Massachusetts orders hospitals to cut nonurgent procedures by 50%

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The Commonwealth of Massachusetts has decreed that hospitals with limited capacity cut their nonurgent procedures by 50% starting Wednesday, December 15, in response to ongoing staffing issues.

Republican Governor Charlie Baker's administration said the move was prompted in part by a critical staffing shortage which has contributed to the loss of approximately 500 medical/surgical and ICU hospital beds. Hospitals are also seeing a high level of patients, which the administration said is mostly due to reasons not related to COVID-19.

On November 23, the Department of Public Health (DPH) released guidance to hospitals to reduce certain nonessential, elective services and procedures by 30%. Late last week, the number was amended to 50%.

In a bid to assure hospital inpatient capacity, the DPH has also issued a COVID-19 Public Health Emergency Order that provides hospitals flexibility with respect to ICU nursing staff ratios, as well as guidance that permits hospitals to create capacity in alternate spaces.

WHAT'S THE IMPACT?

The guidance, according to the Commonwealth, provides additional tools to support acute care hospitals facing critical workforce and capacity constraints.

Added flexibility relative to staffing ratios will presumably allow hospitals to redirect ICU nurses to other inpatient beds currently not being utilized due to staffing constraints, as well as to staff roles that help to reduce or prevent hospitalizations. To ensure patient safety and quality of care, hospitals and hospital systems implementing these flexibilities will be required to meet certain criteria as outlined in the order and guidance to determine safe ICU staffing levels.

To assure capacity, DPH released updates to alternate care space guidance, giving hospitals flexibility to use licensed and unlicensed space for non-invasive outpatient care. Previously, this was limited to COVID-19 vaccination, flu vaccination, and the administration of monoclonal antibody therapies.

The updates also allow hospitals to use alternate licensed inpatient spaces to care for medical/surgical and ICU adult patients through March 31, 2022. Without that step, the flexibility would have expired on December 31.

THE LARGER TREND

Variants, including Delta and Omicron, and the unvaccinated are driving a nationwide surge in the number of COVID-19 cases. This increase, combined with staffing shortages, is overwhelming many hospitals. Some nurses who are mandated to get vaccinated have threatened to leave their jobs.

Due to the surge, Utah-based Intermountain Healthcare said in September it is postponing all nonurgent surgeries and procedures requiring a hospital admission in its trauma and community hospitals. Staff is needed for the ICUs and acute care units, Intermountain said. COVID-19 cases have continued to significantly increase in Utah – resulting in consistently high volumes in hospital ICUs and acute care units across the system.

Then earlier this month, the Cleveland Clinic, including MetroHealth and University Hospitals in Cleveland, Ohio, said it would be postponing some surgeries due to a spike of COVID-19 cases in the area, turning the clock back to the height of the pandemic, when many facilities placed a freeze on elective procedures.

If the move to delay some procedures is a foreshadowing of things to come nationally, hospital finances could be affected significantly. In July 2020, American Hospital Association president and CEO Rick Pollack, pulling from Kaufman Hall data, said the cancellation of elective surgeries was among the factors contributing to an industry-wide loss of $120 billion from July to December 2020 alone. When including data from earlier in the pandemic, the losses were expected to be approximately $323 billion.

ON THE RECORD

"Our healthcare community remains under tremendous pressure, and these flexibilities will provide hospitals with additional tools to remain nimble and accessible as they navigate the weeks ahead," said Steve Walsh, president and CEO of the Massachusetts Health and Hospital Association.

"MHA and our members are grateful for the ongoing coordination with the Baker-Polito Administration, which has empowered healthcare organizations to respond in real time and with swift action over the past 21 months. Patients should know that their hospitals and care teams are there for them, just as they have been over the course of the pandemic."
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com