Massachusetts Health & Hospital Association 
INSIDE THE ISSUE
> Vaccinating Infants
> The Novavax Vaccine
> Administrative Costs
> Violence Prevention
> Minority Health Policy
> Globe Hits the Nail on the Head
MONDAY REPORT
DPH, MHA Urge All Newborns Be Vaccinated Against RSV
The Department of Public Health (DPH) and MHA last week sent a joint letter to hospitals encouraging them to provide the new monoclonal antibody product – nirsevimab – to all infants younger than 8 months, who are born during, or entering, their first respiratory syncytial virus (RSV) season. Infants born shortly before or during the RSV season should receive nirsevimab within their first week of life, according to the guidance.
The letter signed by DPH Commissioner Robbie Goldstein, M.D. and MHA President & CEO Steve Walsh, notes that “RSV is a major cause of childhood illness and the leading cause of bronchiolitis and pneumonia in children under one year of age. These life-threatening respiratory problems in infants can frequently require hospitalization, mechanical ventilation, or admission to an ICU. In the United States, RSV is the most frequent reason for hospitalization in a child’s first year of life. In some cases, RSV infection in infants is fatal.”
Nirsevimab, sold under the brand name Beyfortus, has been shown to reduce the risk of medically attended cases of RSV in infants by 75% in clinical trials.
DPH and MHA called for “effective and equitable” distribution of the drug, which will require “concerted effort and coordination” across the entire healthcare system so that infants are able to gain access to the drug from all care settings. To that end, DPH and MHA urged birthing hospitals and centers to add nirsevimab to inpatient/hospital pharmacies to administer to newborns during their birth admission, and to create clinical pathways and protocols so that nirsevimab immunization is routinely administered at birth along with the hepatitis B vaccine. The letter also urges hospitals to ensure that they are enrolled in the State Vaccine/Vaccine for Children programs. As of October 2, nirsevimab has been added to the State Vaccine Program formulary. Those enrolled in the vaccine programs can order nirsevimab doses for babies born at the facility at no additional cost.
“We ask hospitals with maternal newborn services to take urgent and decisive actions so that the roll-out of this vaccine is a success,” Goldstein and Walsh wrote.
Novavax’s New COVID-19 Formulation Gets FDA OK
The Food and Drug Administration has issued an emergency use authorization for the latest version of the Novavax COVID-19 vaccine. Unlike the Pfizer and Moderna vaccines, the updated Novavax vaccine is not an mRNA formulation.
The 2023-24 formulation of the Novavax COVID-19 is authorized for use in individuals, age 12 and over, who have been previously vaccinated with any COVID-19 vaccine. These individuals receive one dose.
Individuals not previously vaccinated with any COVID-19 vaccine receive two doses three weeks apart.
Immunocompromised individuals can get an additional dose of the Novavax vaccine at least 2 months following the last dose of it, and they can get additional doses after that “at the discretion of the healthcare provider, taking into consideration the individual’s clinical circumstances,” according to the FDA.
Administrative Costs Key Factor in U.S. Health Expenditures
Why is healthcare spending in the United States higher than in other countries?
A new study from the Commonwealth Fund analyzed existing studies and new Organisation for Economic Co-operation and Development (OECD) data to pinpoint how the U.S. differs from 12 comparable countries. And it found that the main factor for the higher spending trends here was administrative waste.
“We estimate that higher administrative costs associated with health insurance — for example, those related to eligibility, coding, submission, and rework — represent approximately 15 percent of excess U.S. health spending,” according to the report. “Higher administrative burden on providers — for example, general administration, human resources, and quality reporting and accreditation — represents an additional 15 percent of the excess. This makes administrative complexity the single biggest component of excess U.S. spending estimated in this study. The large impact of administrative costs is consistent with previous research that found 39 percent of the difference between U.S. and Canadian spending on hospital and physician care was administration.”
Doctors and nurses in the U.S. earn more than in other countries, and higher drug costs in the U.S. were responsible for a 10% share of excess spending. Other factors, according to the report, relate to the utilization of care in the U.S. While the United States population is not older than the other nations in the comparison, people here are sicker “in ways that may increase the intensity of care required,” including higher rates of obesity, diabetes, and heart disease, and a larger share of the population with multiple chronic conditions.
Support for Violence Prevention Legislation
Christi Barney (pictured), a registered nurse who is V.P. of Quality and Patient Safety and Chief Health Equity Officer at Emerson Hospital, testified before the Joint Committee on Public Safety and Homeland Security last Wednesday on MHA’s priority violence prevention legislation. Barney is also a member of MHA’s Health Safety & Violence Prevention Workgroup.
H.2381/S.1538, An Act Requiring Healthcare Facilities to Develop & Implement Programs to Prevent Workplace Violence, from Rep. Mike Moran (D-Boston) and Sen. Jason Lewis (D-Winchester), would support the development of statewide workplace safety standards in a collaborative framework with stakeholder organizations from hospital, workforce, and behavioral health communities under the joint oversight of DPH and the Office of Health Equity.
The legislation would also convene a group of state government, public safety, and healthcare interests to examine the expansion of appropriate treatment and placement options for state agency-involved, criminal justice-involved, and complex behavioral health patients.
“While meeting the most basic needs for our patients: a warm meal, a clean room, a safe environment—[hospital] workers are often in harm’s way,” Barney said. “…Healthcare workers in all roles are not able to fully care for patients when part of their energy is directed to protecting themselves.”
Also presenting supporting testimony for the Moran and Lewis bills were MHA’s V.P. of Clinical Affairs Patricia Noga, R.N., as well as representatives from the Massachusetts Emergency Nurses Association and the Massachusetts College of Emergency Physicians.
Fellowship in Minority Health Policy
The Commonwealth Fund Fellowship in Minority Health Policy at Harvard University – a one year, degree-granting, full-time fellowship – is accepting applications through December 1. The fellowship is designed to prepare physicians, particularly physicians from groups underrepresented in medicine, “to become leaders who improve the health of disadvantaged and vulnerable populations through transforming healthcare delivery systems and promoting innovation in policies, practices and programs that address health equity and the social determinants of health.” Up to five fellowships will be awarded per year. Each fellowship provides an $80,000 stipend, full tuition, individual health insurance, books, travel, and related program expenses, including financial assistance for a practicum project.
Globe Editorial Gets it Right
The Boston Globe last Monday ran a lengthy editorial that bears attention for those who have not yet seen it. Patients in hallways, long waits for beds: Hospital bottlenecks reach crisis levels details the throughput crisis that MHA and its membership has been stressing throughout the pandemic.
“The Massachusetts Health & Hospital Association issued a June 2023 report, which found that between March 2022 and February 2023, 50 hospitals reported an average of 1,057 medical-surgical patients awaiting discharge at any one time, leaving 1 in 7 acute medical beds tied up with someone who did not need to be there. A majority were seeking admission to skilled nursing facilities. The most common reason cited for delays, according to the MHA report, is administrative barriers from private insurance companies. Insurers who need to approve a transfer would delay responding or deny a request.”
Staffing shortage in the post-acute care sector and the lack of guardians or health care proxies for patients incapable of making decisions are the other main reasons for the backups.
The Globe editorial details a series of solutions that MHA has offered, including a review of insurer prior authorization policies.
“Entering the respiratory illness season when hospitalizations spike, doing everything possible to move patients out of hospitals quickly will be vital to ensure hospitals have capacity to care for the sickest people,” the editorial reads.