The move comes amid unusual strain on area hospitals, with summer also being the busiest time for emergency departments. Meanwhile, health care workers are still struggling with pandemic-era staffing shortages and have also had to deal this year with difficulties at Steward Healthcare, the nation’s largest for-profit hospital system, which operates seven hospitals in Massachusetts. Steward declared bankruptcy in May and has been cutting back some services.
“Massachusetts’ emergency medical system is already under strain,” said Michael Caljoux, vice president of government and regulatory affairs for Blue Cross Blue Shield of Massachusetts, the state’s largest private insurer. “We want to be prepared for continued demand in the summer in case there’s a change in stewards in the future.”
Brennan said urgent care centers are equipped to handle less serious medical emergencies than emergency rooms.
“Routine coughs, colds, fevers, stitches, we can handle that,” he said.
Insurers will pay 135% of Medicare reimbursement rates for out-of-network care at urgent care centers in nine eastern Massachusetts counties, Caljou said.
The average visit time at Massachusetts’ roughly 200 urgent care centers is an hour, and the cost is one-fifth of a hospital emergency room, Brennan said. According to the federal Department of Health Services, an estimated 13 to 27 percent of emergency room visits could be treated elsewhere, such as a doctor’s office, clinic or emergency room. Ministry of Health and Human Services.
“With emergency department volumes high during the summer months, this agreement will help reduce congestion and prevent long wait times for treatment,” Department of Health and Human Services spokesperson Olivia James wrote in a letter explaining the policy change.
Brennan and Caljoo said the state’s policies are driven in part by the ongoing crisis. Steward Healthcare is no longer able to maintain specialized care at its hospitals, which health officials and the Globe report say is putting a strain on nearby hospitals. It’s still unclear how Steward’s bankruptcy will affect the hospitals, but if any of its emergency departments stop functioning, they could be overwhelmed by the influx of patients evacuated to other hospitals.
Massachusetts Public Health Commissioner Robbie Goldstein acknowledged at a state Public Health Council meeting in June that Steward was treating fewer patients.
“It’s clear from the data that volumes at Steward facilities are declining,” he said.
Goldstein said at the time that DPH was trying to understand how hospitals were handling the transition of patients from Steward to other health care providers.
“This continues to be an extremely precarious time for our local hospitals,” Steve Walsh, CEO of the Massachusetts Health and Hospital Association, said Wednesday. “With the busy summer months approaching and a wave of Steward Hospital patients seeking care at other facilities, these concerns are only heightened.”
In a statement, a Steward spokesman did not address the health system’s role in contributing to hospital overcrowding.
“Emergency room congestion is well known at most hospitals,” spokeswoman Deborah Chiaravallotti said. “This is not a situation unique to Steward Hospital, and we support the federal government in finding an appropriate solution that benefits all patients.”
Overcrowded emergency departments mean beds line the hallways, agitated and sometimes violent patients push health care workers to their limits.
In Massachusetts, patients are spending significantly more time, on average, in emergency departments: Six years ago, the average emergency department stay was just over four hours. Reported by CHIAIt peaked at nearly six hours at the start of 2023 before falling to five and a half hours late last year, before the stewardship issues escalated.
Dr. Joseph Kopp, chairman of the Massachusetts Society of Emergency Physicians’ government advocacy committee and an emergency physician at Brigham and Women’s Hospital and Faulkner Hospital, said patients transferring from Steward to other Eastern Massachusetts hospitals for specialized inpatient care are already creating a trickle-down effect that exacerbates emergency department congestion. If former Steward patients are occupying hospital beds, emergency department patients may have to wait even longer to be transferred for specialized care.
“All of our hospitals are operating at over 100% capacity,” Kopp said.
Kopp said that border patients, patients who languish in emergency departments while awaiting transfer to other departments or facilities, are becoming increasingly common in Massachusetts hospitals, sometimes taking up more than half of the emergency department beds in the state.
Those wait times can be deadly: Hospitalized 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’s just going to change the way we actually deliver care,” he said. “Inevitably, it’s not going to be as good as it was before.”
Jason Laughlin can be reached at jason.laughlin@globe.com Follow Jasmine Lean.
