INSIDE THE ISSUE

> Surgical Smoke Evacuation
> Climate Bill
> Public Health Emergency
> Independent Dispute Resolution
> Transition

MONDAY REPORT

Improving Safety: Eliminating Surgical Smoke by 2024

The MHA Board of Trustees is calling on all Massachusetts hospitals to eliminate surgical smoke from their facilities by 2024 through the implementation of a nationally recognized smoke evacuation program.

Surgical smoke is produced by the destruction of tissue by use of lasers or electrosurgical devices. Research studies confirm that surgical smoke can contain toxic gases and vapors such as benzene, hydrogen cyanide, formaldehyde, and bioaerosols, as well dead and live material, including blood tissue particles, bacteria, and viruses.

MHA’s Clinical Issues Advisory Council (CIAC) – the group consisting of clinical leaders from across the state that advises the board – created the MHA Workgroup on Surgical Smoke Evacuation, which then developed and fielded surveys on the issue. A 2021 MHA survey found that of the 55 unique responders, 40% always use surgical smoke evacuators and 61% have a smoke evaluation policy in place.

“Massachusetts hospitals continue to improve their efforts to eliminate surgical smoke, but CIAC and now the MHA Board want to jumpstart those efforts,” said Michael Gustafson, M.D., president of UMass Memorial Medical Center, chair of CIAC, and a member of the MHA Board. “The necessary goal is to protect all members of the OR team – surgeons, nurses, allied healthcare staff, and, of course, patients – from hazard. It’s part of the culture of safety that all hospitals strive for.”

MHA sent a commitment letter to each hospital asking them to educate senior leadership on the long-term hazards of exposure to surgical smoke, implement a policy and invest in the devices to eliminate surgical smoke, and report back to MHA on their progress. Currently seven facilities in Massachusetts have received the Association of periOperative Registered Nurses (AORN) “Go Clear Award,” one of the nationally recognized programs hospitals can participate in to meet the MHA Board’s 2024 target.

Surgeons, whose hands hold the lasers and whose vision is affected by both smoke and the evacuation devices, are key to the success of the initiative. Dr. John J. Mazzucco, a general surgeon at Holyoke Medical Center, has been a leading advocate for the elimination of surgical smoke throughout the MHA process. “There is definitely a requirement to adapt to the new technology introduced into the OR,” he says. “But the benefits to the care team in terms of protecting them from the proven bioaerosols, as well dead and live material, including blood tissue particles, bacteria, and viruses far outweighs the need for the learning curve surgeons must undertake.”

Baystate Medical Center and Baystate Franklin Medical Center are among the Massachusetts hospitals that already have received AORN’s Go Clear Gold Award. “Because of how surgeries are conducted, patients are exposed to surgical smoke usually for short periods of time.,” said Patricia Samra, R.N., VP of HR and Total Rewards at Baystate Health. “But studies have shown that perioperative nurses report twice as many respiratory issues as compared to the general population, and the hazard to those in the OR day in and out is of great concern. Eliminating surgical smoke not only makes sense from a clinical viewpoint, but it shows our staff – who work in extraordinarily stressful situations – that we place great importance on their health and wellbeing.”

MHA will be conducting education programs and sharing best practices in the coming months to assist hospitals reach the goal of eliminating surgical smoke by 2024.

The State’s Climate Bill and Healthcare

Earlier this month, Governor Charlie Baker signed the “Driving Clean Energy and Offshore Wind” bill into law. Climate change has emerged as a major policy focus for Beacon Hill in recent years, which just last year passed another climate change law that was equally sweeping and comprehensive.

Whereas last year’s law set out the climate reduction goals for the state and enumerated the process for meeting them, this year’s one seeks to address what policymakers see as the biggest challenges in reaching those goals. This includes new incentives for green technologies such as offshore wind and electric vehicles. It also includes new tools for state and local governments to prompt climate action from utilities, consumers, and institutions such as hospitals.

Three areas where the new climate law affects healthcare include:

First, beginning in 2024, the law requires all buildings over 20,000 square feet, including healthcare facilities, to track and report their carbon emissions annually. This is based on existing emissions reporting rules in Cambridge and Boston, such as Boston’s Building Emissions Reduction and Disclosure Ordinance (BERDO).

Second, the new law will continue the trend of making it harder to use natural gas in the future. One of the most controversial parts of the law was a provision allowing 10 communities to participate in a permanent “pilot” program to ban all fossil fuel use in new construction. Although hospitals and healthcare facilities were ultimately exempted from this particular provision, in the long term, the law is expected to reduce the state’s reliance on natural gas and may contribute to future increases in natural gas prices. One way it does this is by nudging the Future of Gas proceeding – a regulatory process dictating future natural gas investments – to encourage reductions in gas use.

Last, state climate planners are set to finally acknowledge and begin using technology like energy storage to address the unique energy needs of hospitals. The law requires regulators to issue recommendations by the end of 2023 on how to add more energy storage technologies to the electric grid. Because of a successful Senate amendment, this will be required to outline specific recommendations for supporting energy storage use in hospitals and other healthcare institutions.

The climate law comes on the heels of news that more than half of Massachusetts hospitals have signed onto a pledge led by the Biden Administration to cut their greenhouse gas emissions in half by 2030 and achieve net-zero emissions by 2050.

The Public Health Emergency and Its Flexibilities

The United States has been under a Public Health Emergency (PHE) since January 27, 2020, and every 90 days since then the Secretary of U.S. Health & Human Services has renewed the PHE. The next expiration date of the emergency declaration is October 15, 2022.

The PHE allowed the national healthcare system to operate under a series of flexibilities, meaning regulations were waived to allow a rapid and nimble response to the pandemic. Such waivers include those relating to which providers can offer telehealth services and bill for them; how certain hospitals can screen psychiatric patients offsite to prevent the spread of COVID-19; and how facilities can expedite licensing of caregivers to get them to the bedside quicker. The Centers for Medicare and Medicaid Services (CMS) released a document running to nearly 50 pages, listing the waivers.

The Biden Administration wrote to the nation’s governors in January 2021, telling them that they would be notified 60 days prior to the PHE ending. Such a warning has not been issued, indicating that the PHE most likely will run for another 90 days after October or into January 2023. Hospitals have been advocating strongly for an extension of the PHE past October, arguing that the steady influx of patients due to COVID-19 variants, the expected rise in cases during the fall and winter, and the persistent workforce shortages that are rampant across the entire healthcare system are putting an enormous strain on caregivers and finances.

New Independent Dispute Resolution Rules Go Into Effect

Earlier this month, the U.S. Departments of Health and Human Services, Labor, and the Treasury released “Requirements Related to Surprise Billing: Final Rules.” The rules help implement the federal “No Surprises Act” that protects patients from having to pay surprise bills for out-of-network care, and which creates the process for providers and insurers to come to agreement on the payments. The new rules detail the independent dispute resolution (IDR) process for settling payment debates.

Under these final rules, certified IDR entities must consider the qualifying payment amount (QPA) and then must consider all additional permissible information submitted by each party to determine which offer best reflects the appropriate out-of-network rate.

In its first iteration of the rules in October 2021, the Biden Administration said that arbitrators should consider the qualifying payment amount (QPA), defined as the median in-network rate, as the correct amount. Providers, including the American Hospital Association and American Medical Association, filed lawsuits to challenge the reliance on that figure, saying it goes against congressional intent and tips the scales in favor of the insurance companies, which are in charge of calculating the rate. Those objections were heard. The new, final rules require that certified IDR entities must consider the QPA, and then must consider all additional permissible information submitted by each party to determine which offer best reflects the appropriate out-of-network rate.

The new rules also address insurer “downcoding” – where an insurer assigns a different diagnostic code to a treatment, resulting in the provider receiving a lower payment than they are entitled to. The new rule states that if an insurer bases the QPA on a downcoded service number, it must explain why and detail the amount it would have paid if it had not changed the code.

Transition

Molly Gray, R.N., president and chief administrative officer of Baystate Health’s Eastern Region, will retire on October 9 after a 34-year career at Baystate. Baystate Health Eastern Region includes Baystate Wing Hospital and Baystate Mary Lane Outpatient Center.

John LoDico, Editor