Opioids: A Step Forward in D.C., a Potential Step Back in Mass.

The opioid crisis is of such great national importance that a usually fractious U.S. Congress came together last week to reach agreement on the bipartisan “SUPPORT for Patients and Communities Act.” Last Friday, the House voted 393 to 8 to pass the bill; the Senate is expected to vote sometime in the next two weeks before sending the package to the president. 

The 660-page bill makes numerous changes to the Medicaid and Medicare programs and the operations of many federal agencies to put in place new policies to deal with substance use disorder. The bill contains everything from ensuring that Medicare beneficiaries can receive treatment in a community setting, to requiring hospitals to develop protocols on how to discharge patients who have presented with an opioid overdose.

In Massachusetts, where the healthcare community and state government have begun to achieve success in combating opioid use disorder, optimism over the federal bill has been mixed with concern over an impending threat to the commonwealth’s entire behavioral health system.

Question 1 on the November ballot would impose government mandated ratios on all units of every hospital in the state – at all times. All hospitals includes acute psychiatric hospitals and acute care specialty hospitals, among others. One such facility, the renowned McLean Hospital in Belmont, issued a statement last week signed by its leadership team across seven divisions, detailing how Question 1 would cost it $10 million annually and “have a negative impact on patient care.”

“Ballot Question 1 seeks to impose rigid nurse-to-patient staffing ratios that we believe would be catastrophic to the already overburdened behavioral health system,” McLean wrote. “If Question 1 passes, McLean, as well all hospitals in Massachusetts, will be affected. Most concerning to us is the severe negative impact it will have on the state’s most vulnerable population—the people we serve every day.”

McLean’s detailed letter was met immediately by a “tweet’ from the Question 1 proponent’s chief spokesperson, who wrote, “you’re saying this bill will cost you $10M … but the bill DOESN’T APPLY TO YOU. How in God’s name is this going to cost you money to implement.” 

But Question 1 does apply specifically to “acute psychiatric hospitals” such as McLean. The nurses union behind Question 1 also has tried to argue incorrectly that the ratio mandate would not apply to rehabilitation hospitals – but it does. Other recent mistruths have involved the union claiming the ratio mandate would be lifted during declared “states of emergency” (it would only be lifted during declared “public health emergencies” of which they have been only four since 1970); and that ratios would be “flexible” (they’re not and must be applied “at all times”). 

“They’ve been trying to move this ratio law through for the past 20 years without success,” said Amanda Stefancyk Oberlies, PhD, R.N., the CEO of the Organization of Nurse Leaders. “Either they don’t understand the excessively restrictive ratios they are attempting to impose or they are being deceptive about the intent of the bill.  Either way is troubling.”

The Massachusetts Association of Behavioral Health Systems recently released a report, confirming McLean’s concerns by showing how Question 1 would result in the loss of 1,000 behavioral health beds in the state. The Massachusetts Association for Mental Health opposes Question 1, as does the Association for Behavioral Healthcare.

Read the entire Question 1 here.
Read McLean’s full statement here.
Read the Coalition to Protect Patient Safety’s response to the union’s deceptive arguments here.
Read the Mass. Association of Behavioral Health System’s report here.