INSIDE THE ISSUE

MONDAY REPORT

MHA Offers Suggestions on Behavioral Health Trust Fund

The Massachusetts legislature took definitive action last session with funding of a Behavioral Health Trust Fund (BHTF) that will among other things allow investments in a diverse behavioral health workforce.

Last week, MHA wrote to two of the architects of the BHTF – the Chair of the Joint Committee on Public Health Sen. Julian Cyr (D-Truro) and Rep. Adrian Madaro (D-Boston), the co-chair of the Mental Health, Substance Use & Recovery Committee – offering suggestions on how the advisory committee created to oversee the BHTF can disperse its funding. Cyr and Madaro co-chair that advisory committee.

One suggestion, MHA wrote, is to expand the currently successful behavioral health (BH) loan forgiveness program to allow a wider group of BH workers to be eligible for it. The current loan forgiveness program aims at retaining workers in inpatient psychiatric units, community mental health centers, community behavioral health centers, and licensed substance use disorder clinics. MHA recommended that trust fund monies also be used to offer loan forgiveness to emergency department, medical-surgical, and consult service staff who work in behavioral health functions, as well as to hospital outpatient behavioral health staff and employees of substance use disorder programs affiliated with hospitals.

MHA also expressed strong support for language in the advisory commission’s draft report calling on BHTF monies to be used for pipeline development scholarships and grant programs. But, MHA added, those pipeline funds should be made available to hospital-based employees; currently, such employees are not included on the list of potential recipients.

“Not only will such funds expand the availability of staff, but they will also contribute to building a diverse racial, ethnic, and culturally responsive behavioral health workforce to support communities of color,” MHA wrote. “We hear frequently from MHA members that talented staff, who would be excellent candidates to progress up the workforce pipeline, are unable to accept positions due to the cost burdens of educational loans, the financial impracticalities of reducing work hours to pursue coursework, and the financial obligations related to childcare and transportation, among other burdens, that these funds could help alleviate. Retaining current hospital-based staff as well as advancing excellent candidates is critical to ensuring a robust and growing pipeline of healthcare providers across the behavioral health system.”

National Nurses Week: A Time for Gratitude and Advocacy

National Nurses Week runs through May 12. Throughout the public health crisis, the public has been buoyed in large part due to the courage and dedication nurses exhibited on the frontlines of healthcare.

But soon the mounting pressure of their work during the pandemic caused many RNs – a large portion of whom were on the brink of retirement – to make the decision to leave their jobs. Other younger nurses found that the balancing act between job and family – and childcare costs – was difficult to maintain. They too left their jobs, or took lucrative, part-time nursing jobs with traveler agencies. And still through the disruption, the other persistent problem that had existed pre-pandemic – namely, not enough nursing faculty to teach a new generation of nursing students – continued to worsen.

Even though nurses are the frontline, most-patient-facing part of the healthcare team, there’s not enough of them. Hospitals across the state and the U.S. are working hard to reverse that trend. They’re creating in-house “nursing ladders” to train existing non-clinical staff for LPN and RN jobs, paying their tuition, offering scholarships, and guaranteeing work post graduation. Hospital wellness programs are finding new ways to “bring joy” to nurses in their jobs, and to help ease the pressures of their work so RNs can experience the satisfaction and rewards the job can bring.

On the public advocacy front, Massachusetts healthcare organizations are pursuing legislation that would strengthen penalties against anyone committing violence against healthcare workers. They are also committed to continually improving the work environment, bringing more flexibility into traditional scheduling, and championing new team-based care models to provide nurses with the energy and supports to move forward in their jobs. Nurses Week is a time to step back and celebrate the caregivers around us. But the recognition of the nursing profession, to ensuring its participants are respected and rewarded, must be a daily commitment to all within and outside of the healthcare community.

“This is a time for our commonwealth to embrace new, progressive ideas that can boost the ranks of healthcare professionals and take pressure off the caregivers who have been on the front lines of the pandemic for more than three years,” said Patricia Noga, R.N., MHA’s vice president of clinical affairs. “This will require close collaboration and a united approach. We are highly encouraged to see the strides already being made on Beacon Hill and in the halls of healthcare facilities, and will continue to embrace every voice that wants to join us in this effort.”

Massachusetts Hospitals: An Essential Part of the Commonwealth

Massachusetts hospitals stand for caregivers. Employing more than 200,000 people and serving as an essential part of the state’s life sciences supercluster, Massachusetts hospitals provide pathways to rewarding careers.

But pandemic-imposed stresses caused many in the sector to retire early or seek other employment; currently there are approximately 19,000 vacant positions at Massachusetts hospitals. To fill those jobs, hospitals are engaging in the most innovative recruitment and retention strategies to demonstrate to candidates that work within the state’s renowned hospitals, while demanding, is rewarding, well-paying, and meaningful.

To protect workers, Massachusetts hospitals are advocating strongly for violence prevention legislation, and have stepped up to eliminate surgical smoke from their facilities – a known harmful byproduct of laser surgeries.

Massachusetts hospitals stand for improving the mental health system. Hospitals have not only created new behavioral health beds but are involved in helping to strengthen the workforce pipeline to ensure there are enough diverse workers to staff those beds. They are staunch supporters of the recent ABC Act and the Behavioral Health Trust Fund (see related story above). Throughout the past year and going forward, the hospital community has been the most vocal advocate for addressing the boarding crisis, expanding continuing-care beds, and caring for state-involved patients.

Massachusetts hospitals stand for communities. Employing more than 200,000 people, hospitals are usually the largest employer in their service area and serve as the economic engine for communities. Outside of the world-renowned care they provide within their walls, Massachusetts hospitals annually provide more than $750 million in community benefits for residents of the commonwealth, through efforts aimed at alleviating chronic disease, housing instability, mental health, and substance use disorder, among other adverse determinants of health. The IRS – allowing hospitals to count financial losses related to care provided to Medicaid recipients, along with medical education costs, and other metrics – totals hospital community benefits in Massachusetts at approximately $2.3 billion.

Massachusetts hospitals stand for innovation. The hospital community is the greatest advocate for the promise of telehealth (see related story), demonstrating throughout the pandemic its powerful reach into communities and to residents, who have trouble travelling to their care. Massachusetts hospitals have embraced Hospital at Home programs and Mobile Integrated Health to bring high-quality care to patients. They are now championing reforms to ensure these innovative approaches are sustainable in the long-term.

Most importantly, Massachusetts hospitals stand for patients. Their innovations and accountable care efforts are bending the cost curve while at the same time providing world-class care. The research occurring at Massachusetts hospitals in collaboration with life science companies are responsible for dramatic advances in care. Massachusetts hospitals have been vocal in recent months about the importance of reproductive and gender-affirming care at a time when such care is under threat across the U.S. And they continue to lead on efforts around health equity, anti-racism, and racial justice.

The Public Health Emergency, Masking, Vaccine Requirements

The national Public Health Emergency (PHE) that has been in effect since the start of the pandemic in 2020 is ending on Thursday, May 11. This comes as the World Health Organization last Friday announced the end of its global health emergency declaration.

Also last Friday, the Massachusetts Department of Public Health (DPH) issued updated personal protective equipment guidance and a memorandum on mitigating respiratory illness. The documents note that due to the end of the PHE and the drop in COVID-19 rates, DPH’s previous emergency order “directing universal face mask use for all HCP [health care personnel] in healthcare settings will also terminate.” However, DPH reminded all healthcare facilities that they are mandated to develop and implement infection control procedures, and must update those procedures “to mitigate the risk of transmission of respiratory illness, including but not limited to COVID-19 and influenza.” Those mitigation efforts, DPH wrote, may include, if needed, facility-wide mandatory masking or masking “could be targeted to higher risk areas” such as EDs or units providing care to severely immunocompromised individuals.

Last week, before DPH’s guidance, some Massachusetts hospitals announced that they would indeed be ending their mandatory masking policies in many areas of their operations. Certain parts of their facilities, as DPH noted, could continue to require masks, as they had even before the pandemic. MHA is asking the public to remain aware of their local healthcare organization’s policies, and respectfully follow them, as they begin to take hold in the weeks ahead.

Also, the federal Centers for Medicare and Medicaid Services (CMS) on May 1 released a guidance document relating to the expiration of minimum health and safety requirements for healthcare workers that were issued during the PHE. That document states that “CMS will soon end the requirement that covered providers and suppliers establish policies and procedures for staff vaccination. CMS will share more details regarding ending this requirement at the anticipated end of the public health emergency. We continue to remind everyone that the strongest protection from COVID-19 is the vaccine.”

Hospitals Can Use Alternate Spaces to Treat All Respiratory Viruses

One of the flexibilities under the PHE allowed hospitals to use certain alternate spaces on their campuses to treat patients with COVID-19 and influenza. The flexibility was put into place to account for the influx of patients with those conditions. Now, as hospitals continue to face capacity crowding and an influx of patient with respiratory syncytial virus (RSV) and other respiratory disorders, DPH last week allowed permissible alternate space use for all respiratory viruses through May 10, 2024. The DPH guidelines detail the protocols and requirements a hospital must follow to designate and use the outpatient space.

RSV causes approximately 11,000 deaths in the U.S. and more than 100,000 hospitalizations. On May 3, the FDA approved the first vaccine that protects against RSV. The vaccine created by GSK is for adults aged 60 and over and should be available this fall.

DEA Relents on Telehealth Rules – For Now

In February, the Drug Enforcement Agency (DEA) released two proposed federal rules that would change the prescribing of controlled medications via telemedicine in preparation for the end of the PHE on May 11. The reaction to the proposals was fast and pointed; the DEA received a record 38,000 comments, including ones from MHA and the Massachusetts Telemedicine Coalition (tMed), which criticized the agency’s proposals. Last week, DEA said it was relenting – for now – and that it would extend the current flexibilities that 1) allow the prescribing of controlled substances via telemedicine when the patient and provider have not had a prior in-person evaluation, and 2) allow buprenorphine to be prescribed via telehealth for more than a 30-day prescription.

Making it easier for patients with substance use disorder to get their needed medications proved successful during the pandemic. The flexibilities allowed patients who experience housing instability or do not have access to transportation, or who find it difficult sticking with a program, to get their medications easier. Ending such proven success just because the PHE is ending would reverse the gains made, MHA and tMed argued in their comment letters.

“We recognize the importance of telemedicine in providing Americans with access to needed medications, and we have decided to extend the current flexibilities while we work to find a way forward to give Americans that access with appropriate safeguards,” the DEA announced, adding that it had drafted a temporary new rule entitled, “Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications.” Further details about the rule will become public after its full publication in the Federal Register.

Strong Support for Telehealth at Financial Services Hearing

Bills that Rep. Marjorie Decker (D-Cambridge) and Sen. Adam Gomez (D-Springfield) have sponsored – H.986/S.655, An Act Relative to Telehealth and Digital Equity for Patients – received strong support last Wednesday at a Joint Committee on Financial Services hearing.

Dr. Alexa Kimball, the president and CEO of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, and president of the Beth Israel Deaconess Care Organization (BIDCO), told the committee how the virtual visits she conducts with patients – including visits with patients possessing very serious conditions – are essentially the same as the in-person visits she would have, however they are not reimbursed equally.

While Chapter 260 of the Acts of 2020 required reimbursement parity for behavioral health services offered via telehealth to be on par with in-person visits in perpetuity, H.986/S.655 requires reimbursement parity for all telehealth services by removing the sunset dates for primary care and chronic disease management parity that recently took effect. It also requires MassHealth to keep in place its ongoing coverage and reimbursement policies for telehealth which are scheduled to expire on September 30, 2023.

Dawn M. Casavant, vice president of External Affairs & Philanthropy for Heywood Healthcare, and Christine Cutting, Heywood’s Behavioral Health Program Manager spoke of the benefits to patients of telehealth and the importance of parity. Among others testifying were Dr. Hugh Taylor, a private practice physician and vice president of the Massachusetts Medical Society; Dr. Carlos Estrada from Boston Children’s Hospital; Heather Meyers, director, Virtual Care at Boston Children’s; and MHA’s Director, Virtual Care & Clinical Affairs Adam Delmolino. Amanda Lane, a parent of a child who has benefitted from telehealth at Boston Children’s Hospital, also testified in support of the legislation.

Sturdy Memorial Hospital is Now Sturdy Health

Transition at Hebrew SeniorLife

Steve Landers, M.D., is the new president and CEO of Hebrew SeniorLife, effective July 2023. He succeeds Louis Woolf, who is retiring after leading the organization for 14 years. Landers comes to Hebrew SeniorLife from Visiting Nurse Association (VNA) Health Group, where he has served since 2012 as president and CEO. Prior to VNA Health Group – a multi-state organization that includes home health, hospice, primary care, and public health services – he served as a staff physician and administrative leader at Cleveland Clinic. Landers is a graduate of Indiana University at Bloomington, Case Western Reserve University School of Medicine, and The Johns Hopkins Bloomberg School of Public Health. He completed a family medicine residency at University Hospitals of Cleveland/Case Western Reserve University and completed a geriatric medicine fellowship at Cleveland Clinic.

John LoDico, Editor