Health system turns slowly back to preventative care
Photo | Grant Welker
Saint Vincent Hospital in Worcester
Hospitals and community health centers that meet certain criteria will be able to resume offering a limited set of non-emergency services on Monday under the first phase of the state's reopening plan, but many types of care still remain on hold.
As long as they attest to safety standards and capacity levels, hospitals and health centers can on Monday begin offering "high-priority preventative services" like pediatric care, immunizations and screenings for at-risk patients, along with urgent procedures for conditions that would worsen significantly if left untreated.
"These services are intentional to meet the needs of high risk populations, including communities of color and our children," Health and Human Services Secretary Marylou Sudders said at the press conference where Gov. Charlie Baker unveiled a four-phase plan for reopening Massachusetts from the widespread shutdowns put in place to mitigate spread of COVID-19.
Non-hospital providers will be able to offer the same set of high-priority services starting May 25.
Hospitals are already open and likely ready to expand care, according to the state's health reopening plan, while individual clinics and other providers that have been closed may need more time to ramp up. A March 15 Baker administration order mandated that Massachusetts hospitals cancel non-essential elective procedures, and providers have been encouraged to deliver care through telehealth whenever possible.
"I cannot emphasize enough the importance of continuing telehealth," Sudders said. "Providers should continue to maximize it and provide services virtually wherever possible, and appropriately."
Elective procedures typically make up a significant portion of hospital revenues, and many hospitals have experienced a financial squeeze even as they built up their capacity to care for COVID-19 patients.
Hospital reopenings are contingent on bed availability, both statewide and at the individual hospital level, and providers must attest to meeting a set of requirements that include screening and testing protocols for both patients and employees, infection control plans and adequate levels of personal protective equipment on hand. For hospitals, that means a 14-day supply.
The types of care that can resume in the first phase include pediatric visits, substance use disorder treatment, post-operative physical therapy, chronic disease management visits, placement of implantable contraception, biopsies for potential cancer, and in-person exams for new "concerning symptoms" like chest pain or blurred vision, according to a presentation laying out the state's approach to reopening health and human service providers. Providers are also able to use their clinical judgement to determine what services are allowed.
Routine preventative visits -- including annual exams for adults, eye exams and dental cleanings -- are on the list of care that should not resume in the initial reopening period, along with all cosmetic surgeries, most elective joint replacements, tonsillectomies, in-person group behavioral health care, and most physical therapy or chiropractic care.
Sudders said anyone with non-emergency care needs should call their health care provider to figure out next steps.
Dr. Maryanne Bombaugh, president of the Massachusetts Medical Society, said the state's guidelines "rightfully prioritize the safety of individuals above all while increasing access to high-priority preventive care and other urgent procedures and services."
"The expansion of medical practice must proceed in a collaborative manner among patients, physicians, policymakers, and all who engage with and comprise the health care system," Bombaugh said. "The pace and direction of expansion must be flexible and adhere to best practices in safety, infection control, and public health."
The Massachusetts Health and Hospital Association called the ability to reintroduce high priority services "a great step for Massachusetts providers and our patients," noting that there is still more work to do to fight COVID-19.
As of Sunday, 2,597 COVID-19 patients were hospitalized across Massachusetts, including 702 in intensive care units. The number of COVID-19 hospitalizations is one of six key indicators officials plan to watch as the state moves through its reopening plan, as is the overall readiness of the health care system.
The health reopening plan advises that pediatrcians prioritize catching up children on scheduled vaccines that they have missed and be sure to screen for social needs, behavioral health concerns, child abuse and domestic violence. The plan says there has been a "precipitous drop" in both vaccines and reports of possible child abuse and neglect during the COVID-19 emergency, citing a 60 percent decline in state-supplied vaccine orders and a roughly 50 percent decline in abuse and neglect reports.
Like other workplaces that are reopening, health care providers will need to implement a new set of standards to reduce the risk of infection, including ensuring social distancing to the maximum extent possible. If possible, patients will be asked to wait outside until their appointment begins to minimize the amount of time spent in waiting rooms.
Providers and staff will need to wear surgical face masks at all times. Patients and their companions will also need to have their mouths and nose covered, though a provider can choose to waive that requirement under special circumstances.
Tim Foley, executive vice president of the health care workers union 1199SEIU, said a safe reopening requires having "adequate PPE on hand that does not rely on reuse and decontamination but on a stable and reliable supply chain." Foley said there should also be free COVID-19 testing accessible to all health care workers.
Hospitals must create "non-COVID-19 care zones" in their facilities if possible, under the plan, and all acute care hospitals will be required to establish a governance body to monitor compliance with capacity, public health and safety standards. Those panels will need to include senior hospital leadership and labor representatives.
"Because healthcare facilities are under pressure to recoup lost revenue and quickly ramp-up elective and other non-emergency procedures, it is critical the state closely monitors their adherence to safety standards and heeds the advice of frontline healthcare workers," Massachusetts Nurses Association President Donna Kelly-Williams said in a statement.
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