Massachusetts Health & Hospital Association Healthcare System “Gasping for Air”
INSIDE THE ISSUE
> System in Crisis
> Respecting Care Workers
> Biased Kidney Care
> Tracking the Flu
> Serious Respiratory Care
> Nurse Staffing Agencies
MONDAY REPORT
Healthcare System “Gasping for Air”
Massachusetts hospital leaders issued their most urgent message to the public last week, declaring that “every corner of our healthcare system is gasping for air.”
“As scary as things may have been for providers in the early days of COVID, things are now much worse,” said Dr. Eric Dickson, president & CEO of UMass Memorial Healthcare and chair of MHA’s Board of Trustees. Dr. Mark Keroack, president & CEO of Baystate Health, said, “We fear that people will not grasp the magnitude of this situation until they are the ones in need of care and bear witness to it up-close.”
Their concerns were echoed by Christine Schuster, president & CEO of Emerson Hospital, who said, “To our community members, now is the time to act. Now is the time to put our heads down and do all the things that providers and state leaders are asking for.” Michael Dandorph, president & CEO of Wellforce, added, “Providers and state leaders continue to work as one and to do everything in their power to be here when you need us. But these measures are simply not sustainable if they are not supported by public action.”
The healthcare leaders asked the public to take just a few simple steps:
- Mask at all times when in public;
- Avoid emergency rooms for routine testing or for mild COVID-19 symptoms; and
- Get vaccinated and boosted as soon as you are eligible.
“We need to turn this around in a matter of days, not a matter of weeks,” said MHA President & CEO Steve Walsh. “We are counting on the people of the commonwealth to take this message seriously and help lift our providers up in their greatest time of need. There is nothing our healthcare organizations care about more than being there for their patients and communities.”
Once Heroes, Now Targets of Violence
MHA’s heightened call for public awareness of the pandemic’s destabilizing effect on the healthcare system (see above) contained a plea to: “Provide support and gratitude to the healthcare workers in your life.”
Noting that healthcare workers who are beyond the point of exhaustion, MHA added, “What’s worse, they leave the job to see their sacrifices met with unmasked individuals in supermarkets and other places where Omicron can easily be spread. We must continue to fuel their hope through the decisions we make every day.”
Massachusetts hospitals have reported anecdotally in the past few months what healthcare facilities across the U.S. have also detailed – violence and verbal assaults against healthcare workers are increasing. The goodwill that caregivers enjoyed early in the pandemic – the lawn signs, words of praise, expressions of thanks for those wearing scrubs – has dissipated and many people are lashing out at nurses, doctors, and assistive personnel in hospitals, urgent care centers, physician practices, and other care settings.
MHA continues to champion legislation at the State House that would add new measures to mitigate workplace violence at healthcare facilities, strengthen penalties for violent offenders, and enhance supports for victims of assault.
MHA Education Program Addressed Racial Bias in Kidney Care
MHA’s recent webinar – Deracializing Kidney Diagnoses: Removing Race as a Metric in the eGFR Diagnostic Tool – took an in-depth dive into the issue that had for years introduced racial bias into who received 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. Based on a series of now discredited tests on a small population of Black patients, the medical community factored 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, meant that specialty nephrology care, including kidney transplants, was often deferred for Black individuals because the racially biased eGFR test does not a give a true indication of their health. The issue gained prominence in the healthcare community last year and led to changes in kidney care nationally.
MHA’s one-hour webinar, held in conjunction with the Massachusetts Medical Society and the Attorney General’s Office is available here.
MHA Forms Workgroup, Schedules Webinar to Help Solve mAb Puzzle
Monoclonal antibody (mAb) infusion therapy can help individuals with mild-to-moderate COVID-19, who do not require hospitalization. But the two of the most widely used mAbs – casirivimab/imdevimab and bamlanivimab/etesivimab – are not effective against the prevalent Omicron variant.
Sotrovimab is the preferred mAb product for treatment of COVID-19 when Omicron is present but sotrovimab is in very limited supply, as are the oral and IV antivirals used to treat mild-to-moderate COVID-19. The state is limiting their distribution to a subset of hospitals, state supported sites, and community health centers. Last week, the Massachusetts Department of Public Health issued this guidance on the use of outpatient therapeutics.
Now, MHA has assembled a workgroup to assist the healthcare community keep abreast of developments in the monoclonal antibody space and to provide best practices for their use. The group held its first meeting last Friday and is being led by MHA’s Vice President, Clinical Integration Steven Defossez, M.D., and Vice President of Clinical Affairs Patricia Noga, R.N. During the initial meeting, doctors from the state’s Department of Public Health reviewed the latest therapeutic guidance with more than 100 clinicians from Massachusetts healthcare organizations.
In addition, on Wednesday from 3 to 4 p.m., MHA is holding a webinar entitled New Antiviral Medications for COVID-19: What Massachusetts Clinicians Need-to-Know about Prescribing and Access. The webinar will feature discussion from Rajesh Gandhi, M.D., from Massachusetts General Hospital; and Drs. Larry Madoff and Dylan Tierney from DPH. Register here.
Boston MedFlight Offers VV ECMO Help
Patients with life-threatening respiratory failure in need of highly specialized care will benefit from a new agreement between Boston MedFlight, in partnership with the Conference of Boston Teaching Hospitals (COBTH) and MHA.
Community hospitals can now call Boston MedFlight’s Communications Center and complete an intake form to request help with patients who need adult venovenous extracorporeal membrane oxygenation (VV ECMO) care. VV ECMO is a temporary mechanical assistance device that allows for prolonged cardiopulmonary support. It is used with patients who have potentially reversible forms of respiratory failure and as a bridge to lung transplantation for suitable candidates with irreversible disease.
Once a request is received, Boston MedFlight will begin the process of contacting adult VV ECMO providers in Massachusetts to identify a tertiary hospital that is able to accept the patient. Boston MedFlight will then connect the requesting hospital with the tertiary receiving hospital and will assist with transport if needed. Participating hospitals include Baystate Medical Center, Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Massachusetts General Hospital, Tufts Medical Center, Lahey Hospital and Medical Center, Steward St. Elizabeth’s Medical Center. The service is for adult patients only. Pediatric patients will continue to be routed directly to Massachusetts pediatric ECMO providers, including Boston Children’s Hospital and Massachusetts General Hospital for Children.
Calling on the White House for Help With Inflated Agency Pricing
MHA is reaching out to the state’s Congressional delegation urging its members to sign a letter to the White House that calls for oversight of potential anti-competitive practices by some nurse staffing agencies.
The letter to Jeffrey Zients, the White House’s COVID-19 Response Team Coordinator, notes that the pandemic’s strain on the healthcare system “has required many hospitals to rely on nurse-staffing agencies to supply urgently needed staff to care for the increasing number of patients.”
“We are writing because of our concerns that certain nurse-staffing agencies are taking advantage of these difficult circumstances to increase their profits at the expense of patients and the hospitals that treat them,” the letter reads. “We urge you to enlist one or more of the federal agencies with competition and consumer protection authority to investigate this conduct to determine if it is the product of anticompetitive activity and/or violates consumer protection laws.”
To date, Representatives James McGovern, Seth Moulton, Ayanna Pressley, and Jake Auchincloss have signed on.