INSIDE THE ISSUE

> Overdose Prevention Centers
> Markey’s Opioid Bill Advances
> Federal AI Rule
> Paula Griswold
> Hospital Community Collaborative
> BILH Transitions

MONDAY REPORT

Healey Administration, MHA Endorse Overdose Prevention Centers

Last Wednesday, the Department of Public Health (DPH) released Overdose Prevention Center Feasibility Report that examines the feasibility of establishing what were previously known as safe consumption sites in Massachusetts. The report considers overdose prevention centers (OPCs) as an “evidence-based, life-saving tool that aligns with DPH’s approach to reduce the harms of substance use.”

Individuals who use illegal drugs can bring them into OPCs, where the drugs can be tested, and the individuals can receive sterile supplies and overdose reversal medications, as well as referrals to health and social services. The goal is, according to the state report, “to decrease the negative consequences associated with substance use by offering non-judgmental, person-centered care. Decades of research have shown that such harm reduction strategies work to prevent overdose deaths, prevent transmission of infectious diseases, and reduce emergency department visits and other healthcare costs while creating opportunities for connection and engagement to compassionate care.”

However, the drugs being consumed are, nonetheless, illegal and there’s a legal risk to all involved – to the counselors and caregivers in OPCs, the individuals using the drugs, and even the property owners in which the OPC is housed. In comments before the Public Health Council last week, DPH Commissioner Robert Goldstein, M.D., said, “In order for communities to feasibly operate OPCs, DPH recommends the state pursue legal protections through, and in collaboration with, the legislature.”

H.1981/S.1242, An Act Relative to Preventing Overdose Deaths and Increasing Access to Treatment, offers such protection. It would create a 10-year OPC pilot program, require DPH regulations for OPCs, and, importantly, establish legal and licensure protections for providers/operators, patients, and property owners. MHA is part of the MA4OPC Coalition advocating for the passage of the legislation.

“The evidence is clear: overdose prevention centers represent an important, proven part of our response to the substance use crisis in Massachusetts,” said MHA President and CEO Steve Walsh. “MHA and our members fully support these new DPH recommendations, including the need to protect the caregivers at the heart of harm reduction care. OPCs give our commonwealth an opportunity to, once again, step up and address this crisis with the innovation and urgency it deserves.”

OPCs currently operate in Canada, Australia, and parts of Europe. There are two OPCs in New York City operating under an informal agreement between the police, district attorneys, and city government to not pursue criminal actions against participants. But there are no formal legal protections in New York such as would be offered under the proposed Massachusetts legislation. Rhode Island, Minnesota, and Philadelphia are also taking steps to create OPCs.

However, federal drug laws – if they were to be enforced – would apparently make OPCs illegal no matter what state law says. “Although the Biden Administration has embraced harm reduction methods as a core principle and approach in the National Drug Control Strategy, it has not explicitly endorsed the use of OPCs,” the state report notes. “Absent a federal policy or statutory change, enforcement of federal law against OPCs is in the discretion of federal law enforcement officials and actions have a five-year statute of limitations.” As more and more OPCs operate around the U.S., the hope is that their success will lead to changes in federal enforcement.

The Healey Administration, the MA4OPC Coalition, and many other health experts feel the ongoing opioid epidemic and the success of OPCs in other areas argues for giving overdose prevention centers a chance to succeed in Massachusetts, especially given the potency of fentanyl in the drug supply. In the 12-month period ending on September 30, 2023, there were 2,323 confirmed and estimated opioid-related overdose deaths in Massachusetts. This represents eight fewer deaths than the same period in the previous year. Throughout all of 2022, the commonwealth saw 2,359 opioid-related overdose deaths – a record. There were toxicology tests performed on 2,120 of the individuals who died by overdose in 2022, and those tests revealed that fentanyl was present in 93% of the cases.

SUPPORT Reauthorization May Advance in House & Senate This Week

The U.S. Senate Health, Education, Labor and Pensions (HELP) Committee has voted to advance several initiatives to prevent and treat substance use disorders. The Substance Use-Disorder That Promotes Opioid Use Recovery and Treatment for Patients and Communities (SUPPORT) Act, S.3393, reauthorizes community-based treatment and recovery programs.

Incorporated within the SUPPORT Act is the Eliminating Opioid-Related Infectious Diseases Act that Sen. Edward Markey (D-Mass.) sponsored. Markey’s bill would fund and expand a Centers for Disease Control and Prevention program to partner with states on education, surveillance, and treatment of opioid-related infectious diseases such as human immunodeficiency (HIV) and hepatitis C.

The HELP Committee also voted to advance the Modernizing Opioid Treatment Access Act that allows board-certified addiction medicine and addiction psychiatry doctors registered with the Drug Enforcement Administration to prescribe methadone. Following the committee vote Markey said, “Methadone for opioid use disorder is locked behind arcane laws that criminalize and stigmatize people in recovery. The experts and evidence are clear: this outdated system is costing lives, and we should no longer stand by as outdated federal law keeps people from treatment they need no matter where they live.”

Also last week, the U.S. House passed it own version of the SUPPORT Act – H.R. 4531. The entire Massachusetts House delegation, except for Rep. Ayanna Pressley, voted aye.

New National Healthcare AI Rule Released

U.S. Health & Human Services (HHS) released a 904-page final rule last week that regulates the use of artificial intelligence in healthcare.

The rule requires companies seeking certification from HHS’ Office of the National Coordinator, to meet certain standards, such as being more transparent about the predictive algorithms they create for use by providers. So, when a provider uses predictive Decision Support Interventions (DSI) – that is, AI to make decisions about the course of care provided to a patient – the company that developed that DSI must be transparent about how they developed the algorithms used. They have to include “exclusion and inclusion criteria” that influenced the data set, and they must describe the external validation process they used to verify it.

The head of the ONC is Micky Tripathi, well known in the Bay State as the longtime president and CEO of the Massachusetts eHealth Collaborative.

The new rule is focused on the provider side of healthcare. AI that health insurers use to determine whether to approve a certain service is not subject to the rule. Insurers’ use of AI is currently the subject of numerous lawsuits, the most recent of which was filed last Tuesday against the large national insurer Humana. Like the recent suits against Cigna and UnitedHealth Group, the case against Humana alleges that the insurer, using a predictive AI tool, routinely overruled the determinations of patients’ doctors, resulting in elderly patients being prematurely discharged from care facilities.

Patient Safety Champion Griswold to Step Down in 2024

Paula Griswold, the executive director of the Massachusetts Coalition for the Prevention of Medical Errors for the past 23 years, has announced she will be stepping down from the position in 2024.

The Coalition, of which MHA is a founding member, was created 25 years ago and has worked to eliminate hospital-acquired infections and other harms through its initiatives with clinicians, as well as with patients and families. The organization has been housed for many years in MHA’s offices in Burlington, Mass., and Griswold has been a valued colleague, source of knowledge, and friend to many at the association.

“Paula is a highly committed and passionate patient and workforce safety leader who has led the Coalition across Massachusetts and beyond for nearly all of its 25-year history,” said MHA’s Vice President of Clinical Affairs Patricia Noga, R.N., PhD. “She steadfastly advocates for safety for patients and the healthcare workforce across all settings of care. Her knowledge and skills as a convener, activist, influencer, and unwavering voice for patient and provider healthcare safety has grown the Coalition and positively affected the healthcare environment across the commonwealth.”

A search is now underway for her replacement using this position description. Candidates who may be interested in the position should contact Griswold at pgriswold@macoalition.org, with subject line “MA Coalition ED Search.” She will send additional information about the position, the organization, and how to follow up.

AHA’s New Program Strengthens Hospital-Community Efforts

The American Hospital Association’s free Hospital Community Collaborative provides instructional videos, learning resources, virtual coaching, a discussion forum, and more in a single online training lab that helps hospitals and health systems collaborate with their community partners.

Those enrolling in the program will have complimentary 90-day access to Metopio’s data analytics platform, which includes metrics on various places and populations and allows users to build the findings into presentations.

While all Massachusetts hospitals and health system currently have vibrant partnerships with community partners, as evidenced by the $904 million they expended on community benefits in 2022, AHA’s Hospital Community Collaborative can help further refine those partnerships.

Transitions

Beth Israel Lahey Health (BILH), led by President & CEO Kevin Tabb, M.D., last week announced changes to its leadership structure. Among the changes, Peter Healy, the current president of Beth Israel Deaconess Medical Center (BIDMC), will continue in that post but take on the role of divisional president, Metro Boston, overseeing BIDMC, Joslin Diabetes Center, Mount Auburn Hospital, and New England Baptist Hospital. Both Tabb and Healy are members of MHA’s Board of Trustees.

Peter Shorett, who most recently served as BILH’s executive vice president and chief strategy officer, has been named to the new position of senior executive vice president and chief operating officer, overseeing the system’s multi-year strategic plan.

Tom Sands will serve as interim divisional president, community care. Susan Moffatt-Bruce, M.D., will continue as president of Lahey Hospital & Medical Center and, along with Healey and Sands, will report to Shorett. Cindy Rios has been named executive vice president and CFO. She has served as interim CFO since 2022.

John LoDico, Editor