A New Guidance For Non-Opioid Pain Management and more...

Smuggling Drugs Into Hospitals?

One aspect of the opioid crisis that is affecting the hospital community specifically involves patients caught so firmly in the grip of substance use disorder that while they are being treated, the patients are either having their friends or family smuggle illicit drugs into the hospital, or they are leaving the beds to get their drugs from the streets surrounding care facilities.

MHA, working at the suggestion of one of its trustees -- Deeb Salem, M.D., physician in chief and chair of the department of medicine at Tufts Medical Center -- last week sent out a call asking hospitals to send MHA any policies they may have on the issue.  That is, how do hospitals identify and help patients with substance use disorder avoid the symptoms of opioid withdrawal while hospitalized? Do hospitals search patient rooms? Do they enter into “opioid patient contracts”? Do they attempt to limit contacts with recovering patients or monitor friends bringing items into a patient’s room?

MHA discussed the issue with its Physician Leadership Council and then with the MHA Board of Trustees, both of whom endorsed the information gathering step as a prelude to MHA compiling best practices and, potentially, creating a template for all hospitals to follow.

MHA’s VP of Clinical Integration Steven Defossez, M.D. is heading up the association’s effort. 

A New Guidance For Non-Opioid Pain Management

MHA, through a collaboration with Mallinckrodt Pharmaceuticals and Beth Israel Deaconess Hospital – Plymouth, helped develop, and will issue, provider guidance for implementing a comprehensive pain stewardship program (PSP) within healthcare facilities.

The PSP guidance provides hospitals with best practices for using multimodal analgesia-based acute pain care, which is a non-opioid treatment. Using a multimodal analgesia reduces both opioid use and length of stay. The PSP guidance provides evidence-based pain management tools to assess and improve current hospital protocols and identify areas for improvement.

MHA’s Substance Use Disorder Prevention and Treatment Task Force (SUDPTTF), consisting of substance use disorder experts and physicians from across the state, created guidelines for opioid management within a hospital setting. Recommendation #6 from the guidelines calls on facilities to develop a comprehensive pain stewardship program to ensure proper internal controls to appropriately manage patient populations. Every Massachusetts acute care hospital has signed a commitment letter to work on adopting the recommendations in the MHA guidelines.

The PSP Guidance materials were developed with the clinical input and assistance of a subset of SUDPTTF members led by John Connolly, VP of medical management and chief of the anesthesia service at Beth Israel Deaconess Hospital – Plymouth.

A Unified Hospital-Political Front Against NIH Cuts

The benefits of funding from the National Institutes of Health run from seeding the research that helps cure disease to strengthening the national life sciences sector. The benefits associated with  cutting  NIH funding by 18% or $5.8 billion, as President Donald Trump has proposed in his first budget, are harder to pin down.

Trump’s Health & Human Services Secretary Tom Price says the NIH cuts will target “inefficiencies” and “overhead payments” universities, hospitals, and research facilities receive.

But on Thursday, opponents of the cuts – including members of the state’s congressional delegation, Boston Mayor Marty Walsh, and hospital leaders – attended a forum at Dana Farber Cancer Institute to say the proposed NIH cuts are destructive. The event was hosted by Mayor Walsh and the Conference of Boston Teaching Hospitals (COBTH).

Senator Edward Markey attended along with Representatives Michael Capuano, Katherine Clark, and Joseph Kennedy.  They were joined by the following MHA-member hospital CEOs: Sandra Fenwick (Boston Children’s Hospital); Laurie Glimcher, M.D. (Dana Farber); Elizabeth Nabel, M.D., (Brigham and Women's Hospital); Peter Slavin, M.D. (Massachusetts General Hospital); Peter Healey (Beth Israel Deaconess Medical Center); Kate Walsh (Boston Medical Center); Michael Wagner, M.D. (Tufts Medical Center); and John Fernandez (Massachusetts Eye and Ear).

The hospital leaders said they would undertake a grassroots campaign to both educate policy makers on all the components of NIH funding (including administrative costs), as well as reach out to peers across the U.S. to urge them to contact their members of Congress. They said that would begin contacting the network of U.S. medical personnel that have either studied or had residencies in the Boston area, in the hope that the effort to save NIH funding can reverberate through the U.S.

Harrington Closes One Door, Opens Another At UMass 

In an era of increasing pressure on costs and quality improvement, Harrington Hospital announced recently that it resolved two pressing issues with a “best-of-both-worlds” solution. The Southbridge, Mass. hospital had been facing staffing difficulties, low-birth volume and a $3-4 million annual cost in running its family birthing center. The closure of the center was necessary (issue one) but Harrington was able to cover the pending coverage gap (issue two) by entering into an agreement with UMass Memorial Healthcare. Under the agreement, three Harrington OB/GYNs will become employees of the UMass Memorial Medical Group, Inc. and will join delivery call rotation there. These providers will continue to manage their current patient panel as well as new obstetrics and gynecology patients at two co-branded satellites within the Harrington service area.

Ed Moore, Harrington’s president & CEO, said he understands his community’s concerns with losing Harrington Hospital’s Family Birthing Center, but added, “Our patients will still be able to stay local but now they can get their deliveries done in a tertiary center with a neo-natal ICU.”


Last week’s  Monday Report  incorrectly identified the interim director of Health Care For All between the time the previous director left in September 2016 to the recent naming of new Executive Director Amy Rosenthal.  Steve Rosenfeld was the interim during most of the search process.

John LoDico, Editor