INSIDE THE ISSUE
With PHE Ending, Need for Flexibilities Remains
Last Monday, the Biden Administration announced that the national Public Health Emergency (PHE), first declared in January 2020 and renewed every 90 days since then, will end on May 11, 2023. Also ending that day is the COVID-19 national emergency declaration issued in March 2020.
The PHE allowed the federal government to waive a number of administrative rules within the Medicare and Medicaid programs, and through the regulatory agencies, to allow a quicker, more flexible response to the pandemic. Many of the payment and financing strategies constructed during the pandemic through such legislation as the American Rescue Plan Act (ARPA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act, among others, had provisions within them tied to the PHE.
The Biden Administration had always said it would give at least 60-days’ notice before ending the PHE to allow for a wind-down of the many moving parts involved in the pandemic response. However, the Republican-controlled U.S. House last Tuesday, a day after the administration announcement, passed The Pandemic is Over Act that is intended to end the PHE immediately. The Senate is not expected to take up the measure and the Office of Management and Budget said hospitals and nursing homes “will be plunged into chaos” by such legislation.
In Massachusetts, MHA and other healthcare interests have been working to assess what pandemic-era flexibilities have been successful and how to codify the innovations as the PHE ends. Such issues include payment parity for telehealth, prescribing controlled substances through telehealth without an in-person examination, and permitting use of alternative spaces within healthcare facilities to quickly assist facilities during patient surges.
The state already has passed regulations that, post-PHE, will allow a broader pool of professionals to administer vaccines, and expedite the licensing process for clinicians, including, physicians, nurses, physician assistants, and respiratory care providers. And the federal government plans through pending rulemaking to remove the requirement that patients have an in-person appointment before being prescribed buprenorphine via telehealth, and to make permanent an increase in the amount of “take-home” methadone a patient can receive – easing access to these lifesaving medications and a direct result of knowledge gained during the pandemic.
“The waivers and flexibilities made possible by the PHE – including those relating to COVID-19 treatment, insurance coverage, and telehealth – were a critical part of our pandemic response,” said MHA’s Senior Vice President and General Counsel Mike Sroczynski. “And they have become an essential tool in addressing the capacity and workforce crises that have emerged in the time since. Fortunately, several of the state-level flexibilities put into place during the height of the pandemic have already been extended thanks to the actions of local leaders.”
Sroczynski said going forward it will be important to grasp how the end of the PHE will affect those priorities that accelerate patient access to needed care. “We’ll be collaborating closely with state officials and our federal delegation to ensure that Massachusetts is set up for success,” he said.
As Session Opens, MHA Prioritizes Enhanced Violence Protection Bill
Of the 6,200-plus bills filed this 2023-2024 legislative session at the State House, MHA has secured sponsorship for 33 bills, many of which were filed as both House and Senate proposals. The bills focus on specific measures within the broad categories of data, oversight, finance, clinical affairs, patient access, equity, administrative simplification, workforce, behavioral health, and transportation.
Among other actions, the bill requires the Department of Public Health (DPH) to issue statewide standards for evaluating and addressing known security risks at healthcare facilities. Based on those measures, hospitals would be required to develop a workplace violence prevention plan, submit the plan to DPH, and report each on-site instance of assault and battery, workplace violence, and aggravated and non-aggravated interference with the conduct of a healthcare facility. Any employee who is a victim of assault and battery or aggravated interference can take paid leave to address criminal or other legal action, thereby ensuring protections for the worker’s sick and vacation time. To further protect workers, the bill amends the criminal justice statute to allow an employee that is a victim of violence to provide the address of their employer or their labor union – not their home address – for any subsequent legal communications. The bill increases penalties for those, of sound mind and with intention, who attempt to, or actually, harm a healthcare provider; and it tasks state agencies with developing recommendations to improve information sharing between hospitals and public safety officials, expanding state-run treatment and placement options for patients in mental health crisis exhibiting violent behavior, and establishing new pathways to trigger the forensic behavioral health system that do not require a patient to be arrested.
MHA’s violence protection bill follows the release last month of the association’s report: Workplace Violence at Massachusetts Healthcare Facilities: An Untenable Situation & A Call to Protect the Workforce, which detailed the prevalence of violence at healthcare facilities and the measures being taken to prevent them. With the release of the report, MHA’s Board of Trustees endorsed the United Code of Conduct Principles within it, which include measures to promote a safe and respectful environment and consequences for violations.
FOCUS ON WORKFORCE:
Hospital-Univ. Partnership Allows Newton-Wellesley to Fill OR Positions
Surgical technologists – sometimes known as “scrubs” – are an extraordinarily important part of the operating room team. They oversee all instruments used during a procedure, enforce strict aseptic principles, and help ensure that everything that goes into a patient – sponges, clips, instruments – are removed before the patient is closed. When a surgeon says, “Retractor!” with palm outstretched, it’s usually the surgical tech that places the instrument in his or her hand. Surgical techs have to be nimble to adapt quickly to rapidly changing situations within the OR – and they must be flexible in terms of scheduling.
And here’s another fact about surgical techs: there’s a dramatic shortage of them in Massachusetts. To address the workforce shortage, Newton-Wellesley Hospital has partnered with Lasell University for an innovative education-training program.
Read the rest of the story about Newton-Wellesley Hospital’s workforce strategy, as well as workplace stories from other providers throughout the state, by visiting MHA’s Workforce Toolkit.
Federal Grant Money Available to Build Nursing Workforce
The Health Resources and Services Administration’s (HRSA’s) Bureau of Health Workforce sent notice last week of forecasted FY23 nursing workforce programs. These are grants that are open and available, and include:
- Advanced Nursing Education Nurse Practitioner Residency and Fellowship Program: $30 million available to prepare new advanced practice registered nurses to effectively provide primary care by supporting the establishment, expansion, and/or enhancement of existing community-based nurse practitioner residency and fellowship training programs.
- Nurse Education, Practice, Quality and Retention-Pathway to Registered Nurse Program: $8.9 million available to strengthen nursing workforce capacity to improve access to care and health equity through the development and implementation of bridge programs.
Other grants are available for the Advanced Nursing Education Workforce Program, the Nurse Faculty Loan Program, and the Nurse Anesthetist Training Program.
AONL Study Focuses on Nursing Leadership
The American Organization for Nursing Leadership (AONL) has released part two of its three-part study on the nursing workforce. Part two focuses on nursing leadership and a positive practice environment; the report’s part one focused on recruiting and retaining nurses.
“From day one, the nurse manager is expected to provide operational oversight for multiple individuals who provide direct care, ensure positive patient outcomes and experience, and manage finances while engaging the nurse workforce,” AONL writes in the 20-page report that distills its research on leadership best practices and provides exemplars of its findings. “Given the complex role expected of nurse managers, support from the organization, interdisciplinary team members, peers and those they supervise is essential.”