Massachusetts Health & Hospital Association Policies Change as Pressure Builds
INSIDE THE ISSUE
> Overwhelmed Hospitals
> Easing the Burden on EDs
> Hospital at Home
> Tracking the Flu
> School Lunches and Health
> Assisting with Pediatric Boarders
> Transition
MONDAY REPORT
State Works With Hospitals to Institute Flexibilities
As the pandemic continues to worsen in Massachusetts, stressing the hospital and healthcare system, the Baker Administration undertook a series of steps to ease the burden on providers.
DPH issued a memorandum on January 5 allowing hospitals to restrict patient visitors to one at a time and urging them to restrict any non-essential personnel who do not provide direct patient care from entering the facility. DPH also allowed hospitals to “post signage at the [emergency department] that informs the public that routine COVID-19 testing of asymptomatic individuals is not performed at the ED and directs patients to the available alternate locations for routine COVID-19 testing.” The DPH directive also provides greater flexibility to hospitals when discharging and transferring patients, in an attempt to allow expedited movement of patients across care settings.
In another effort to assist hospitals in moving patients from acute care hospitals to nursing facilities, chronic disease hospitals, and rehabilitation hospitals, the state’s MassHealth program stressed to hospitals the availability of MassHealth’s Hospital Presumptive Eligibility (HPE) process for expediting transfers. The HPE allows for provisional MassHealth coverage of services prior to submitting a full MassHealth application.
MHA served as a conduit between state government and the beleaguered healthcare community, helping to devise the strategies that are needed to provide assistance as the Omicron variant surges along with increases in flu cases.
“We are in the midst of the most daunting stretch our healthcare system has ever experienced,” said MHA President & CEO Steve Walsh. “We are grateful for these actions the Baker Administration has taken to help support our hospitals and health systems in what has been an extraordinarily challenging start to the new year.”
Another line of assistance was offered by four hospitals leaders, who wrote an op-ed in the region’s largest newspaper – the Boston Globe. Michael Dandorph, president and CEO of Wellforce; Dr. Anne Klibanski, president and CEO of Mass General Brigham; Dr. Kevin Tabb, president and CEO of Beth Israel Lahey Health; and Kate Walsh, president and CEO of Boston Medical Center, wrote, “Those of us in healthcare have done our part — and more. But we can’t do it alone. Public health requires, well, the public to do their part. As much as we believe in the power of individual choice, there are times that require individual action for the common good. This is one of those times, and the public can take actions that are simple (even if they aren’t easy) and effective.”
As healthcare leaders across the state echoed a similar message, MHA’s Walsh said, “Healthcare providers are doing everything in their power to get the commonwealth back on track, but it simply will not be possible without action from the general public. We are issuing a plea for everyone in Massachusetts to get vaccinated and boosted, to mask at all times when in public, and to use EDs for emergency situations only.”
An Effort to Ease the Burden on EDs
Acute care hospitals are urging patients not to show up in their emergency departments to be tested for COVID-19, given that EDs are at capacity and must direct resources to patients in immediate need of medical attention. Many systems are amplifying the message through direct e-mails to patients, social media posts, and engagement with the news media.
The Massachusetts College of Emergency Physicians and Massachusetts Emergency Nurses Association issued a notice, declaring in bold letters: “We are overwhelmed.” The groups wrote, “Let us be clear, we do not want you to ignore your symptoms or avoid emergency care when needed. You will be safely cared for despite the growing volume of patients with COVID-19. However, we ask you NOT to use Emergency Departments for routine testing for COVID-19 exposures or mild symptoms. Doing so is overwhelming our departments and staff and diverting our focus away from those who need us most.”
Last week, MHA assisted its membership in promoting the message through social media channels, while pointing community members to the other testing sites available in their area.
DOI Gives a 90-Day Boost to Hospital at Home Programs
In an effort to get the health insurance industry more involved with the COVID-19 response, the state’s Division of Insurance issued its first bulletin of the year, directing the insurers to authorize – and reimburse – Acute Hospital Care at Home programs.
Such programs, organized under federal guidelines, allow hospitals to provide certain medical procedures outside of the hospital walls. DOI told the health insurance companies that for the next 90 days they are to reimburse the programs at a level that is no less than the Medicare rate of reimbursement as they negotiate facility-specific rates of reimbursement that may apply following the end of the 90-day period.
The state has released a toolkit with pre-made marketing materials to help spread the word about the help line and Community Behavioral Health Centers. There are posters, brochures, and palm cards in 14 languages available free of charge, for distribution in waiting rooms or other patient-facing areas. Here is the order form for the materials.
Influenza Rates
As the healthcare system keeps close track of COVID-19 cases, it is also watching the trend line of influenza activity in Massachusetts. The overall influenza rate in Massachusetts (based on weekly reporting by sentinel provider sites and posted by DPH) is “moderate.” While the most recent week’s data showed more flu cases than the previous three seasons in the same week, the percentage of influenza-associated hospitalizations is comparable to previous seasons.
Testifying in Favor of Free School Meals
Last Tuesday, MHA testified before the Massachusetts legislature’s Joint Committee on Education in support of H.714/S.314, An Act Relative to Universal School Meals, sponsored by Rep. Andres X. Vargas (D) and Sen. Sal N. DiDomenico (D).
The bill would require all schools to make breakfast and lunch available at no charge to each attending student. The cost would be reimbursed through federal funds and, if those funds are not available, funding would be borne by the state’s Department of Elementary and Secondary Education.
In testimony to the joint committee, MHA’s Manager of State Government Affairs Allie Cataldo said, “Over the last several years, the healthcare sector has taken a closer look at population health management in an effort to improve patient outcomes by addressing the various social determinants of health of individuals and their families. Food insecurity is the social determinant that has a particularly extensive effect on the overall health of an individual. Universal school meals also have the capacity to address a major underlying issue within food security, which is nutrition security.”
She added, “As you all are aware, the healthcare sector’s resources have been stretched thin over the last two years. Building an equitable response to food and nutrition insecurity requires stakeholder collaboration and partnerships. Our sector has a significant role to play in this work, and MHA and its members are committed to working with organizations like Project Bread to ensure all students have access to free school meals so that these disparities and their health effects don’t extend throughout adulthood.”
New Resource Guide Addresses Pediatric ED Psychiatric Boarding
Since the onset of the COVID-19 pandemic, the number of children and adolescents awaiting inpatient psychiatric placement has increased dramatically and the number of days youths remain in emergency departments (EDs) awaiting an inpatient psychiatric admission or other services has also increased. As the story below shows, at one point last week there were 85 pediatric patients boarding in hospital EDs.
In response to the growing problem, a working group of ED and behavioral health experts from MHA members and the Parent and Professional Advocacy League has developed this resource guide of best practices that organizations can implement when working with pediatric patients and their families or caretakers during psychiatric boarding in the ED. The recommendations are intended to be advisory in nature. Individual hospitals may have different practices that meet the special needs of pediatric patients requiring psychiatric care. In addition to the best practice recommendations for providers, this document also includes contact information for outside support and resources for children and caregivers while their child boards.
Transition
Jacob Krilovich is the new executive director of the Home Care Alliance of Massachusetts, replacing Patricia Kelleher, who retired on December 31, 2021, after leading the Alliance for 26 years. Krilovich was previously director of legislative and public affairs for the Alliance. Prior to joining the Alliance in 2017, he was director of advocacy for the National Multiple Sclerosis Society, Greater New England Chapter. Krilovich holds a BA in Political Science from the University of Massachusetts, Amherst.