Staffer at the Brigham wears the hospital’s new transparent mask
— Photo by Brigham and Women’s Hospital
Brigham and Women’s Hospital, in Boston, has made transparent face masks for workers to wear when caring for patients who are deaf, hard of hearing, or otherwise rely on lip reading.
The seat of local government in Hanover, Mass., where an innovative mobile health program is underway
—Photo by ToddC4176
From The New England Council (newenglandcouncil.com):
As our region and our nation continue to grapple with the Coronavirus Disease (COVID-19) pandemic, The New England Council is using our blog as a platform to highlight some of the incredible work our members have undertaken to respond to the outbreak. Each day, we’ll post a round-up of updates on some of the initiatives underway among Council members throughout the region. We are also sharing these updates via our social media, and encourage our members to share with us any information on their efforts so that we can be sure to include them in these daily round-ups.
You can find all the Council’s information and resources related to the crisis in the special COVID-19 section of our website. This includes our COVID-19 Virtual Events Calendar, which provides information on upcoming COVID-19 Congressional town halls and webinars presented by NEC members, as well as our newly-released Federal Agency COVID-19 Guidance for Businesses page.
Here is the April 15 roundup:
Medical Response
Brigham and Women’s Hospital Researchers Construct New Intubation Device – Healthcare professionals at Brigham and Women’s Hospital have built a new intubation device that limits potential exposure when treating COVID-19 patients. The design was created to be reusable and to protect workers from even microscopic exposure to the virus transmitted through the air by covering a patient’s nose and mouth. WHDH has more.
South Shore Health Launches First Mobile Health Program in Massachusetts – South Shore Health has partnered with the town of Hanover to provide local residents with an innovative mobile health program that offers both testing and health services. Healthcare providers and emergency workers in Hanover will provide at-home testing for those who meet certain criteria or are in vulnerable populations, as well as daily follow-up calls from a volunteer nurse phone bank until infected patients recover. Read more from Boston 25 News.
Economic/Business Continuity Response
IBM Offering Free Computer Systems Training – IBM is offering a free training course on how to code in Common Business Oriented Language (COBOL). States from Kansas to Connecticut still use COBOL in their statewide unemployment systems—now facing increased demand—along with several federal agencies and almost half of United States banking systems. The course is free online and includes a forum where learners can get real-time help from those proficient in COBOL. TechSpot has more.
Boeing Producing Reusable Face Shields in Factories Boeing manufacturing sites across the country are being repurposed to produce reusable face shields to meet the growing demand for protective equipment. Masks will be 3-D printed and distributed to healthcare workers directly exposed to the virus. The aerospace manufacturer has already delivered 2,300 shields and plans to increase output weekly to alleviate strain on existing equipment supplies. Read more from KIRO 7 Seattle
UMass Medical Students Receive New Pandemic Training – As students at the University of Massachusetts (UMass) Medical School are continuing their education remotely because of the pandemic, the Worcester school is now offering a special two-week coronavirus pandemic course. The new class replaces typical hands-on experience with simulations for scenarios that have become common in medical students’ future workplaces, such as navigating telehealth or managing an emergency room with only medical students. Read more in The Worcester Telegram.
Citizens Bank Establishes Small Business Grant Fund – Citizens Bank, in partnership with the Local Initiatives Support Corporation (LISC), is awarding $400,000 in grants to small businesses in Massachusetts. Grant awards are meant to prevent layoffs, avoid insurance gaps, and promote stability in the wake of economic uncertainty. Priority will be given to minority- and women-owned businesses. Read more in MassLive.
Community Response
John Hancock Providing Free Meals to Boston Hospital Staff – To provide assistance to essential healthcare workers exposed to the novel coronavirus, John Hancock is partnering with nonprofit Off Their Plate to donate 8,500 meals to workers in Boston hospitals. The meals will be prepared by a variety of restaurants in the city to support restaurants and their staff as they face their own revenue losses. Read more from PR Newswire
Brigham and Women's Hospital, in Boston, tries to stop dangerous 'tailgating.'' Read about it by hitting this link.
By SHAFALI LUTHRA
For Kaiser Health News
For the past six years, Mardi Chadwick has run a violence prevention program at Boston’s Brigham and Women’s Hospital. The program’s goal is to address broader, community-based health issues and social problems that make people ill or prone to repeated injury from gunshots, stabbings or environmental causes.
In Chadwick’s view, this endeavor — almost from its inception — made a big difference in nearby neighborhoods. But its profile in the eyes of hospital administrators got a boost from an Affordable Care Act provision that required nonprofit hospitals to conduct triennial assessments of local health needs and devise strategies, updated yearly, to address them. Falling short would trigger a financial penalty.
“Everyone, all of a sudden, cares about the social determinants of health,” she said. “Our expertise is being brought in. … We have a bigger seat at the table.”
But will programs like this one continue to get such attention? As the GOP-controlled Congress works to scrap Obamacare, the answer is uncertain.
Requiring this “community health needs assessment” was part of a broader package of rules included in the health law to ensure that nonprofit hospitals justify the tax exemption they receive. Another directive was that these facilities establish public, written policies about financial assistance available for medically necessary and emergency care and that they comply with limits on what patients who qualify for the aid can be charged.
These requirements add to the ongoing controversy about whether all nonprofit hospitals do enough to deserve a tax break. People on one side of the issue view the assessment rule, for instance, as an undue, unfunded burden while others say it doesn’t do enough. So far, though, the community health assessment requirement hasn’t exactly been a hot topic in the repeal-and-replace debate and was not addressed by the House Republicans’ health plan unveiled March 6.
Sen. Chuck Grassley (R.-Iowa), who has long urged that more scrutiny be applied to nonprofit hospitals’ tax status, championed the provision. His spokeswoman said he will continue to advocate that it remains in effect in whatever new health policy plans emerge. Regardless, the financial uncertainty of any overhaul of the health law could undermine some hospitals’ efforts.
The decades-old nonprofit tax status, granted by the Internal Revenue Service to institutions that meet the “community benefit” standard, spares hospitals from paying federal taxes and is collectively worth billions of dollars. Nonprofit hospitals have generally cited the uncompensated or “charity” care they provide, as well as initiatives they undertake to promote public health, as sufficient proof that they earn their tax exemption. But for-profit hospitals, which do pay taxes, cry foul, saying they make similar contributions.
The new requirements overall were meant to hold nonprofits to a higher standard — and penalize those that didn’t deliver. Under the law, hospitals that fail to complete the assessment and implementation strategy face a $50,000 fine — which can seem small next to their overall operating budgets. But down the line, the penalties can accumulate and ultimately could jeopardize their valuable tax exemption.
Meanwhile, federal data show that as recently as 2011 nonprofit hospitals targeted less than 10 percent of their operating expenses to benefit the community — this includes charity care, unreimbursed costs from Medicaid and other government programs and medical research and education. Less than 1 percent went to community health improvement services like Chadwick’s.
Advocates hoped the health law would change this. The idea was to push nonprofit hospitals to invest more in public health initiatives that do not directly earn them money — giving such programs more value on the balance sheet. But it’s hard to gauge whether that’s happened.
“You can find hospitals that have done this. But … are we seeing a real shift in the hospital community? Or are these a few hospitals that are outliers?” said Gary Young, director of the Center for Health Policy and Healthcare Research at Northeastern University. “We’ve asked them to make a sea change in how they’re doing things. And that can’t happen overnight.”
Part of the problem, analysts say, is that the underlying idea — reaching into the community to help people navigate the social and economic factors that can influence health — goes beyond what hospitals have traditionally viewed as their mission. Despite the potential for long-term payoff, administrators tend to focus on the immediate questions: How many beds are full? What medical services are being provided? How are they doing with their operating budget?
“It’s a new world out there in terms of the hospital not being the center of the universe,” said Lawrence Massa, president of the Minnesota Hospital Association, the state’s hospital trade group, which has been tracking hospital response to the health assessment requirement.
Initially, they found the money nonprofit hospitals put toward “community needs” went up after the assessment requirement: from about $355 million in 2011 to $459 million in 2013, according to an analysis by the association. (The needs assessment requirement took effect in between, for the tax year starting after March 2012.) But the increase leveled off in 2014 — the most recent year for which data are available.
Massa’s conclusion: Caring for the health of people before they come into the hospital is unfamiliar territory. Not everyone took naturally to it. “We saw some communities that embraced this, and did a nice job. … In other communities, there’s been friction between public health and the acute setting — and lack of understanding.”
With continued time and sustained emphasis, that could have changed, said Sara Rosenbaum, a professor of health law and policy at George Washington University.
But now? Even if the community benefit requirements remain intact, she and others fear this accountability effort could take a hit. Repeal of the health care law is likely to create fresh financial challenges for hospitals. For instance, although the House GOP’s American Health Care Act would restore some of the uncompensated-care funding cuts hospitals absorbed under the ACA, the coverage changes proposed in Republicans’ plan could mean tens of millions more uninsured people.
That scenario, policy experts and trade groups say, would increase the amount of free care nonprofit hospitals provide, creating new budget pressures that could lead them to tamp down on efforts to promote community health work.
“We could be right back in a situation where there is a fair amount of charity care, and that could become a large component of how hospitals are justifying their nonprofit status,” said Ken Fawcett, a physician who runs a community health worker initiative at Spectrum Health in Grand Rapids, Mich.
Meanwhile, the health assessment’s impact has been evident at Boston-based Massachusetts General Hospital. There, administrators used it to devise an intervention strategy around drug abuse — partnering, for instance, with local schools and community organizations, and hiring former addicts to help patients navigate recovery.
“There’s no question the Affordable Care Act required us to bump up our game,” said Joan Quinlan, its vice president for community health. If people lose coverage, she added, hospitals will increasingly argue that’s enough reason for a tax break. It could stifle efforts to promote more substantial community benefit.
“If the ranks of the uninsured or underinsured grow, then charity care will increase. And the ability to do some of these more creative downstream efforts will be hampered,” she said. “There might be heightened awareness. But if there aren’t resources to address them, it’s going to be hard.”
