Massachusetts Health & Hospital Association Healthcare Agents, MAVRIC Delayed, and more …
INSIDE THE ISSUE
> Easing the Capacity Crisis
> MAVRIC Delayed
> COVID Liability Protection
> Letter: Protect the ACA
> HPC on BH ED Boarding
MONDAY REPORT
Healthcare Agents & Proxies Key to Easing Capacity Crunch
MHA’s most recent survey that tracks how patients are moving from acute care providers to post-acute care shows that on average during October, more than 2,000 patients each day were stuck in acute care beds, awaiting placement in a skilled nursing facility, long-term acute care hospital, inpatient rehabilitation facility, or home healthcare.
When a patient is stuck in a hospital for additional days after their course of care has been completed, they do not have access to the specialized care they need. The hospital generally does not receive any additional funding and often must absorb the additional costs on its own as it provides the extra care to keep the patient well. 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.
Delayed insurance company prior authorizations approving the transfers are a main reason for the delays, as is workforce shortages at the post-acutes. But another significant cause is due to patients not having designated a healthcare agent and proxy form.
A healthcare agent is the person empowered to make care decisions for a patient if that patient becomes incapacitated. A proxy document allows a person to outline their care wishes should they ever be in a position to not do so themselves. Without them, a patient who is ready for discharge and would otherwise be transferred from an acute care hospital to post-acute care often becomes stuck in the hospital. Without guidance from a proxy, providers are unable to determine who can authorize treatment for an incapacitated patient. A hospital may then have to go to the courts to establish guardianship for the patient, which causes transfer delays.
Last Wednesday, MHA joined with Honoring Choices Massachusetts to host a webinar on the “Simple Step Campaign” that encourages people, of all ages, to designate a healthcare agent.
Dr. Robbie Goldstein, the commissioner of the Department of Public Health, spoke during the webinar, saying, “We all know the challenges that healthcare is facing right now and that includes concerns around capacity and flow through the healthcare continuum. Having a healthcare proxy is a key tool to help address these issues. Starting at 18 years old, adults can designate a trusted person to be their healthcare agent by completing a healthcare proxy document and this person can then make healthcare decisions when an adult is not able to make their own decisions. They can talk with treating clinicians to provide the best possible care, and having a healthcare proxy can help with safe and timely care transitions from the hospital to a post-acute care setting and eventually to home.”
In September, DPH and MHA urged providers, colleges, public health departments, and other entities to join the initiative and share the importance of long-term healthcare planning with their audiences.
Death Certificate Registration System Delayed Until Early 2025
The state’s planned rollout of the digitally based Massachusetts Vital Records Information Collaborative (MAVRIC) to record death certificates has been delayed once again – this time to “early 2025,” according to the Registry of Vital Records and Statistics (RVRS).
MAVRIC, which will replace the current Vitals Information Partnership system, was most recently delayed due to the upcoming holiday season.
In the interim, the state urges provider organizations to undertake the necessary role-specific training and preparations for the launch. Resources are available on the MAVRIC website. The state is also re-launching its campaign to pre-enroll those personnel who pronounce the time of death, and the certifiers who determine the cause of death and sign the certificate. RVRS will reach out to specific groups that have not yet enrolled or taken training.
COVID-19 Liability Protections Extended for Another 5 Years
MHA has joined a group of providers, patient advocates, insurers, labor unions, employer groups, and many others in urging the state’s Congressional delegation “to do everything in your power to protect children and adults from efforts to undermine the Affordable Care Act and Medicaid, including federal financing.”
The joint letter came just a week before the Congressional session ends this Friday, December 20. At risk, unless Congress acts, is funding for the hospital-at-home program, extension of telehealth flexibilities, and funding for Disproportionate Share Hospitals (DSH). Without Congressional action, $8 billion in DSH cuts go into effect on January 1.
Mass. Healthcare Interests Asks Delegation for Help
MHA has joined a group of providers, patient advocates, insurers, labor unions, employer groups, and many others in urging the state’s Congressional delegation “to do everything in your power to protect children and adults from efforts to undermine the Affordable Care Act and Medicaid, including federal financing.”
The joint letter came just a week before the Congressional session ends this Friday, December 20. At risk, unless Congress acts, is funding for the hospital-at-home program, extension of telehealth flexibilities, and funding for Disproportionate Share Hospitals (DSH). Without Congressional action, $8 billion in DSH cuts go into effect on January 1.
HPC Previews ED Boarding Report
The Health Policy Commission (HPC) has released a preview of its mandated study on behavioral health emergency department boarding. Chapter 126 of the Acts of 2022 requires the HPC to conduct an analysis and issue a report on the ongoing effects of the COVID-19 pandemic on behavioral health-related boarding in acute care hospital settings, including, but not limited to, boarding in EDs, medical surgical units, or observation units. The final report will include recommendations on how to address the burden on acute care hospitals and payer reimbursement. The HPC’s preliminary, but comprehensive, report can be found beginning on page 61 of this slide deck. MHA and its members have been active in addressing the boarding crisis for several years, especially since its escalation during the COVID-19 pandemic (see metrics below).