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> Capacity Constraints
> Mental Health
> Paxlovid
> Monkeypox
> Clinician Suicide
> Telehealth Survey
> Transition

MONDAY REPORT

State Continues to Address Post-Acute Capacity Issues

Last week the state announced new facilities participating in a program set up earlier this year to assist with patient care transitions from acute care hospitals to skilled nursing facilities (SNFs).

Since the beginning of 2022, the Executive Office of Health and Human Services and Department of Public Health have sent state-contracted nursing teams to augment existing staff at skilled nursing facilities across the state. Two SNFs in each of the state’s five designated Emergency Medical Service (EMS) regions receive the additional staff. In return, the SNFs must accept all hospital referrals for patients that require short-term rehabilitation skilled nursing services. As of August 9, more than 2,200 admissions to skilled nursing facilities had been facilitated by way of this program.

The current designated facilities are: Region 1, Chestnut Hill of East Longmeadow (East Longmeadow) and Charlene Manor Extended Care Facility (Greenfield); Region 2, Holy Trinity (Worcester) and St. Mary Health Center (Worcester); Region 3, Bear Mountain at Andover (Andover) and D’Youville Center for Advanced Therapy (Lowell); Region 4, Maristhill Nursing and Rehab (Waltham) and Alliance of Marina Bay (Quincy); and Region 5, Baypointe Rehab Center (Brockton) and Hathaway Manor (New Bedford).

MHA’s July survey showed that statewide there were 744 patients in acute care hospitals awaiting discharge to a SNF, long-term acute care hospital, inpatient rehabilitation facility, or to home health. Of those 744 patients, 491 were awaiting discharge to skilled nursing facilities, and 261 of the 491 were awaiting short-term rehabilitation beds in SNFs.

While “throughput” issues were significant before the pandemic, COVID-19 has exacerbated the situation and created a large volume of patients who are ready for discharge from hospitals but cannot find an appropriate bed in a post-acute care setting. In some cases, patients who require specialized post-acute care services wait weeks or even months to find an appropriate bed or service. Based on current survey data, more than 133 patients have been waiting in hospitals for SNF beds between 30 days and six months, and 30 additional patients have been waiting for more than six months for a nursing home bed.

The reasons for these backups can vary, but according to hospital case managers, the three most common pressure-points cited are private insurance administrative barriers, workforce shortages in the post-acute sector, and the need for timely decisions on guardianships and conservatorships to assist with the discharge of patients.

Governor Inks Behavioral Health Bill

The hard-fought effort to get a comprehensive behavioral health bill enacted is complete with Governor Baker’s signing last Wednesday of the Mental Health ABC Act. (A ceremonial signing is expected this week.) The bill is most notable for its mandate of coverage and reimbursement parity for mental health services, the funding it devotes to workforce development, and its special focus on children’s behavioral health.

At the signing, Baker said the new law “takes steps to ensure our healthcare system treats mental health the same way we do physical health.”

Paxlovid and Paxlovid Rebound

President Biden’s recent bout with COVID-19, followed by Paxlovid treatment, and then a “rebound” of COVID once again raised questions about the antiviral drug.

According to the most recent guidance from the U.S. Department of Health & Human Services’ Administration for Strategic Preparedness and Response (ASPR), Paxlovid is still the preferred treatment for COVID-19-positive patients who are at risk for progression to severe COVID-19.

The five-day Paxlovid pill treatment is available to patients 12 and over, who have had symptoms of COVID-19 for no more than five days, and have one or more risk factors for severe COVID. Risk factors include being over age 50, or being unvaccinated, or having one of the medical conditions detailed through the ASPR guidance.

As for Paxlovid rebound, ASPR writes, “Rebound (defined as experiencing recurrence of symptoms and/or SARS CoV-2 antigen positivity after initial resolution) has been observed not only among patients treated with Paxlovid but also occurs in patients receiving no treatment and in patients treated with other COVID-19 therapeutics. Recent studies suggest patients experiencing rebound have an extremely low probability of developing severe COVID-19. Further studies on this phenomenon are ongoing.”

FDA Moves to Stretch Monkeypox Vaccine Supply

The U.S. Food & Drug Administration (FDA) has issued an emergency use authorization (EUA) order that allows healthcare providers to administer the JYNNEOS monkeypox vaccine intradermally to high-risk adults and subcutaneously to children at high risk for the infection. (Intradermal injections go just under the skin, as opposed to subcutaneous injections, which go under a layer of fat.)

The intradermal shots are one-fifth the vaccine dosage of a subcutaneous shot, meaning that the U.S. can stretch the supply of the vaccine. In its EUA, the FDA noted that approximately 1.6 to 1.7 million people are currently estimated to be at elevated risk of monkeypox in the U.S., which means 3.2 to 3.4 million doses of the two-shot regimen are needed to immunize them. Only about half that amount of vaccine, however, is estimated to be available by the end of 2022.

Two doses of the intradermal vaccine will still be needed 28 days apart. “Administration by the intradermal route resulted in more redness, firmness, itchiness and swelling at the injection site, but less pain, and these side effects were manageable,” the FDA noted.

Recognizing and Taking Action to Prevent Caregiver Suicide

Saturday, September 17, 2022, has been designated as National Physicians Suicide Awareness Day. Suicide risk among doctors is said to be between 5 and 7 times that of the general population with nearly 400 physicians taking their own lives in the U.S. each year.

Leading up to September 17, various health groups are drawing attention to the issue. One such group – the ALL IN: WellBeing First for Healthcare campaign – created a list of five evidence-based actions healthcare groups can take to minimize burnout and the risk of suicide. Examples include: “Get Rid of Stupid Stuff,” which means collaborating with clinicians to remove low-value work, such as repetitive electronic health record clicks for common workflows; or “Designate a Well-being Executive” – a single person with operational authority to oversee and align all clinician well-being efforts.

In the commonwealth, the Massachusetts Medical Society and MHA had formed the MMS-MHA Joint Task Force on Physician Burnout to address the issue. And MHA is leading the health-community-wide Caring for the Caregiver initiative that is addressing workforce issues on many fronts, including improving the wellbeing of clinicians, ensuring their safety, and fostering a workplace culture and environment that embodies the defined values of each organization and supports a productive workforce.

Take a Brief Telehealth Survey

The pandemic showed how telehealth could assist patients and providers overcome unique issues relating to the temporary closure of physicians’ offices and the deferral of elective procedures. The pandemic also showed more than ever before how telehealth could improve patient access to caregivers, but also how some parts of the state and some communities that were not technically proficient missed out on telemedicine’s benefits.

Now MHQP wants to get an overall sense of what has been learned about telehealth since the pandemic began in early 2020. The group has created two surveys – one for patients and one for clinicians – each of which will only take 5 to 10 minutes to complete. MHQP asks that you complete the survey by Friday, August 26.

Transition

President Joe Biden announced that he will appoint Dr. Monica Bertagnolli as the director of the National Cancer Institute. She would be the first woman to hold the post. Bertagnolli is currently a professor of surgery in the field of surgical oncology at Harvard Medical School, a surgeon at Brigham and Women’s Hospital, and a member of the Gastrointestinal Cancer and Sarcoma Disease Centers at Dana-Farber Cancer Institute. She is a graduate of Princeton University and the University of Utah medical school, trained in surgery at the Brigham, and was a research fellow in tumor immunology at Dana-Farber.

John LoDico, Editor