New Coalition on Staffing, Senate Tax Bill, and more...

Coalition Launched to Oppose Nurse Staffing Ballot Question

Nurses and hospital leadership groups last Tuesday announced the launch of the Coalition to Protect Patient Safety to protect the state’s healthcare system and its patients from the costs and consequences of a ballot question promoting rigid, government-mandated nurse staffing ratios. The question is expected to be placed before voters at the November 2018 election.

The Coalition was registered with the state Office of Campaign and Political Finance to counter a proposed ballot question that would threaten patient care, significantly increase healthcare costs, and endanger the viability of community hospitals. The ballot was filed by  the Massachusetts Nurses Association (MNA), which represents less than 25% of the registered nurses in the state.

“Nurses throughout Massachusetts are trained to make real-time decisions about patient care,” said Pat Noga, R.N., FAAN, MHA’s VP of clinical affairs. “This ballot question strips away nurses’ ability to be flexible and adjust to life and death situations. It will completely undermine their input and expertise, and make them interchangeable parts in a healthcare system run by government bureaucrats.”

The petition would require that hospitals across the state, no matter their size or specific needs of their patients, adhere to rigid nurse staffing ratios within all patient care areas.

Amanda Stefancyk Oberlies, R.N., CEO of the Organization of Nurse Leaders (ONL), said the ballot question “will force many hospitals to reduce critical services and will dramatically increase emergency room wait times. Further, there are no scientific studies or reports that demonstrate the effectiveness of this one-size-fits-all staffing requirement improving quality of care.”

The petition would create an unfunded mandate that requires hospitals to meet these ratios “without diminishing the staffing levels of [their] healthcare workforce,” severely limiting hospitals’ ability to support the required additional nursing workforce, and endangering the viability of smaller community hospitals. The measure will cost the state more than $880 million each year. Patients will feel the costs through higher premiums, deductibles and taxes. Hospitals will be forced to cut vital health programs, such as cancer screenings, opioid treatments, mental health services, early childhood intervention, domestic violence programs and pre- or post- natal care.

The MNA has pushed mandated staffing ratios at the State House for more than 20 years without success. In fact, despite being considered at length in dozens of states, mandated staffing ratios have only been adopted in California, with no evidence that they have improved quality of care.

 “This narrow and reckless initiative is not supported by the state’s leading healthcare organizations, and will do nothing to improve the quality of care for patients at our hospitals,” said Steve Walsh, MHA President & CEO. “We hope that voters across Massachusetts will join us in defeating this dangerous measure in 2018.”

The Coalition to Protect Patient Safety’s membership includes MHA, ONL, the Massachusetts Council of Community Hospitals, the Conference of Boston Teaching Hospitals, and other healthcare leaders.

Current, and Future, Tax Bill Concerns

The House and Senate tax bills now moving to conference committee each contain provisions that are of great concern to hospitals. And the increase to the federal budget deficit that the $1.5 trillion in tax cuts will generate may affect future funding of the Medicaid and Medicare programs, according to Republican legislators that crafted the bills.

The Senate bill, but not the House’s, contains a provision to repeal the Affordable Care Act’s individual mandate. MHA, the American Hospital Association, and others members of the Coalition to Protect America’s Health Care oppose eliminating the individual mandate as it would increase the rate of uninsured and raise premiums in the  non-group health insurance market. (Massachusetts residents 18 years of age and older would still be subject to the state individual mandate, which was introduced as part of the state’s 2006 healthcare reform law.)

Hospitals also oppose the House bill’s elimination of the tax exemption for private-activity bonds, which are an important source of low-cost capital that hospitals need for facility improvements that, in turn, are needed for safe patient care. Hospitals are similarly opposed to the repeal of the tax exclusion for interest on tax-exempt advance refunding bonds, which is included in both the House and Senate bills.

The House bill eliminates taxpayers’ ability to itemize deductions for large medical expenses, while the Senate bill does not eliminate deductibility for medical expenses, but lowers the threshold for medical expense deductions from 10% to 7.5% for two years. Hospitals have weighed in with opposition to both provisions.

The Republican bills – no Democrats in either the House or Senate voted “aye” – would increase the federal deficit by $1 trillion over 10 years, according to the Joint Committee on Taxation. Even Republicans who say the bill will spur economic growth generally agree with that deficit figure. To reduce the deficit, the GOP says, Congress must cut spending especially among the so-called “entitlement programs” – Social Security, Medicare, and Medicaid. House Speaker Paul Ryan (R-Wisc.) and Sen Rand Paul (R-Ken.) recently made comments about the need to restructure the federal programs. 

MHA’s Congressional delegation has actively opposed the bills and Rep. Richard Neal (D) has been named a House member of the conference committee.

Last Friday, MHA sent this letter to the delegation thanking them for their past support on the tax issues and outlining the areas of concern for hospitals and healthcare. In that letter, MHA President & CEO Steve Walsh wrote, “We believe that if you talk with Massachusetts business owners throughout the state they would say any tax bill that undermines the financial stability of their local hospital, increases the cost of health insurance, and reverses the strides we have made in reducing the number of uncovered residents cannot be seen as economically beneficial for their communities. We urge you to keep in mind that the provisions in the legislation would occur in an environment where hospitals are already operating within increasingly burdened Medicare and Medicaid programs and existing sequester cuts.”

Moody’s Outlook for Hospitals is Bleak

As the Senate tax bills raise concerns among hospitals about the potential for increased numbers of uninsured and constrained access to capital, a major rating service issued an opinion last week cautioning that hospitals are facing uncertain finances in the months ahead.

Moody’s Investors Service last Monday issued a negative outlook report on the non-profit healthcare and hospital sector, predicting that operating cash flow will decrease over the coming year by 2-to-4%.

Moody’s said hospital volume is increasing but reimbursement rates are low and bad debt is rising.

“Bad debt will grow in 2018 with high deductibles, rising copays, and contracting exchange enrollment because of changes in federal marketing,” Moody’s wrote, adding, “Uncertainty around the Affordable Care Act (ACA) makes it very difficult for hospitals to effectively plan and model long-term strategies. Recent federal tax proposals will also contribute to rising costs for hospitals.”

A Renewed Focus on Dementia Care in Massachusetts

Healthcare groups around the state, including MHA, are redoubling their efforts to address dementia care.

Chapter 228 of the Acts of 2014 created a dementia care advisory committee to, among other things, “craft a strategy to address dementia-capable care in all acute care settings in the commonwealth.” Two MHA-nominated representatives served on that committee, which began meeting in December 2016.  And MHA conducted a membership survey to help understand the specific type of dementia-related care provided within emergency departments and inpatient units.

Concurrently, the Dementia Friendly Massachusetts Initiative began to coalesce after a leadership summit in May 2016. The goal has been to create dementia friendly communities that engage all sectors of a community to create safe and respectful places for people living with dementia. Dementia Friendly Massachusetts Initiative is co-convened by the Executive Office of Elder Affairs and Jewish Family & Children’s Service and is supported by the Tufts Health Plan Foundation.  MHA has participated in stakeholder meetings of the group.

In addition, MHA has met with the Alzheimer’s Association to be introduced to its Dementia Care Coordination Program and to its array of resources available to care providers and to the public.  In the coming months MHA will be convening its own workgroup to gather member expertise on the issue, develop best practices for hospitals to follow, and recommend strategies to implement the advisory committee recommendations.

“While the medical component of fighting Alzheimer’s and dementia continues, there’s another struggle occurring to ensure patients and their families are treated with dignity – not only within a hospital’s walls but throughout the care continuum and throughout the community,” said Pat Noga, R.N., FAAN, MHA’s VP of clinical affairs. “MHA is involved with the many committed organizations who are attempting to change the way we are collectively coping with a very challenging healthcare issue affecting more than 120,000 Massachusetts residents.”

Opioid Crisis Results in Spike of HIV Infections

The opioid crisis has generated another public health concern: DPH notified providers last week that it has noticed an increase in HIV infections in people who inject drugs.

From January 1 to November 21, there have been 64 HIV infections reported among individuals who inject drugs in Massachusetts, representing 14% of all HIV infections reported this year, DPH said in a clinical advisory.

Those reports run counter to data from the past 5 to 10 years, where new HIV cases resulting from injectable drug use represented “a stable proportion of 4-8% of all reported HIV infections,” DPH wrote, adding “Investigation of cases is ongoing.”

DPH said the potential for a wider-ranging problem exists, noting a four-month 2015 outbreak in Indiana of 180 new HIV infections caused by one HIV-infected individual introduced into a needle-sharing network.

DPH is asking for increased vigilance among providers, including: remaining alert to the potential for HIV infection and offering HIV testing to anyone reporting injection drug use; following current federal guidelines for HIV testing; and reporting all new cases of HIV to DPH.  Read the DPH Clinical Advisory here for full details.

Transforming Healthcare to Be Inclusive of LGBTQ Patients

Wednesday, January 10, 2018; 9 a.m. – 12 p.m.
MHA Conference Center, Burlington, Mass.

Caring for specific populations – and ensuring that they are receiving equitable, high-quality care – can be daunting in today’s fast-paced environment. Despite the challenges, the effort to eliminate population-based health disparities is critical. This program will help practitioners have a better understanding of the needs of LGBTQ patients. We will review basic principles of practice transformation, LGBTQ-specific health disparities, and steps to take to ensure that all receive access to high-quality, equitable care. Issues affecting both organizational structures, systems, and interpersonal communications will be described, including involvement of both leadership and staff. We’ll look at how to collect data to learn patient needs, and describe examples of how to communicate affirmatively with patients about their care. We hope you’ll join us at this timely program. View speaker list and registration details here.

John LoDico, Editor