THE HEALTH CARE STAFFING SHORTAGE
Proposals to Prevent a Crisis in Health Care Staffing

The Commonwealth and the Nation as a whole faces a shortage of nurses and other health care workers that, if not addressed immediately, will have devastating consequences on the quality of health care patients receive in Massachusetts.  The legislation outlined below will encourage new, qualified people to enter the health care profession and help retain and support those dedicated professionals already in the profession. Of particular importance are the two bills establishing the Clara Barton programs and the  insurance assistance program. 

• LEGISLATION ESTABLISHING THE DIRECT CARE WORKERS INSURANCE ASSISTANCE PROGRAM: This bill would provide a health insurance subsidy for lower paid (less than 300% of the federal poverty level) direct care health care employees.  This bill is aimed at addressing the problem many lower-paid direct care providers have in affording their own health insurance, and the difficulty of providers in luring and retaining staff.

• LEGISLATION ESTABLISHING THE CLARA BARTON NURSING EXCELLENCE SCHOLARSHIP PROGRAM. Studies show that we are facing a nursing shortage. This bill would encourage students to enter the field of nursing by providing them with scholarships to study nursing. The scholarship program is being named after Clara Barton, a native of Oxford, Mass., a teacher, nurse, and founder of the American Red Cross

• LEGISLATION ESTABLISHING THE CLARA BARTON NURSING EXCELLENCE PROGRAM. Studies show that we are facing a nursing shortage. In an attempt to recruit and retain nurses in health care facilities in Massachusetts, this bill would provide for: student loan repayment plan, a signing bonus, a mentoring bonus for those who have demonstrated an excellence in nursing. Additionally, this bill would provide grants to healthcare institutions and institutions of higher ed for the establishment and maintenance of a mentoring and or internship program.  This initiative is being named after Clara Barton, a native of Oxford, Mass., a teacher, nurse, and founder of the American Red Cross.

• LEGISLATION PROVIDING FOR THE PROPER PREVENTION OF PNEUMONIA IN HEALTH CARE WORKERS.  This bill would allow Physicians, nurses and employees in acute inpatient hospitals, outpatient care settings, nursing homes and chronic care facilities, health care workers with high risk medical conditions or age 65+, and those who provide home care to persons with high risk for the flu, to receive an annual pneumococcal vaccine. The Commissioner of DPH can establish exceptions to this requirement based on medical concerns. Elder care facilities shall offer this vaccine to all residents and users of such facilities by November 30 of each year.

• LEGISLATION TO ENCOURAGE VOLUNTEER PHYSICIANS. The Board of Registration of Medicine will grant or renew a qualified physician's registration for free so the physician can participate in the free care program operated by a non-profit organization. The Board may restrict, by regulation, physicians’ scope of practice whose registration is granted or renewed under this section. Physicians licensed to provide voluntary care are not required to carry malpractice insurance but are required to meet all other Board requirements regarding care, education and competence in medicine.

• LEGISLATION TO STREAMLINE THE PHYSICIAN CREDENTIALING PROCESS. This bill would establish a standard application form and date for all credentialing and re-credentialing activities, require the use of a single centralized credentialing verification organization, and establish provisional credentialing for new physicians, while maintaining credentialing for physicians who change the location at which they practice.

• LEGISLATION TO CREATE A NURSING HOME ADVISORY COUNCIL. This bill would require a 15 member advisory council to study and make recommendations on measures to ensure quality of care for residents of long-term care facilities. The recommendations shall include appropriate staffing levels which will ensure the safety and comfort of the long-term care residents. The provisions of this bill was part of the FY01 conference committee report, but it was vetoed by the Governor.

• LEGISLATION TO SURVEY THE HEALTH INSURANCE STATUS OF HEALTH CARE WORKERS. This bill would require a study of health insurance provided to staff of long term care facilities, home health agencies, home care agencies, personal care attendants and others workers who provide direct health care services. Many of these direct care workers are paid lower salaries and cannot afford health insurance. This bill is aimed at make recommendations to correct this injustice. The provisions of this bill was part of the FY01 conference committee report, but it was vetoed by the Governor.

• LEGISLATION REQUIRING NURSING HOMES TO MAINTAIN SAFE STAFFING LEVELS TO PROTECT THE HEALTH AND SAFETY OF RESIDENTS. This bill would require the promulgation of regulations that increase the minimum staffing levels that are not less than the staffing ratios recommended by the National Citizens’ Coalition for Nursing Home Reform.

PATIENT SAFETY AND MEDICAL ERROR REDUCTION
Restoring Faith in the Safety and Quality of our Health Care System

With the realization that unacceptable error rates and a lack of quality controls have allowed too many “mistakes” to harm patients in our health care system, the Committee will take up proposals to reduce the incidence of medical error.  The proposals below will encourage the creation of patient safety systems in hospitals and other health care centers by creating institutions to monitor error rates, improve current safety systems and where appropriate mandate new laws ensuring the public is protected from harmful medical practices or practitioners.  The first three bills set a new structure for addressing the issue of patient safety and medical error.  The remainder of the bills address the specific issues within the new structure. 

• LEGISLATION TO ESTABLISH THE BETSY LEHMAN CENTER FOR PATIENT SAFETY AND MEDICAL ERROR REDUCTION. Establishes a center called the Betsy Lehman Center for Patient Safety and Medical Error Reduction (Center).  The Center is to coordinate state efforts around patient safety and medical error reduction.  The Center shall report annually to the Legislature on the medical error and patient safety improvement efforts and is authorized to seek federal and foundation financial support.

• LEGISLATION TO PROMOTE PATIENT SAFETY.  Requires any state agency, department, board or commission providing direct patient health care;  contracting with public and private entities providing direct patient health care; licensing individuals and institutions who provide direct patient care, to certify, develop, implement, and/or file with the Secretary of Health and Human Services, a patient safety and medical error reduction program by 12/31/03.

• LEGISLATION RELATIVE TO PATIENT CARE ASSESSMENT BOARDS.  Eliminates the Patient Care Assessment (PCA) Board in the Board of Registration in Medicine and places the PCA Board under the Executive Office of Health and Human Services, with the appropriate confidentiality protections, so quality of care issues can be addressed for all health professions and all health institutions and not exclusively physicians and hospitals.

• LEGISLATION  REQUIRING THE DIVISION OF MEDICAL ASSISTANCE TO PROVIDE REIMBURSEMENT FOR HOME HEALTH AGENCIES FOR THE COSTS ASSOCIATED WITH CRIMINAL BACKGROUND SCREENING.  This bill would require the division of medical assistance, subject to appropriation, to reimburse long term care facilities and home health agencies for the portion of their costs associated with obtaining criminal offender record information on employees.

• LEGISLATION ENSURING THE SAFETY AND PROTECTION OF HOSPITAL PATIENTS. This bill adds to the current law by allowing other health care facilities to get criminal offender record information for current employees and applicants.

• LEGISLATION FURTHER REGULATING INVESTIGATIONS OF ABUSE AGAINST RESIDENTS OF LONG TERM CARE FACILITIES.  This bill would make changes to M.G.L. c. 111 § 72H regarding the Department of Public Health's investigations of allegations of abuse, neglect or mistreatment of a resident or misappropriation of a resident's belongings in a facility and would require DPH to establish a screening and prioritization system for such investigations. Additionally, the bill would amend chapter 29 to establish a separate fund to be known as the Department of Public Health Inspections Fund. The bill would credit to this fund: a) federal reimbursement received as a result of DPH’s certification of nursing facilities for participation in the Medicaid program; b) revenues from the establishment of a per diem surcharge to private insurance programs covering services provided in nursing facilities; and c) any funds appropriated by the General Court. The bill authorizes the Commissioner of Public Health to expend funds from this fund, without further appropriation, for the costs relating to the investigation of abuse of residents in long-term care facilities.

• LEGISLATION RELATIVE TO MEDICATION OCCURRENCE REPORTING. This bill would authorize DPH to impose an administrative fine for failure of any registrant to report to said agency the theft or loss of a controlled substance or the administration of a drug in a manner which violates any provision of M.G.L.Ch 94C (the Controlled Substances Act) or regulations promulgated there under. Said fine could be up to five hundred dollars for the first failure to report such incident and up to one thousand dollars for each subsequent failure.

• LEGISLATION RELATIVE TO THE REDUCTION OF PRESCRIPTION DRUG ERRORS. This bill, based on a similar successful program run in the state of Oregon, would require prescription drugs to be labeled with its physical description, including, but not limited to color, shape and any identification code that may appear on tablets and capsules.

• LEGISLATION RELATIVE TO THE PRACTICE OF BODY ART.  Authorizes the Department of Public Health (DPH) to license and regulate body artists and body art establishments.

• LEGISLATION RELATIVE TO PROVIDE FOR THE PAYMENT OF A ONE-TIME BONUS TO HEALTH CARE PROVIDERS FOR THE IMPLEMENTATION OF MEDICAL ERROR REDUCTION TECHNOLOGY. This bill would provide one-time supplemental payments to healthcare institutions which institute a comprehensive computerized medication order entry system, or other computerized system designed to identify, track and prevent medical errors. 

• RELATIVE TO THE DIVISION OF PROFESSIONAL HEALTH LICENSURE Creates a new division called the Division of Professional Health Licensure.  Moves health related professions under DPH and the Division of Professional Licensure to the Division of Professional Health Licensure.  Also places the Division of Professional Health Licensure and the Board of Registration in Medicine under the Executive Office of Health and Human Services. 

• LEGISLATION RELATIVE TO THE ISSUANCE OF A HEALTH CARE TECHNOLOGY BOND.  Will authorize the Commonwealth to issue a bond which shall provide for grants and zero or low interest loans to state and local agencies of government, institutions of higher education, health care providers, and other health care organizations.  The grants and loans  will be used to monitor or implement patient safety, medical error reduction systems including but not limited to medication error reduction systems.

• LEGISLATION RELATIVE TO THE LEGIBILITY OF PRESCRIPTIONS.  Will authorize the boards of registration in medicine, nursing and pharmacy to develop guidelines for the reduction of medication error by convening a task force which shall include the Massachusetts Medical Society, the Massachusetts Organization of Nurse Executives, the Massachusetts Hospital Association, pharmacy organizations and others.  The task force shall develop guidelines for improving the legibility of prescriptions and improving the educational requirements of those writing prescriptions.