $17 billion will be distributed in the form of bonus payments for providers based on the amount and type of services they provide to Medicare, Medicaid, and Children’s Health Insurance Program patients. HRSA released new information on its reconsideration process of Phase 3 funding decisions. This process is only available for providers that originally applied for Phase 3 distributions. The deadline to apply for Phase 3 funding reconsideration is 11:59 p.m. ET on Friday, November 12, 2021. 

Skills and Best Practices for Administrative Excellence in Healthcare

October 6, October 20, November 3, November 17
8 - 9 a.m. ET

Administrative professionals often serve as the backbone of the fast-paced, ever-changing healthcare environment. In this four-part webinar series, you’ll be introduced to a fresh approach to leading and managing your workday. The series will include sessions on emotional intelligence, leading effective virtual meetings, skills for strong communication, and goal-setting. You will be provided with tools to help you improve attention, clarity, and connection, while diminishing procrastination, distraction, and conflict. Each session will be highly interactive and will include opportunities to network and learn from your colleagues. Register today and don’t miss out on your opportunity to polish and sharpen your administrative professional skills.

John LoDico, Editor