Healthcare Community Unites Against Ratios, and more...

Just About Every Type of Caregiver Opposes Question 1

The Massachusetts physician community thinks that Question 1 on the November 6 ballot – the measure that would impose rigid nurse-to-patient ratios on all hospitals at all times – is a very bad idea.

More than three dozen physician groups, representing thousands of M.D.s who provide primary and specialty care to patients across the state, have joined the Coalition to Protect Patient Safety in opposition to Question 1.  They join the 25,000-member Massachusetts Medical Society in opposing government-mandated ratios.

The physicians, who refer patients to hospitals and conduct care within hospital walls, are, in turn, joined by: Massachusetts Society of Respiratory Care; American Academy of Pediatrics - Massachusetts Chapter; Massachusetts Radiological Society; Massachusetts Orthopaedic Association; and the Massachusetts Society of Anesthesiologists.

Add to those impressive groups these nurses who are opposed to Question 1:
the American Nurses Association – Massachusetts;
Emergency Nurses Association – Greater Boston Chapter;
Academy of Medical-Surgical Nurses;
Organization of Nurse Leaders;
Infusion Nurses Society;
Massachusetts Association of Colleges of Nursing; and
the Western Massachusetts Nursing Collaborative.

The community of caregivers knowledgeable about hospital care urging a No vote in November also includes:
The Massachusetts Society of Health-System Pharmacists, Massachusetts Independent Pharmacists Association, Massachusetts Academy of Dermatology, Massachusetts Society of Pathologists, and the Massachusetts Society of Otolaryngology – Head and Neck Surgery.

The Massachusetts Assisted Living Association (Mass-ALA), which represents 230 assisted living residences in Massachusetts serving more than 10,000 seniors, also thinks Question 1 is the wrong prescription for improving care in the state.

“We are concerned that this ballot measure, which could dramatically reduce the availability of nurses beyond hospitals, would create new barriers to care for residents and erode the gains we have made as a commonwealth in supporting seniors,” said Brian Doherty, president and CEO of Mass-ALA. “If passed, this ballot question would make it more challenging to provide affordable assisted living to seniors who believe our residential model best fits their needs.”

The mental health and substance use disorder community is adamantly opposed to Question 1. The Massachusetts Association for Mental Health opposes Question 1, as does the Association for Behavioral Healthcare and the Massachusetts Association of Behavioral Health Systems – which released a study showing how Question 1 would result in the loss of 1,000 behavioral health beds.

Even the folks who transport patients to hospitals think government-mandated ratios are a bad idea; the Massachusetts Ambulance Association opposes Question 1.

But what about patients? The Parent/Professional Advocacy League – the group that presents the family voice on children’s mental health issues – last week endorsed the effort to defeat Question 1.

Question 1 is supported by one nursing union representing less than 25% of the RNs in the state.

To see a continually updated list of healthcare interests urging a No on Question 1 vote, click here or visit the Coalition webpage here.

Kudos to Lawrence General (and a Caution About Ratios)

Congratulations to Lawrence General Hospital which treated a large influx of patients from the gas explosions that rocked the towns of Lawrence, Andover, and North Andover on September 13.

LGH reported treating 13 patients from the blasts, one of whom was med-flighted to a Boston trauma center. The trauma patient required many staff members to stabilize him for transport. There were already 25 patients in the ED when the first patients began to arrive. A call went out for additional doctors and nurses, and the hospital reported that many “helping hands” showed up on their own to assist.  

Interestingly, if the ratios mandated in the Question 1 ballot question were in place, the surge of patients into its ED would have pushed LGH out of compliance with the ratio law and subjected the hospital to $25,000-per-incident, per-day fines. That’s because the “at all times” ratio law only allows for exemptions in the event of a declared state or national “public health emergency.” Click here for a blog clarifying this stipulation.

Gas explosions, casualties from mass transit accidents, flu outbreaks and other such surges are not enough to trigger lifting of the rigid ratio scheme.

While Governor Baker ultimately declared a “state of emergency” due to the natural gas explosions, that is an entirely different designation than the more rare “public health emergency.” There have been only four public health emergencies in Massachusetts since the 1970s and their declaration involves a drawn-out regulatory process. The last public health emergency was declared by Governor Deval Patrick in 2014 in response to the opioid crisis.

A Federal Opioid Bill Due Soon

Federal legislation to combat opioid use disorder is moving along fairly quickly and may be ready by the end of September.

Last week the U.S. Senate voted 99-1 to support H.R. 6 – the House opioid legislation as amended by the Senate. Sen. Mike Lee (R-Utah) was the only No vote. A conference committee is now resolving differences between the two bills.

Senator Edward Markey (D-Mass.) had two of his priorities included in the Senate bill. The first authorizes the Centers for Disease Control and Prevention to expand its efforts to counter the spread of infectious disease (such as HIV of hepatitis C) caused by injection drug use. The second initiative requires the federal government to benchmark and measure its progress in combatting opioid use disorder.

In other opioid news, the Agency for Healthcare Research and Quality released a report showing that opioid-related hospital stays and emergency department visits for patients 65 and older increased 54% and 100%, respectively, between 2010 and 2015.

While Lawsuits Continue, 340B Stewardship Principles Are Urged

The American Hospital Association last week announced 340B drug program “good stewardship principles.”

The 340B program was created to provide drug discounts to hospitals and clinics serving low-income patients. Under the 340B program, manufacturers of prescription drugs, as a condition of having their outpatient drugs covered through Medicaid, are required to offer 340B hospitals and clinics outpatient drugs at or below a set ceiling price.  The AHA and other hospital groups are contesting a drastic 30% cut to the 340B program that CMS made this year. AHA also filed suit to compel the Trump administration to implement Obama-era regulations to address 340B drug pricing calculations and to impose penalties on drug manufacturers that overcharged providers.

While those cases move forward, AHA released the stewardship guidelines to cover three issues: committing hospitals to annually publish a narrative showing how the 340B program benefits the community; publicly disclosing on an annual basis the savings achieved through 340B; and continuing to conduct internal reviews to ensure each hospital’s 340B program meets the program’s rules. Read the full stewardship document here.

Medical Group Mgt. Assn. Meeting in Boston this Year

The Medical Group Management Association’s annual conference takes place in Boston from Sept. 30 to Oct. 3. There’s still time to attend. Choose from 135+ sessions focusing on the latest best practices and earn up to 15.25 ACHE credit hours. Use promo code LOCAL300 for $300 off a full-conference or two-day registration. Click here to register today.


David L. Longworth, M.D. has been named CEO of Lahey Hospital & Medical Center. Dr. Longworth has served as the interim CEO since April 2018 while also serving as Chief Medical Officer and chair of the Department of Primary Care. Longworth joined Lahey Hospital & Medical Center in July 2015 as the chair of the Department of Primary Care and CMO of the Community Physician Network. Prior to joining Lahey, he spent more than 30 years in leadership positions at Cleveland Clinic and Baystate Medical Center. Dr. Longworth received his undergraduate degree from Williams College, his medical degree from Cornell University, and he completed residency training in internal medicine at the University of California San Francisco, followed by fellowship training in infectious diseases at the combined Beth Israel–Brigham program.

WEBINAR Essentials of ED Facility Reimbursement 2019 Update
Tuesday, November 27; 1-2:30 p.m.

Successful Emergency Department financial performance requires identifying opportunities and avoiding common pitfalls. Join us and position your ED for optimized performance by taking a focused look at the critical areas of ED documentation, revenue capture, and compliance. Learn about the most important and timely 2019 OPPS changes affecting ED facility reimbursement and the evolving Observation Comprehensive APC. Topics covered will include correct E/M level assignment, procedure charge capture, and observation services. Learn more, including registration details, by visiting here.

John LoDico, Editor