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Mass. Reopening Plan Allows Limited Expansion Of Non-Emergency Health Care Services

The Lynn Community Health Center. (Jesse Costa/WBUR)
The Lynn Community Health Center. (Jesse Costa/WBUR)

Part of the "new normal" that Gov. Charlie Baker outlined in his coronavirus reopening plan involved a limited expansion of non-emergency health care services.

The first phase of the governor's plan, which began in part Monday, allows for hospitals and community health centers to provide some preventative care, pediatric care and treatment for high-risk patients, so long as those facilities meet certain requirements.

The types of care where in-person visits can resume includes some cancer screenings and biopsies, substance use disorder treatment, some physical therapy, chronic disease management visits and implantable contraception. Providers are to use their discretion as to whether and when an in-person visit is required.

"These services are intended to meet the needs of high-risk populations, including communities of color and our children," state Health and Human Services Secretary Mary Lou Sudders said at a press conference Monday. "I cannot emphasize enough the importance of continuing telehealth. Providers should continue to maximize it and provide services virtually whenever possible and appropriate individuals with non-emergency needs should call their health care provider to determine next steps."

Many providers praised the governor for slowly reopening, and including a continued monitoring of health care facilities as a metric for the plan's pace.

"The re-opening plan outlined today carefully balances the protection of public health with the need to begin transitioning into a new normal," the Massachusetts Health and Hospital Association said in a statement. "The Massachusetts healthcare community supports the Governor’s efforts and we look forward to our continued partnership, driven by the wellbeing of the commonwealth’s patients, as we move into the next phase of our recovery."

The Massachusetts Medical Society commended the administration for guidelines that "rightfully prioritize the safety of individuals above all, while increasing access to high-priority preventative 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," said Massachusetts Medical Society president Dr. Maryanne Bombaugh. "The pace and direction of expansion must be flexible and adhere to best practices in safety, infection , control and public health."

In order to provide non-emergency care, facilities must follow public health standards, meet certain capacity requirements and have a sufficient supply of personal protective equipment that does not rely on the state stockpile. Hospitals must have at least 30% of their ICU bed capacity open to begin seeing non-emergency patients. (For more on hospital and ICU capacity, see our maps and charts here.)

The Massachusetts Nurses Association — the union representing most nurses in the state — said it hopes the state monitors health care facilities during this phase of the reopening to make sure that patient limit requirements are followed.

“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 front line health are workers," nurse and MNA president Donna Kelly-Williams said.

The union also called for an advisory group of health care professionals working on the front lines of COVID-19 to provide recommendations on patient care to prepare for the possibility of another wave of infections.

Health care providers in central Massachusetts said they're getting ready to take new, non-emergency patients, even though their surge of COVID-19 patients happened later than in the Greater Boston area.

Last week, UMass Memorial Medical Center in Worcester saw the most patients yet in its intensive care unit. It's at about 75% of its total ICU capacity, which was increased because of the pandemic. The hospital has now redeployed medical workers who were sent to work only on COVID-19 back to their original positions.

"I think we'll be in the phase one reopening by the end of this week," said Dr. Eric Dickson, president of the UMass Memorial Medical Group. "But we never shut down, so we're ready."

Dickson said he is concerned about another surge, especially if it comes quickly and as people are resuming more routine health care procedures.

"We went from zero patients to 400 patients in the region in about eight weeks. It's going to take about eight months for that number to go down," Dickson said. "So you could have a surge on top of the declining plateau of the previous surge. The additive effect could be difficult to manage. There are a lot of ways this could go wrong and only one way it can go right — and that's for all of us to be careful."

He added the hospital has contingency plans in case of another surge, and could reopen certain areas for emergencies as well as stop elective procedures if need be.

Atrius Health, which has 30 medical practices in Massachusetts serving 745,000 patients, said it's still reviewing the governor's plan, but is preparing to resume elective procedures.

"We are committed to working with Governor Baker and the Department of Public Health to ensure a safe environment for care as Massachusetts reopens, and encourage patients to contact their providers so they can receive appropriate care in person or virtually when needed," Atrius President and CEO Steven Strongwater wrote in a statement.

As phase one of the governor's reopening plan rolls out, more health care providers soon will be able to offer the same limited services. As for moving into new phases, the state said each phase will last at least three weeks.

This article was originally published on May 18, 2020.

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Deborah Becker is a senior correspondent and host at WBUR. Her reporting focuses on mental health, criminal justice and education.

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