Massachusetts Health & Hospital Association Best in U.S.; IV Shortage; 2,149 Stuck Patients
INSIDE THE ISSUE
> Nation’s Best Healthcare at Risk
> Patient Backups
> IV Solution
> Steward Insurance Coverage
> Nashoba Valley Workgroup
> Virus Alerts
> Fair Credentialing
> Holiday
MONDAY REPORT
The Most Accessible Healthcare System, If We Can Keep It
Massachusetts has the most accessible healthcare system in the United States.
That’s according to 14 methodologies Forbes Advisor used to determine in which states a person can access high-quality, affordable care. In response to the recent recognition, MHA issued a strong warning that the healthcare system – while clearly doing its part to serve patients – is faltering and now facing undue attacks.
The Forbes metrics include the number of hospital beds per 1,000 residents; number of primary care physicians, specialist physicians, nurse practitioners, critical care physicians critical care nurses, and physician assistants per population; percentage of residents who lack health insurance; number of community health centers; annual average premium and deductibles for employees, and more.
Connecticut and Rhode Island were next in line after nation-leading Massachusetts. Five Western states – Utah, Nevada, Arizona, Wyoming and Idaho – rank at the bottom of states where healthcare is least accessible.
Last year, The Commonwealth Fund, using 58 measures relating to access, quality, use of services, costs, health disparities, reproductive care, women’s health, and health outcomes ranked Massachusetts Number 1 for health system performance. Other organizations have placed individual Massachusetts hospitals at or near the top of national rankings.
“Healthcare is the bedrock of Massachusetts from which the recent Nobel Prize winners in medicine emerged, and upon which our state’s vibrant life science sector is built,” MHA President and CEO Steve Walsh stated. “But make no mistake: despite being ranked the most accessible state in the country and leading in almost every measurable category, including quality and equity, our healthcare system remains in crisis. Our future as a national leader is at risk.
“I hope for our collective sake that everyone – including the handful of pundits using this moment of weakness to sow division – can come to recognize the essential role our hospitals play in making our healthcare system the leader that it is. There is simply too much at stake to attack the institutions that are literally the foundation of our commonwealth’s success,” Walsh continued.
Having what numerous surveys and studies demonstrate is the nation’s premier healthcare system is apparently comforting to Massachusetts residents; that is, healthcare ranks far down the list of things about which people in the Bay State worry.
A poll last week from Suffolk University and the Boston Globe found that the item most worrying voters in the upcoming election is the future of American Democracy (31%), followed by concern over the economy (27%), immigration (13%), and foreign policy and abortion (both at 6%). Healthcare followed all of those at 5%.
2,149 Patients With Nowhere to Go
For the first time in the three years that MHA has been collecting the data, the number of patients awaiting discharge from acute care hospitals to the next level of post-acute care has exceeded 2,000 individuals.
Specifically, at a point of time in August as reflected by the MHA throughput survey, 2,149 patients were stuck in hospitals unable to be transferred to either a skilled nursing facility, long-term acute care hospital, inpatient rehabilitation facility, or home healthcare. (The previous month’s total of stuck patients was 1,768.)
Reasons for the transfer delays have been well documented – but seem to be worsening. Workforce shortages at the post acutes and delays in getting prior authorization approvals from insurers – especially national health insurance companies – mean that a patient that has completed treatment at an acute care hospital but needs additional care at a post-acute can’t be transferred.
If a patient is stuck in a hospital for additional days after their course of care has been completed, the hospital generally does not receive any additional funding and often must absorb the additional costs on its own. MHA has estimated this cost to hospitals totals more than $400 million annually. Plus the occupied bed cannot be used to help ease overcrowding in a hospital’s emergency department. The emotional and physical wellbeing cost to patients and their families is immense.
The effort to build the healthcare workforce and to strengthen cooperation and communication between providers and insurers continues apace, especially with the passage of the state’s recent long-term care law. But the patient “throughput” pressure is building as respiratory virus season approaches and is the latest symptom of a Massachusetts healthcare system that while accessible and able to deliver extraordinarily high-quality care (see story above) is, nonetheless, threatened.
IV Shortage: Latest Developments
Massachusetts hospitals, like those around the country, are navigating disruptions to IV product supply in the wake of Hurricane Helene. The hurricane forced the closure of Baxter International’s North Carolina plant, which produces 60% of the nation’s supply of IV fluids.
The destructive Hurricane Milton that swept through Florida last week fortunately did not seriously disrupt the B. Braun Medical facility in Daytona Beach that produces IV supplies for the nation’s healthcare system.
Braun had amped up its production to help cover the drop in IV supplies after Hurricane Helene closed Baxter’s plant in North Carolina. Braun, assisted by the federal government, had moved truckloads of IV solution out of the path of the approaching Milton last week.
Baxter announced last week that it was working with the FDA to import IV solution as it worked to get its North Carolina plant up and running. The company said it would restart the plant in phases and hopes to achieve 90% of its production by the end of 2024. In the interim, Braun has increased its allocation to customers from 40% to 60% based on the customer’s prior purchase history.
Last Wednesday, the FDA approved the import of IV products from Baxter’s plants in China, the UK, Canada, and Ireland in an effort to bolster supply even further.
On Mondays and Thursdays, Baxter will post updates here on its supplies and reopening strategy. It has set up a dedicated e-mail address (hurricanehelenesupport@baxter.com) that hospitals can use to contact the company with questions related to the IV solution situation.
MHA is continuing to work with its members to assess how the Baxter situation is affecting them and the strategies they are using to deal with the issue.
AG Concerned About Steward Workers’ Comp & Malpractice Coverage
Massachusetts Attorney General Andrea Campbell last week filed an emergency motion with the bankruptcy court overseeing the dissolution of Steward Health Care, asking the court to prohibit Steward from reneging on its continuing obligations to maintain workers’ compensation and medical malpractice insurance coverage.
The AG wrote the court, “[E]ven though the commonwealth has worked with all interested parties to achieve the transition of 6 hospitals to new operators, a health and safety issue has arisen: employees, from doctors to mechanics, from nurses to food service personnel, can only unreservedly fulfill their obligations to patients if they have workers’ compensation and malpractice insurance coverage for the periods Steward is required to provide them, and Steward’s failure to provide that required coverage threatens this basic tenet.”
Campbell said that in the purchase agreements it signed with the buyers of its former hospitals, Steward “explicitly confirmed” it would continue to provide the coverage. But it hasn’t posted the bond required to cover its self-insured obligations for worker comp claims in 2024, and its medical malpractice entity – TRACO – doesn’t have the capital to pay clams.
“The Debtors [Steward] cannot cut and run from Massachusetts leaving their former employees and patients without any coverage,” the AG wrote. “The Debtors must be required to provide coverage to comply with Massachusetts law.”
Specifically the commonwealth is asking the court to order Steward to provide medical malpractice insurance coverage for all of its Massachusetts-licensed workers for seven years “in amounts determined to be adequate by an independent actuarial analysis,” and to provide a non-cancelable insurance policy to cover all “known and future” workers’ comp claims for injuries sustained between January 1, 2024, and the date in which Steward ceases all operations in Massachusetts.
Nashoba Valley and Carney Working Group Members Named
The commonwealth has named the members of the working group created to help determine the healthcare future of the Nashoba Valley region now that Steward’s Nashoba Valley Medical Center has closed.
The working group is led by Joanne Marqusee, assistant secretary in the Executive Office of Health and Human Services, and Ayer Town Manager Robert Pontbriand. Marqusee was CEO of Cooley Dickinson Hospital from 2014 to 2021.
Among its members are Christine Schuster, R.N., president & CEO, Emerson Health and a member of the MHA Board of Trustees; and Amy Hoey, R.N., president, Lowell General Hospital. The CEOs of Southern New Hampshire Health and St. Joseph Hospital, both of which are in Nashua just 17 miles away from Nashoba Valley, also will serve on the working group.
Other members of the group, including elected officials, first responder representatives, labor leaders, and healthcare providers are listed here.
The City of Boston has created a similar group to assess community health needs following the closure of Carney Hospital in Dorchester. That group is led by Dr. Bisola Ojikutu, the commissioner of public health for the City of Boston, and Michael Curry, the president and CEO of the Massachusetts League of Community Health Centers.
The Carney group also draws its membership from elected officials, healthcare experts, and community leaders.
Health System Alerted to National, International Viruses
While the healthcare system copes with regular challenges involving capacity, costs, and respiratory ailment season, other issues percolate just below the surface.
Currently, hospitals, health systems, and physician practices have been advised to be alert to possible cases of H5 bird flu, which was observed in California last week, as well as Marburg Virus, which is experiencing an outbreak in Rwanda.
The CDC reported that two cases of H5N1 bird flu in California occurred in people with occupational exposure to infected dairy cows. There have been a total of 16 human cases of H5 in the U.S. during 2024, in Texas (1), Michigan (2), Colorado (10), Missouri (1) and California (2).
Marburg is a rare, severe viral hemorrhagic fever that can lead to death. Rwanda has reported 49 cases and 12 deaths from it. No confirmed cases of Marburg Virus have been reported in the United States or other countries outside of Rwanda, yet the CDC issued this health advisory to inform clinicians of what to look for in patients and actions they can take. Also, the Region 1 Emerging Special Pathogens Treatment Center at Massachusetts General Hospital created this Marburg Symptom Screening Tool to assist clinicians.
Advancing Responsible Credentialing
Mass General Brigham joins Sturdy Health as recipients of the Wellbeing First Champion Badge from the Dr. Lorna Breen Heroes’ Foundation.
The badge is a recognition that MGB and Sturdy have eliminated potentially stigmatizing or invasive questions from their credentialing processes. This follows an MHA-led effort in which every hospital and local health plan committed to removing such questions from their credentialing forms. Massachusetts was the first state in the nation to take such a step.
Each year, thousands of local physicians and healthcare professionals go through the credentialing process to ensure they are in good standing to deliver safe patient care. However, the forms used within this process have often included outdated, unnecessary questions about clinicians’ mental health history and past drug use. Caregivers have been discouraged from seeking behavioral health services because they know they will encounter these overly broad questions and fear their livelihoods will be threatened as a result of answering honestly. Earlier this year, the Integrated Massachusetts Application (IMA) – the formal document that is used by Massachusetts health plans and nearly 40 Massachusetts hospitals to credential clinicians – was finally edited to remove an invasive question about past drug use.
The Lorna Breen Heroes’ foundation served as a central advisor in the statewide initiative announced last December, and the organization has encouraged all Massachusetts hospitals to take the step of “getting badged.” Also joining the MHA initiative were the Massachusetts Medical Society, American Medical Association, Massachusetts Association of Health Plans, and Blue Cross Blue Shield of Massachusetts.
MHA Offices Closed Today
MHA’s offices are closed today. Massachusetts officially designates the holiday as Columbus Day. However, more than 20 cities and towns across the commonwealth, as well as MHA, have designated the holiday as Indigenous Peoples Day.
While there is no official Indigenous Peoples Day federal holiday, Joe Biden became the first president to annually issue a presidential proclamation recognizing the day. He has said of indigenous people and tribal nations, “They challenge all of us to celebrate the good, confront the bad, and tell the whole truth of our history.”
At least 12 states and the District of Columbia do not celebrate Columbus Day. According to the Massachusetts Secretary of State, “The term ‘federal holiday’ is not applicable to individual states and the private sector since each state has jurisdiction over its holidays.”