The move comes amid extraordinary strain on the region’s hospitals, with summer also the busiest time for ERs. Meanwhile, providers are still reeling from pandemic-era workforce shortages and, this year, must also contend with difficulties at Steward Health Care, the largest for-profit hospital system in the country, which operates seven active hospitals in Massachusetts. Steward declared bankruptcy in May and has curtailed some services.
“It’s an already strained emergency department ecosystem in Massachusetts,” said Michael Caljouw, vice president of government and regulatory affairs for Blue Cross Blue Shield of Massachusetts, the state’s largest private insurer. “Looking forward, we want to make sure we’re all prepared for continuing care demands during the summertime if and when Steward changes occur.”
Urgent care centers are equipped to handle less-dire medical emergencies than ERs, Brennan said.
“For your everyday cough, cold, fever, sutures, we can handle that,” he said.
Insurers will pay 135 percent of the Medicare reimbursement rate for out-of-network care at urgent care centers in nine Eastern Massachusetts counties, said Caljouw.
The roughly 200 urgent care centers in Massachusetts have an average turnaround time of one hour, Brennan said, and cost one-fifth as much as a visit to a hospital emergency room. An estimated 13 to 27 percent of emergency department visits could be handled elsewhere, including at doctors’ offices, clinics, or urgent cares, according to the federal Department of Health and Human Services.
“This agreement will help reduce overcrowding and longer waits for care, as emergency department volume is typically high during the summer months,” Olivia James, a spokesperson for the Executive Office of Health and Human Services, wrote in a letter describing the policy change.
Brennan and Caljouw said the state’s policy is in part driven by the ongoing crisis at Steward Health Care, which has been unable to maintain specialized care at its hospitals. That has stressed nearby hospitals, according to health officials and Globe reporting. It remains an open question how Steward’s bankruptcy will affect its hospitals; if any of its emergency departments stop operating, the influx of displaced patients to other hospitals could be overwhelming.
Massachusetts public health Commissioner Robbie Goldstein acknowledged during a meeting of the state’s Public Health Council in June that Steward was treating fewer patients.
“It is very clear from the data that there are decreasing volumes at the Steward facilities,” he said.
DPH was working to understand how hospitals are responding as patients shift from Steward to other care providers, Goldstein said at the time.
“This continues to be a tremendously fragile time for our local hospitals,” Steve Walsh, chief executive of the Massachusetts Health and Hospital Association, said Wednesday. ”These concerns have only grown with the busy summer months upon us and with a wave of Steward patients seeking care at other facilities.”
A Steward spokesperson did not address the health system’s role in contributing to hospital overcrowding in a statement.
“Emergency room overcrowding is well documented at most hospitals,” said the spokesperson, Deborah Chiaravalloti. “This is not a situation unique to Steward hospitals and we support the Commonwealth in finding appropriate solutions that will benefit all patients.”
Overcrowding in emergency departments has led to hallways lined with beds, agitated patients who sometimes become violent, and health care workers pushed to their limits.
Patients are spending much longer, on average, at emergency departments in Massachusetts. Six years ago, the average length of an emergency room visit was just over four hours, CHIA reported. That peaked at close to six hours at the beginning of 2023, edging down to 5½ hours at the end of last year — before Steward’s problems became acute.
Patients shifting from Steward to other Eastern Massachusetts hospitals for specialized inpatient care are already causing a trickle-down effect that exacerbates overcrowding at emergency departments, said Dr. Joseph Kopp, chairman of the Massachusetts College of Emergency Physicians’ government advocacy committee and an emergency physician at Brigham and Women’s Hospital and Faulkner Hospital. Patients at emergency departments may have to wait longer to be transferred for specialized care if former Steward patients are occupying the hospital’s beds.
“Hospitals — they’re all operating at 100 percent capacity or more,” Kopp said.
Patients languishing in emergency departments while waiting for a transfer to another department or facility, called boarders, are increasingly common in Massachusetts hospitals, Kopp said. At times, they occupy more than half the emergency department beds in the state.
Those waits can be deadly. Boarding patients have worse outcomes, are more likely to fall victim to medical errors, and are more likely to die from avoidable complications, Kopp said.
“It just changes the way that you actually deliver your care,” he said. “It’s by necessity not going to be as good.”
Jason Laughlin can be reached at jason.laughlin@globe.com. Follow him @jasmlaughlin.
Source: State mandates insurance coverage at urgent cares to relieve overwhelmed ERs – The Boston
