Dementia Care Guidance, Big Merger,  and more...

MHA Workgroup Creates Guidance for Dementia Care

The MHA Alzheimer’s and Related Dementias Workgroup – which met from December 2017 through the summer of 2018 – has developed a guidance document to assist hospitals with implementing care and management practices for patients with Alzheimer’s and related dementias.

This 25-page document – Guidance for Developing an Operational Plan to Address Diagnosis and Care for Patients with Alzheimer’s Disease and Related Dementias in Hospital Settings – is based on recommendations from the state’s Alzheimer’s and Related Dementias Acute Care Advisory Committee.

There are several forms of dementia, the most common of which is Alzheimer’s disease. However, hospitals also treat patients who suffer from delirium, which is separate and distinct from dementia. Unlike dementia, delirium – which is common in hospitalized patients with dementia – is a temporary condition and may be preventable. The MHA guidance addresses both dementia and delirium in patients in hospital emergency departments and inpatient units.

According to the federal CDC, Alzheimer’s is among the 10 leading causes of deaths in the U.S. and the latest figures (from 2017) show that deaths from Alzheimer’s increased 2.3% from the previous year.
Clinicians and a patient and family representative from 11 Massachusetts hospital and health systems, and members of the Alzheimer’s Association – MA/NH Chapter, served on the MHA workgroup, contributing expertise on the following six broad components:

1. The need to provide culturally sensitive training on dementia and/or delirium to a broad range of caregivers;
2. The importance of providing the optimal environment for patients, which may include sound reduction measures and special lighting;
3. The necessity of learning the patient’s prior history by working with the patient, family, caregivers, EMS personnel, among others;
4. Management of treatment once the patient is in the care of providers in the hospital;
5. Improving communication in care transfers and in discharges; and
6. Incorporating advanced care planning into the general information provided to a patient and caregivers to ensure that patients with Alzheimer’s and related dementias have the full resources available to them.

Each broad recommendation is accompanied by a list of the care team members who would be involved in carrying out the guidance, suggested action steps, and resources to assist hospitals in adopting or revising their clinical and operational dementia care practices.

In June 2017, the Massachusetts Alzheimer’s and Related Dementias Acute Care Advisory Committee (jointly coordinated by DPH and the Executive Office of Elder Affairs) issued statewide recommendations for acute care hospitals to address dementia care.  The committee was composed of healthcare clinicians from MHA member hospitals, family caregivers, patient advocates, researchers, and state agencies. As result of the recommendations, several provider and advocacy groups worked with the legislature to pass Chapter 220 of the Acts of 2018, which created a new statewide advisory council to coordinate the development of Alzheimer’s and other related dementias services. 

Chapter 220 requires every hospital licensed by DPH to implement by October 1, 2021, an operational plan for the recognition and management of patients with dementia or delirium in acute care settings.  The law became effective November 7, 2018.

Beth Israel Lahey Health Gets State & Federal Approval for Merger

Perhaps the largest and most complex healthcare merger in state history is all but final after Massachusetts Attorney General Maura Healey’s office announced last Thursday that the new system had agreed to the conditions the AG had placed on the deal.

The most dramatic part of the AG’s conditions is to impose a seven-year price cap guaranteeing that all parts of the new entity – Beth Israel Lahey Health (BILH) – will keep price increases below the state’s healthcare cost growth benchmark.  The Health Policy Commission had cautioned earlier that the proposed merger could result in total healthcare spending increasing by more than $200 million annually.

The merger would unite Anna Jaques Hospital; Beth Israel Deaconess Medical Center; Beth Israel Deaconess – Milton; Beth Israel Deaconess – Needham; Beth Israel Deaconess – Plymouth; Lahey Clinic Foundation (including Lahey Hospital & Medical Center); Mount Auburn Hospital; New England Baptist Hospital; Northeast Hospital Corporation (including Beverly Hospital); Northeast Behavioral Health Corporation; and Winchester Hospital. Also, Seacoast Regional Health Systems will merge into Anna Jaques Hospital.

"We share with the state and with the attorney general and her staff a real commitment to strengthening patient care but also to reducing health care costs," said Dr. Kevin Tabb, who will lead BILH. "This agreement with the attorney general does exactly that."

BILH, under this 55-page agreement with the AG (known formally as an “Assurance of Discontinuance”), will for eight years following the merger “engage in joint business planning with its safety net hospital affiliates,” which include Lawrence General Hospital, Cambridge Health Alliance, and Signature Brockton Hospital.

BILH will also attempt to ensure that all its licensed providers under its umbrella are enrolled to treat MassHealth patients, and the new system will undertake a marketing campaign to increasing MassHealth patients.
According to the agreement, BILH will spend $71.6 million over eight years “to improve access to healthcare for low-income and underserved communities, with a focus on financial support for community health centers, safety net hospitals, and behavioral health.”

The Federal Trade Commission, which also has oversight over the deal, also announced last Thursday that based on the AG’s agreement, the FTC was closing its investigation into the deal.

Clinician and Staff Peer Support Program

The Betsy Lehman Center is seeking five pilot hospitals to participate in creating a peer support program to help clinicians and other staff deal with medical errors and other unexpected patient outcomes. (The Center is also creating a statewide peer support network for patients and families.) 

Medical errors and other unexpected patient outcomes are obviously traumatizing for patients and families, but clinicians and staff also may suffer emotional or physical distress, believing they have failed their patients as they second guess their own clinical competence. Some even decide to leave their positions or professions. Caregivers are often reluctant to reach out for help following an incident for fear of being stigmatized or of compromising collegial relationships.

The five pilot sites will receive guidance in establishing a hospital-based multi-disciplinary team to oversee program development and implementation, onsite training of peer supporters, among other benefits.

Peer supporters do not participate in quality assurance or root cause analysis, and they don’t address job performance issues, advise on malpractice risk, or provide substance use disorder or violence prevention coaching.

If your hospital is interested in becoming one of the five pilot hospitals, please contact Linda Kenney at Linda.kenney@state.ma.us or (617) 701-8193.

Webinar Provides Up-Close Look at Violence and Violence Prevention

Healthcare workers are often the target of verbal and physical violence from patients. Hospitals, aware of the trend, are continually making strides to protect their workforce.

Recently, a national webinar hosted by the AHA’s Health Research and Educational Trust (HRET) featured MHA and Harrington Healthcare System’s Elise Wilson, R.N., who was violently attacked while caring for a patient.

The hour-long webinar – Workplace Violence: Up Close – is available for viewing.  In it, MHA’s V.P. for Clinical Affairs, Patricia Noga, PhD, R.N., discussed MHA’s statewide efforts to prevent and mitigate workplace violence, as well as MHA’s Caring for the Caregiver initiative that focuses on gratitude, workplace safety, and employee wellbeing.
Elise Wilson shared her compelling story of the assault against her, her injuries, and the aftermath of the event. And Carlton Rondeau, manager of public safety at Harrington, described the hospital’s response to the event and efforts to prevent workplace violence through enhancements in physical security measures, emergency preparedness activities, and education and awareness.

MHQP Announces Winners of New Patient Experience Awards

Massachusetts Health Quality Partners (MHQP) has announced the winners of its first annual “MHQP Patient Experience Awards,” which recognizes primary care practices that perform highest on MHQP’s annual survey.

MHQP receives more than 65,000 responses to its annual survey of commercially insured patients across the state. This year, for the first time, the results were used to identify the top primary care practices that performed highest in each of nine categories, as well as an overall performance category determined by the practices with the most best-in-class results across multiple categories. The nine performance categories included are: patient-provider communications; coordinating patient care; how well providers know their patients; assessment of patient behavioral health issues; ease of access to care; empowering patient self-care; office staff professional excellence; pediatric preventative care; and assessment of child development.

Please visit MHQP’s website here to view all of the winners.

An Opportunity to Help Lessen EHR Burden

Numerous studies have identified electronic health records (EHRs) as being the cause of great physician dissatisfaction and burn out with their jobs. Doctors feel that the requirements to use EHRs cuts into their personal interaction with patients and causes the MDs to spend more time documenting patient care than actually performing patient care. A much-used statistic indicates that an MD will spend two hours on the computer for every one hour of face-to-face time with a patient.

The 21st Century Cures Act recognized the issue and mandated U.S. Health and Human Services (HHS) to develop a strategy to reduce EHR-related burdens that affect care delivery. Last week, the HHS Office of the National Coordinator for Health Information Technology (ONC), along with CMS, issued a 73-page draft document entitled Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs.

The public has 60 days, until January 28, 2019, to submit comments on the draft strategy, which has three main goals:

Reduce the effort and time required to record health information in EHRs for clinicians;
Reduce the effort and time required to meet regulatory reporting requirements for clinicians, hospitals, and healthcare organizations; and
Improve the functionality and intuitiveness (ease of use) of EHRs.

“Information technology has automated processes in every industry except healthcare, where the introduction of EHRs resulted in additional burden on clinicians,” said the ONC’s Don Rucker. “Health IT tools need to be intuitive and functional so that clinicians can focus on their patients and not documentation. This draft strategy identifies ways the government and private sector can alleviate burden.”

2019 Outpatient Prospective Payment System Update

The Centers for Medicare & Medicaid Services (CMS) recently released the final rule to update the Medicare fee-for-service outpatient prospective payment system and ambulatory surgical center payment system effective Jan. 1, 2019. The rule has a number of significant troubling developments for hospitals.  At this program, faculty from Hooper & Lundy will take a deep dive into the areas that will affect hospitals and their clinics.  We’ll look at: OPPS payments; site neutral payments and new changes affecting hospital clinics; changes to the quality reporting requirements; HCAHPS modifications; and the 340B drug discount program. There’s still time to register for this important program this Friday, Dec. 7 from 9 a.m. to noon at MHA's Conference Center in Burlington. Register here.

John LoDico, Editor