INSIDE THE ISSUE

> Transfer Challenges
> MHA’s New Website
> 9/29 CARe Event
> BILH-Legal Group Partnership
> 10/25 Pediatric Conference
> Noga for AONL President-Elect

MONDAY REPORT

Concerns About Patient Transfers in Coming Months

MHA’s latest (July) Throughput Survey Report showing the number of patients awaiting discharge from an acute care hospital to post-acute care shows little change from the previous month, but a confluence of issues not reflected in the report paint a disconcerting picture for the upcoming months.

The July report shows 722 patients across the state awaiting discharge from an inpatient bed to either an inpatient rehabilitation facility, long-term acute care hospital, skilled nursing facility (SNF), or home care service. That’s slightly lower than the 755 patients in the June report.

As fall approaches, the numbers are expected to rise for a variety of reasons. First, the resurgence of flu and uptick in COVID-19 coupled with increases of respiratory syncytial virus (RSV) will inevitably drive-up volume in acute care hospitals and, subsequently, the post-acutes.

More importantly, discharge and transfer flexibilities that have been in place during the pandemic have ended. Most notably, Medicare’s “three midnight rule” is now being enforced, which means that before Medicare will cover services provided in a SNF, the patient is required to spend at least three consecutive midnights of inpatient care in an acute hospital setting. Having that rule waived during the past three years provided some measure of assistance to acute care hospitals attempting to quickly coordinate patient transfers to SNFs.

Patient transfers to SNFs have been assisted throughout the past few years by the state’s creation of a short-term rehabilitation capacity program in all regions of Massachusetts. That program provides additional resources to SNFs that are then required to accept all hospital referrals for short-term care if they have the capacity to accept patients. The hospital community has been grateful for the efforts from the state and SNFs to address the issue. However, the state plans to taper down this program in the coming months.

“Given the upcoming changes, we are especially concerned about the inevitable rise in patients who need long-term care beds in skilled nursing facilities,” said MHA’s Senior Director of Virtual Care & Clinical Affairs Adam Delmolino. “Currently 238 patients are waiting for long-term care beds and of those 238, 104 have dementia diagnoses and 56 have behavioral health diagnoses, in addition to the 42 who are awaiting the appointment of guardian or conservator by the courts. We anticipate that the temporary lull in patients awaiting discharge that we saw this summer is just that – temporary. We want to ensure that patients are able to be discharged from the hospital when they are ready to move to the next most appropriate level of care.”

MHA’s “A Clogged System: Keeping Patients Moving Through their Care Journey” from June 2023 provides a cogent view of the throughput issue.

MHA Unveils New Website

MHA has launched a new, streamlined, and easier-to-navigate website (available the same URL: mhalink.org).

The re-designed site contains an Issues & Advocacy section, where viewers can easily track MHA’s latest public policy efforts. MHA’s priority bills are laid out by category across the State Issues pages.

A faster, more cohesive Education section allows visitors to more easily view past events and search for education opportunities by category.

A Key Resources section allows members and the public to find all of MHA’s reports in one place. This includes MHA’s recent reports to illustrate the pressures facing the healthcare system, as well a weekly log of MHA’s Behavioral Health Boarding Reports, and a monthly log of MHA’s Throughput Reports.

Anyone can access this publication, Monday Report, without having to log in, as well as find the latest resources and initiatives on care delivery, the healthcare workforce, and health equity.

Let us know if you’d like help finding anything or have any suggestions by e-mailing communications@mhalink.org.

September 29: Register for the Annual CARE Forum

Register for the 10th Annual Communication, Apology, and Resolution (CARe) Forum scheduled for Friday, September 29 from 10 a.m. to 12:30 p.m. The forum will feature existing communication and resolution programs, simulations of real CARe cases, and discussions with those who have implemented the CARe model at their organization. The event is hybrid, and there is no cost to attend. For those joining in person at 501 Boylston Street, 5th Floor, in Boston, registration begins at 9:30 a.m. and lunch will be provided after closing remarks. Register for the in-person event here, or attend online here.

BILH & Lawyers Group Launch Medical-Legal Partnership

Beth Israel Lahey Health (BILH) and Lawyers for Civil Rights (LCR) have announced a partnership that will provide free legal support to low-income patients in an effort to address health equity and expand healthcare access for patients living in under-resourced communities. The program will begin at Beth Israel Deaconess Medical Center.

Patients in need – especially those with disabilities or who are underinsured and struggling with medical costs – will receive free legal assistance from representatives of LCR’s HealthJustice Project, who will be embedded in select primary care practices.

“Together, the medical and legal team will identify and address legal issues with the goal of empowering patients to live healthier lives and improve health outcomes,” according to a BILH media release. “In collaboration with the patient’s care team and other providers, LCR will engage in a broad range of holistic advocacy efforts—representing patients in court, negotiating with landlords, advocating before administrative agencies—all with the aim of improving health outcomes by addressing a broad range of health-adjacent issues. The partnership will focus on tackling poverty, housing insecurity, discrimination, and immigration issues.”

October 25: Pediatric Immunization Conference

Sign Up for October The Massachusetts Immunization Action Partnership (MIAP) holds its 28th annual pediatric immunization skills building conference on Wednesday, October 25 from 8 a.m. to 4 p.m. The conference will be hybrid in nature, with the in-person events held at the DCU Center in Worcester; in-person spots are limited and MIAP encourages early sign ups by registering here.

The conference will review current ACIP recommendations, provide updates on state immunization efforts and the respiratory syncytial virus (RSV) infection, and feature the story of how two staunch anti-vaxxers returned to the science fold. There will be breakout sessions on vaccine storage and handling, optimizing clinical workflows, and challenging immunization scenarios. View the fill agenda, speaker lineup, and fees at the link above.

Vote for AONL President-Elect Ends September 12

Voting for the next president-elect of the 11,000-member American Organization for Nursing Leadership (AONL) ends next Tuesday, September 12. Among the four candidates for the post is MHA’s Vice President of Clinical Affairs Patricia Noga, R.N., PhD. Noga is a longtime board member of the Organization of Nurse Leaders – MA, RI, NH, CT, VT, and currently represents Region 1 (New England) on the AONL Board.

Visit Noga’s campaign website to see the list of healthcare leaders who have endorsed her candidacy, as well as her views on her four key priorities for AONL – mental health and wellbeing; diversity, equity, inclusion, and belonging; safe and healthy workplaces; and supporting the next generation. And if you are an AONL member, cast your vote here.

John LoDico, Editor