INSIDE THE ISSUE
Transportation: An Often Overlooked, but Essential, Element of Healthcare
Getting patients to and from care is an important component of the healthcare system. Access to appropriate and timely patient transport has long been challenging for MHA members, even before the COVID-19 pandemic, which exacerbated the issue. Members report that it has become increasingly difficult – and sometimes impossible – to secure healthcare transportation services, especially for non-emergent patients. Lack of transportation options for patients, specifically in rural parts of the state, is one reason why the rise in telehealth has been so important, as it ensures those people can communicate with their caregivers. Lower-income people who don’t have a car and can’t easily afford to pay for Uber or a cab often miss follow-up appointments. The much-reported troubles of the state’s public transit system affect the ability of patients and many healthcare workers from getting to their appointments and jobs on time.
Perhaps the greatest need for efficient transportation relates to the current capacity problems hospitals are facing. Lack of reliable transportation is one factor that prevents patients at acute care hospitals that are ready for discharge from being transported to a post-acute facility or even home. The bed occupied by a patient who no longer requires an acute level of care is, in effect being denied to a patient who needs it but either is forgoing care or is boarding in some other part of the hospital. Other issues contributing to the capacity crunch include workforce shortages, insurance prior authorization bottlenecks, and patients lacking a healthcare proxy and care plan (see story below).
MHA has filed two bills in the current legislative session that work to address transportation issues.
H. 1050, An Act to Improve Patient Access to Non-Emergency Medical Transportation, sponsored by Rep. Dan Hunt (D-Boston), requires prior authorization for patient transportation to be valid for three business days to take into account any transport delays, and also to ensure that emergency medical services (EMS) are adequately reimbursed by MassHealth for non-emergency medical transportation for behavioral health, dialysis, and post-acute care transportation. The bill would address the issue EMS providers face when being offline for hours as they transport a patient to an available bed that can sometimes be across the commonwealth or even state lines. Many hospital-based ambulance providers are absorbing the cost of transporting patients in an effort to ensure non-acute patients can move along the care continuum.
H. 2154, An Act Establishing a Task Force to Study the Sustainability of Emergency Medical Services, from Rep. Bill Driscoll (D-Milton), establishes an EMS task force to ensure the stability of EMS in the commonwealth, and to issue a report and recommendations on ways to ensure that the state’s emergency medical services capabilities are met. Specifically, the bill mirrors Maine legislation to study classifying EMS as an essential service, among other provisions.
Masking: Post-Pandemic Policies
Due to the national COVID-19 Public Health Emergency ending on May 11, the state will be ending the universal masking requirement for all healthcare facilities – including acute and post-acute hospitals, physician offices, community health centers, and others. As such, individual facilities are revisiting their staff and visitor masking policies.
MHA’s Vice President of Clinical Affairs Patricia Noga, R.N., said last week, “Each organization will take the time to construct its own masking policy based directly on local public health trends, the expertise of infectious disease leaders, feedback from frontline workers, and the unique needs of their patient population.” So, hospital units caring for patients who are severely immunocompromised due to cancer or HIV treatment, for example, may require masks while the facility’s masking mandate may be eased in other areas. MHA is seeking universal support from the public on respecting the decisions of each facility. Noga asked the public to remain aware of what their facility decides, to follow the facility’s guidance, and in all instances to treat workers enforcing the policy – whatever it may be – with courtesy.
National Healthcare Decisions Day is April 16
Next Sunday, April 16, is National Healthcare Decisions Day when the public is encouraged to give serious thought to advance care planning. A main step in this process, and one all adults over age 18 should take, is to designate a healthcare agent to make healthcare decisions for you if you are unable to make decisions yourself. Individuals can fill out a two-page health proxy document to designate an agent and outline his or her responsibilities.
This Wednesday, MHA, Honoring Choices Massachusetts, and a coalition of leading healthcare advocacy groups will issue a call to action on advance care planning and issue a toolkit and other materials to spur action.
Also on Wednesday from noon to 12:30, MHA is holding a half-hour webinar entitled A Cross-Continuum Push for Healthcare Decision-Making, featuring Honoring Choices CEO Ellen DiPaola.
FOCUS ON WORKFORCE
Saint Vincent Hospital: Alleviating the Knowledge Gap
One of the biggest challenges in nursing today is the growing knowledge gap. With Massachusetts having some of the oldest nurses in the U.S. and more of them retiring or otherwise leaving the bedside each year, the decades of experience, insight, and institutional knowledge is leaving too, leaving the role of orienting and mentoring newly graduated nurses and nursing students to nurses barely out of school themselves. Where a unit’s nurses previously had many decades of knowledge and experience, that collective knowledge base is now decreasing.
To help maintain the sharing of deep knowledge, Saint Vincent Hospital recently formed a partnership with Assumption College to create a 24-bed dedicated education unit – that is, a clinical setting optimized to provide nursing students and clinicians with a positive learning/teaching environment. Within the unit, nursing students will complete a three-month clinical education rotation practicing nursing on real patients while supervised and mentored by experienced clinical faculty from Assumption College. Beyond learning essential nursing skills, the students will also learn how to teach future new nurse graduates and continue to pass along important knowledge and wisdom – essentially, training the future trainers.
As Jay Prosser, chief nursing officer and Doctor of Nursing at Saint Vincent Hospital explains, “As we look forward to the future of healthcare in America, our best hope for recovery is nursing students. This is why the work of Assumption is so important … As a hospital, we want to ensure that these nurses receive the best education possible coupled with a clinical experience that gives them consistent patient interaction and experience.”
Learn more about Saint Vincent’s program, as well as about other workforce initiatives throughout the state, by visiting MHA’s Workforce Toolkit. Do you have a workforce program that you would like featured in the toolkit? Contact MHA’s Kim Stevenson at email@example.com.
DPH Offers Specific Requirements Relating to Wayfinding
Pursuant to An Act Ensuring Safe Patient Access to Emergency Care, which is known as “Laura’s Law” (Chapter 384 of the Acts of 2020), DPH last June issued regulations requiring that hospitals implement specific physical changes to make it easier for people to find and access emergency departments. The new rules relating to “wayfinding,” lighting, signage and security requirements must be met for a hospital to be licensed in the state. The new requirements must be implemented by January 1, 2024.
Last week, DPH issued a memorandum providing hospital EDs with additional information on the regulatory requirements. Specifically, the memo instructs hospitals to not only provide good lighting and signage but to keep in mind shadows and glare that might prevent people from seeing the markers. “Emergency department entrance lighting should be brighter than other entrances and/or clearly differentiated from other entrances,” DPH wrote, and signs directing patients must be placed in such a manner “to ensure visual continuity from one sign to the next.” The memo outlines other specific requirements, including the need for hospitals to conduct an annual review of security, wayfinding, signage, and lighting policies and procedures, and mandates that the group reviewing the policies must consist of personnel from multiple departments.
Dr. Robbie Goldstein is the New DPH Commissioner
Robbie Goldstein, M.D. – the current senior policy advisor at the Centers for Disease Control and Prevention, an infectious disease physician at Massachusetts General Hospital, and the medical director of MGH’s Transgender Health Program – is the new Massachusetts Department of Public Health Commissioner, effective Tuesday, April 18.
Health & Human Services Secretary Kate Walsh announced Goldstein’s appointment last week. The DPH Commissioner’s purview is wide, overseeing 18 bureaus and offices. The department has been run by Margret Cooke, who was appointed acting commissioner mid- pandemic in June 2021 and who became full commissioner in February 2022.
Among Goldstein’s initial priorities will be overseeing the transition of the health infrastructure out of the public health emergency. Mike Sroczynski, MHA’s senior vice president and general counsel, said last week of Goldstein’s appointment, “This is a critical time for public health, especially as we continue to address the widespread impacts of the pandemic, accelerate our focus on health equity, and strengthen the foundation of preventative care that keeps patients healthy before they reach hospital doors. Dr. Goldstein’s experience and proven leadership within some of the highest levels of public health make him an outstanding choice to help lead the commonwealth on these priorities.”
Goldstein holds a BS, M.D., and PhD from Tufts University. He completed his residency training in internal medicine at MGH where he served as chief resident.
MassHealth Redeterminations: Flexibility for System CACs
The massive MassHealth redetermination process, affecting more than 1.2 million people, began on April 1. MHA is assisting its membership as they help MassHealth members fill out the necessary paperwork needed for them to continue receiving coverage. Last week MHA was in contact with MassHealth to help resolve a question from hospital systems – namely, can a hospital system Certified Application Counselor serve MassHealth redetermination applications at each of the system’s facilities? MassHealth responded, Yes. The state is urging providers to bring more CACs on board and to use them throughout systems.
CMS’ First Health Equity Conference, June 7-8
The Centers for Medicare & Medicaid Services’ inaugural Health Equity Conference on Wednesday and Thursday, June 7-8 at Howard University in Washington, D.C. is already booked solid for on-site participation. But registrants can join an in-person waitlist and still participate virtually by clicking here. The call for proposals is now open. Academics, researchers, community organizations, and others are encouraged to submit presentation proposals by Friday, April 14. Learn more here.
Baystate Health and Lifepoint Behavioral Health have announced that Roy Sasenaraine has been named CEO for the new joint venture behavioral health hospital currently under construction in Holyoke. The 150-bed hospital, to be called Valley Springs Behavioral Health Hospital, is slated to open in August. Most recently, Sasenaraine served as VP of Operations for the central region of Spire Orthopedic Partners. Prior to that, he was VP of Operations for Hartford Healthcare System’s behavioral health network. Sasenaraine has a bachelor’s in healthcare administration and an MBA, with a focus in healthcare administration, from Quinnipiac University.