Boston-based Mass General Brigham is gearing up for what could be a unique respiratory virus season.
Medical and public health experts have warned that recent changes to federal vaccine policy could limit uptake and drive up hospitalizations in the winter months. The FDA in August limited approval of updated COVID-19 vaccines to individuals 65 and older, and those with at least one condition that puts them at high risk for severe disease.
The CDC on Oct. 6 voted to recommend the vaccine based on shared decision-making — a shift away from recommendations in past years that all individuals 6 months and older receive the vaccine. The changes align with recommendations the agency’s Advisory Committee on Immunization Practices voted on in September.
“What patients do with vaccines is going to matter,” Michael VanRooyen, MD, chair of emergency medicine at the health system, told Becker’s.
“We might see a different season coming up because of the approach to vaccines. … If people are not getting their flu vaccines or COVID vaccines, the respiratory season is going to be ugly and that [will be] really tough on the healthcare system.”
To mitigate ED boarding and capacity strain this virus season, Mass General Brigham plans to lean into tried and true strategies, Dr. VanRooyen said. These include offloading strain on the system’s academic medical centers by accelerating transfers to community hospitals when appropriate and continuing efforts to reduce length of stay on inpatient units, which has been a priority among the system’s leaders.
“We’ve had good collaborations with our CEO and president to really help keep length of stay initiatives front and center,” Dr. VanRooyen said.
The system is also encouraging greater utilization of its discharge lounges, which are dedicated spaces where patients awaiting discharge have a comfortable space to relax. The lounges enable hospitals to turn around beds more efficiently, helping to shorten ED wait times.
Massachusetts General Hospital regularly uses between 16 and 20 auxiliary beds, where admitted patients essentially board on an inpatient unit. The use of these beds is another important capacity management tool, Dr. VanRooyen said.
“Those auxiliary beds really help because not only do they help offload patients from the emergency department, but they also encourage staff on the floors to move their length of stay because they feel the discomfort of having crowding in that setting,” he said.
Respiratory virus season is usually an opportunity for the system to increase its hospital-at-home census, as patients with flu complications are often a good fit for in-home admission. However, the recent expiration of the CMS waiver that allowed for reimbursement inpatient-level care at home has disrupted the reliability of that lever. Following the Oct. 1 expiration, Mass General Brigham had to discharge hospital-at-home patients or return them to the hospital, and is now using that infrastructure to provide advanced care at home for patients post-discharge, a spokesperson told Becker’s.
Hospitals and health systems across the country are navigating capacity strain, but the issue is especially acute in Massachusetts due to a lack of access to outpatient care, making operational strategies to improve access particularly salient for hospitals across the state.
The state ranks fifth lowest when it comes to the share of physicians who work in primary care, which pushes up wait times for preventive care, according to a January report from the Massachusetts Health Policy Commission that examined primary care access issues.
Relative to other major U.S. metro areas, Boston has the longest average wait time — 70 days — for the third next available medical appointment across 11 specialties, according to a 2024 report from ECG Management Consultants. Analysts used the third next-available metric to gauge patient access, since wait times for the first or second next-available appointment can be artificially late due to last-minute cancellations or other anomalies.
A lack of timely access to care in appropriate settings drives more patients to seek care in the ED: Around 40% of ED visits in Massachusetts involve a condition that could have been treated or prevented in a primary care setting, the commission’s report found.
