Question 1 Defeated; Focus Returns to Host of Issues

Question 1 Defeated; Focus Returns to Host of Issues

By a 70-30 vote, Massachusetts communities in last week’s election rejected ballot Question 1’s rigid, unit-by-unit, patient-to-nurse ratios that would have been imposed on all hospitals at all times.

In polls, exit interviews, and through anecdotal feedback, many voters indicated they heard nurses’ concerns that they are often asked to perform their caring jobs under very demanding conditions. But voters, often relying on their RN friends or relatives for Question 1 advice – and realizing that many nurses were opposed to the question – felt that determining hospital care through a popular vote was the wrong prescription for change. They voted NO against a ballot question they knew would be expensive to implement with no clear evidence that the change would improve care.

MHA’s President & CEO Steve Walsh, who began his post at MHA last November and has been focused on coordinating the healthcare community’s response to Question 1, said, “The voters of Massachusetts voted to protect patient safety and support the best healthcare and hospital system in the country. This is not a victory, but an opportunity to continue to find solutions together as health care professionals -- working together, as one, for patients. Question 1 forced some difficult and necessary discussions about the future of healthcare and the future of our workforce going forward. These conversations with our care teams and in our communities have been critically important and will continue in bargaining sessions, legislative debates, board rooms, and newspapers. MHA will play a key role in these conversations, and our members will continue to rely on us to protect the nation’s best healthcare system.”

Question 3, which upheld a state law protecting transgendered rights and which MHA strongly supported, also won a very wide margin.

Now that the focus on Question 1 has abated, MHA will redouble its efforts on a series of topics that staff have continued addressing despite the political turmoil: substance use disorders; Alzheimer’s and dementia care protocols for caregivers; the state’s innovative MassHealth ACO program and new hospital MassHealth RFA contract; federal strategies to maintain provisions of the Affordable Care Act; strategies to lower infection and readmission rates; a statewide Healthcare Safety Summit on December 4; reforms to dual-eligible programs;  workforce safety and wellness initiatives; and promoting a Caring for the Caregiver initiative – among many, many other patient-focused issues to which MHA and its membership are committed.

Rep. Neal in New Post Says the Focus is Healthcare

While much attention was focused on Question 1 in, other developments in the national political scene could greatly affect Massachusetts healthcare.

Now that Democrats have regained control of the U.S. House of Representatives, Massachusetts Rep. Richard Neal (D) will become chairman of the powerful Ways & Means Committee through which all legislation dealing with taxes, trade, healthcare, and Social Security, among other topics, flows.

"It's pretty clear that the most important issue last night was the issue of healthcare," Neal said last Wednesday in a post-election news conference. "And I want to say that at the Ways and Means Committee, that will be the priority issue that we bring up — ensuring and defending the idea that people who are born with an ailment are not wrongfully treated because of a pre-existing condition. We intend to enshrine the principle of pre-existing condition as a guarantee of our national network through the [Affordable Care Act].”

He stated, “I will be unyielding in defense of Social Security, Medicare and Medicaid,” noting that many Massachusetts hospitals – he specifically mentioned Holyoke Hospital and Berkshire Medical Center, which he referred to as a “jewel” – get the majority of their funding from Medicare and MassHealth. Neal also said he hopes he is able to work with the administration on lowering prescription drug pricing.

Another important Congressional development for Massachusetts is the likelihood of Rep. James McGovern (D) being appointed chairman of the House Rules Committee, which decides how or if legislation can be debated or changed when it comes to the House floor.

Lawrence General Looking Beyond its Walls to Improve Care

The American Hospital Association’s “Value Initiative” program has a great write-up of a successful program Lawrence General Hospital is operating to help its communities fight obesity and resultant health problems.

The “Healthy on the Block” program came about because Lawrence, which is predominantly Latino, has only one full-service grocery store, many of its residents lack transportation access to it, and so they get most of their staples from small convenience stores, or bodegas.

“In 2014, Lawrence General Hospital leaders joined the city’s Mayor’s Health Task Force to discuss how to allocate the hospital’s $2.5 million community benefit fund,” AHA writes. “The neighborhoods in Lawrence are like cultural pods in which people can meet all of their basic needs on foot within a two-block radius. The group decided that they might have the most impact by working with the neighborhood bodegas, which are not only a food resource, but are often the hub of the community.” Healthy on the Block provides “a one-time capital investment to set up refrigeration systems in bodegas so that produce and other healthy foods can be stored properly. Bodega owners are also advised on ways to display and label healthy food options so they are more appealing to customers.”

In the future, the Task Force hopes to track how much produce each bodega sells and then track diabetes rates around certain bodegas to see if the program is working as well as intended.

“Our work as a health care provider is to look beyond our four walls and redefine what it means to be a hospital,” says Dianne Anderson, R.N., Lawrence General’s president and CEO. “Keeping people healthy is the best outcome we can hope for.”

MHA Safety Summit Set for Tuesday, Dec. 4

Details are quickly coming together for the important MHA 2018 Healthcare Safety Summit at MHA’s Conference Center in Burlington on Tuesday, Dec. 4 from 8 a.m. to 3 p.m.

The program is designed for security and safety personnel and those in risk management, healthcare quality, human resources, nursing, public affairs, and employee assistance programs, among others.

The caregiving professions are profoundly difficult jobs, taking an emotional and spiritual toll on the healthcare workforce. And hospital jobs can be dangerous as well, as nurses and others face environmental risks, violent attacks from the public, and conflict.

Panel discussions at the summit include a focus on current trends and types of healthcare conflict; preventive methodologies for mitigating/reducing healthcare violence and conflict; and how to acknowledge the valued contributions of hospital staff and support them with resources to enhance the safety of their work environment and wellbeing.

More details will follow, but register here today to reserve a seat.

New Guidance on Dispensing Tranquilizers

DPH recently released a notice outlining new requirements for providers prescribing benzodiazepines, which are tranquilizers such as Valium, Xanax, or Halcion. In the past, prescribers were required to check MassPAT (the commonwealth’s prescription monitoring program) before issuing benzodiazepine to a patient for the first time. The new directive requires prescribers to check MassPAT before every prescription for a benzodiazepine. DPH also suggests clinicians consider prescribing naloxone to patients they are prescribing benzodiazepine.

Communication and Resolution Following Medical Errors

MHA is a founding participant of the Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI). This group of providers, patient advocates, insurers, and others believes in sincere apologies and fair compensation in cases of avoidable medical harm. The approach is called Communication, Apology, and Resolution (CARe) and not only is it ethically correct but it supports caregiver learning and improvement that leads to greater patient safety. More information about the CARe model and MACRMI can be found at www.macrmi.info.

Now a new study published in Health Affairs by researchers from Brigham and Women’s Hospital, Baystate Medical Center, Beth Israel Deaconess Medical Center, Stanford University, and Ariadne Labs finds that the CARe communication-and-resolution program instituted at select Massachusetts hospitals did not expand liability risk at any of the test sites.  Currently 11 Massachusetts hospitals and a physician practice use the CARe model.

“The program allowed these organizations to fulfill their ethical obligations to disclose adverse events and promote patient safety without encountering negative liability consequences,” the researchers wrote.  Free access to the study is here.

WEBINAR: Riding the Disruption Wave in Healthcare

In today’s fast-paced technology marketplace, healthcare organizations have three options: deny change, get bigger, or “get different.” Just in the last few months, news headlines have heralded huge disruptive changes in the healthcare space – from Amazon teaming up with Berkshire Hathaway and JPMorgan Chase to form a healthcare company headed by Atul Gawande, MD; to speculation of a Walmart-Humana deal; to tech behemoth Apple launching its Health Records platform. With continued vertical integrations, mergers and acquisitions, and big tech companies making healthcare moves, what does this mean for the future of healthcare? Is there an upside to disruption for industry stakeholders? What should hospital leaders focus on to find a sound strategy through these chaotic and industry-changing times? Join Apurv Gupta, MD, adjunct senior lecturer, Healthcare Leadership, Brown University for this insightful webinar on Thursday, Dec. 4 from 1 to 2:30 p.m. Learn more info and registration details by clicking here.

John LoDico, Editor