Payments from the $10 billion distribution will go to more than 1,000 hospitals across the nation beginning Monday.
The Department of Health and Human Service on Monday will begin distributing another $10 billion in emergency funds for more than 1,000 hospitals in the nation's COVID-19 hotspots.
"The top priority for HHS's administration of the Provider Relief Fund has been getting support as quickly as possible to providers who have been hit hard by COVID-19," HHS Secretary Alex Azar said.
"Because we've carefully targeted support, we can make payments to areas most in need as the pandemic evolves, like we are doing with this round of funds," he said.
In early June, HHS told hospitals it would distribute a second round of funding for hospitals in COVID-19 hotspots and asked them to submit data on their COVID-19 positive-inpatient admissions from January 1 through June 10.
Those submissions determine eligibility and the share of the second round of the funding being announced today.
So far, the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act have doled out more than $175 billion in relief funds to hospitals and other providers, especially those disproportionately affected by the pandemic.
In May, HHS announced the first round of high impact funding totaling $12 billion that was shared by 395 hospitals. So far, the two rounds of hotspot funding from the Provider Relief Fund program is more than $20 billion, almost 12% of the $175 billion program.
The latest funding formula identified hospitals with more than 161 COVID-19 admissions between January 1 and June 10, or one admission per day, or that experienced a disproportionate intensity of COVID admissions (exceeding the average ratio of COVID admissions/bed). Hospitals will be paid $50,000 per admission, HHS said.
The first round of funding distributed funds to hospitals with 100 or more COVID-19 admissions between January 1 and April 10 and paid $76,975 per admission.
The previous high impact payments were also taken into account when determining each hospital's payment in this second round distribution.
American Hospital Association President and CEO Rick Pollack thanked HHS for the latest funding measure, but said more help will be needed.
"Since this distribution of funding for 'hot spots' does not take into account the latest spike in cases and hospitalizations in some parts of the country, we look forward to working with the Administration to ensure that additional relief will be distributed to 'hot spots' and all hospitals," he said.
The government watchdogs are calling on the Centers for Medicare and Medicaid Services to collect the money from hospitals.
The estimates come from an OIG random audit of 200 severe malnutrition diagnosis code claims filed by hospitals in fiscal years 2016 and 2017. The auditors found that only 27 of the claims were filed correctly, while the remaining 173 claims were not.
"For nine of these claims, the medical record documentation supported a secondary diagnosis code other than a severe malnutrition diagnosis code, but the error did not change the (diagnostic related group) DRG or payment," the audit said.
"For the remaining 164 claims, hospitals used severe malnutrition diagnosis codes when they should have used codes for other forms of malnutrition or no malnutrition diagnosis code at all, resulting in net overpayments of $914,128," the audit said, adding that based on their sample, "we estimated that hospitals received overpayments of $1.024 billion for FYs 2016 and 2017."
CMS concurred with OIG's recommendations and said it would instruct its contractors to recover the overpayments. However, CMS noted that the overpayments represent less than .5% of the overall payments made for inpatient services during the two-year span.
In a letter to OIG, CMS Administrator Seema Verma said that Medicare has since the audit implemented new fraud prevention measures that identify upcoding.
"Additionally, CMS has taken action to prevent improper Medicare payments by educating health care providers on proper billing," Verma said
Nutritional marasmus (diagnosis code E41) and unspecified severe protein-calorie malnutrition (diagnosis code E43) are two types of severe malnutrition. They are each classified as a type of major complication or comorbidity (MCC), which can result in higher payments
In 2016 and 2017, Medicare paid $3.4 billion for 224,175 claims that contained a severe malnutrition diagnosis code and for which removing the diagnosis code changed the diagnosis-related group (DRG). The OIG random sample of 200 found payments totaling $2.9 million.
The auditors sent the 200 claims to medical and coding review to determine whether the services were medically necessary and properly coded.
"Of the claims that we reviewed, 82% were not correctly billed, which we maintain is significant and needs to be addressed," OIG said. "We continue to recommend that CMS review all claims in our sampling frame that were not part of our sample but were within the reopening period and work with the hospitals to ensure they correctly bill Medicare when using severe malnutrition diagnosis codes."
Earlier OIG audits of severe malnutrition found that hospitals had incorrectly billed Medicare by using severe malnutrition diagnosis codes when they should have used codes for other forms of malnutrition or no malnutrition diagnosis code at all.
Critics say a move this week to bypass the CDC's role in reporting hospital data on COVID-19 volumes could "severely weaken" the quality and availability of data.
The Trump Administration's abrupt decision this week to bypass the Centers for Disease Control and Prevention from collecting daily hospital COVID-19 data is "troubling" and could "undermine our nation's public health experts," the Infectious Diseases Society of America said Wednesday.
"COVID-19 data collection and reporting must be done in a transparent and trustworthy manner and must not be politicized, as these data are the foundation that guide our response to the pandemic," said IDSA President Thomas M. File, Jr., MD. "Collecting and reporting public health data is a core function of the CDC, for which the agency has the necessary trained experts and infrastructure."
Instead, hospital data would be sent directly to HHS, using a private company, TeleTracking, which has compiled data for HHS since April. Initially, no explanation was given for why the CDC was bypassed. However, as the announcement gained traction in the media, HHS and CDC issued a joint statement defending the switch.
"We have not changed the data ecosystem; we have merely streamlined the data collection mechanism for hospitals on the frontlines," CDC Director Robert Redfield said. "This reduces the reporting burden—it reduces confusion and duplication of reporting. Streamlining reporting enables us to distribute scarce resources using the best possible data."
"All elements of our public health system are being stretched right now, and streamlining the hospital reporting system allows the National Health Safety Network to concentrate its COVID-19 activity on the high-priority area of protecting the vulnerable in nursing homes," he said.
File was not appeased.
"Placing medical data collection outside of the leadership of public health experts could severely weaken the quality and availability of data, add an additional burden to already overwhelmed hospitals and add a new challenge to the U.S. pandemic response," he said.
HHS's move to bypass the CDC comes as critics note the increasing attempts to demonize anyonewho contradicts the Trump administration's messaging, most notably, Anthony Fauci, MD, the government's top infectious disease expert.
"At this critical time when many states are experiencing surges, reliable, comprehensive data are essential to inform the distribution of supplies and treatment," File said. "The administration should provide funding to support data collection and should strengthen the role of CDC to collect and report COVID-19 data by race and ethnicity, hospital and ICU capacity, total number of tests and percent positive, hospitalizations and deaths."
The American Hospital Association and other hospital associations have stayed quiet on the new mandate, other than then AHA issuing an advisory to its members informing them of the changes.
That may be because hospital associations continue to press the federal government for emergency funding to offset massive losses brought on by the pandemic.
AHA reports total community benefits for nonprofits were 13.8% of total hospital expenses in 2017.
The nation's more than 2,764 tax-exempt hospitals provided $100 billion in total benefits to their communities in 2017, the most recent year for which data is available, according to a report from the American Hospital Association.
The analysis also shows that tax-exempt hospitals' and health systems’ total community benefits were 13.8% of their total expenses in 2017.
Nearly half of that total, came in the form of financial aid for patients and hospitals eating losses from Medicaid and other "underpaying" government programs, AHA said.
"Hospitals and health systems of all sizes and types deliver a wide range of benefits, activities, services and programs on a daily basis to meet the varied needs of their patients and communities," AHA President and CEO Rick Pollack said. "This new analysis shows that improving the health of their communities remains at the heart of the mission of hospitals and health systems."
The community benefits were fairly consistent across the board, with variations found based on size, location, and patient mix. Urban/suburban hospitals generally reported larger community benefits as a percentage of total expenses (13.6%), versus rural hospitals (10.1%).
Pediatric hospitals generally reported higher percentages of community benefits (15.9%) from total expenses.
Effective July 15, hospitals can no longer use CDC/NHSN COVID-19 module to fulfill federal data reporting requirements.
The federal government is pressing hospitals to begin on Wednesday using new modules for collecting data on daily capacity, utilization, and testing.
The Centers for Disease Control and Prevention National Healthcare Safety Network COVID-19 module will no longer be an option for daily reporting, effective July 15, the Department of Health and Human Services announced.
Instead, in guidelines set out last week by HHS, hospitals will be given the option of using one of four daily reporting modules, including:
Reporting data to state health departments that have written authorization regional federal administrators to report hospital data to HHS.
Reporting to the HHS TeleTracking portal, which has been used for special data reporting requests for distribution of high-impact funds and remdesivir.
Authorizing health IT vendors and other third-party stakeholders to share information directly with HHS, which has to be approved by HHS regional administrators.
Publishing on a hospital website in a standardized format, such as schema.org, which would also require approval from regional administrators.
HHS is also asking for more granular detail in the daily reporting, including breakdowns of pediatric and adult patients, and inventories of remdesivir.
HHS said it will also no longer ask for one-time requests for data to aid in the distribution of remdesivir or any other treatments or supplies.
"This means that the daily reporting is the only mechanism used for the distribution calculations," the American Hospital Association said in an advisory to its members.
But more funding will be needed, and soon, hospital stakeholders say.
The federal government's announcement that it will provide another $4 billion in emergency funding to hospitals slammed by the coronavirus pandemic was greeted with cheers by industry stakeholders, who also suggested that more funding will be needed.
Safety net hospitals will get a $3 billion slice of this latest CARES Act Provider Relief Funds payment, part of a package of emergency funds that have already sent more than $175 billion to hospitals and other healthcare providers over the past four months.
This latest round of funding, which will be divided among 215 acute care hospitals, is in addition to the$10 billion in CARES Act funding that safety nets received in June. In total, the federal government has sent $12.8 billion in direct payments to 959 safety net hospitals across the nation, the Centers for Medicare & Medicaid Services said.
The remaining $1 billion in this latest Provider Relief Fund disbursement will go to rural hospitals, and smaller hospitals in metropolitan areas with high concentrations of Medicaid patients, CMS said. In May, nearly 4,000 rural hospitals shared $10 billion in Provider Relief Funds.
"We've been distributing the Provider Relief Funds as quickly as possible to those providers who have been hardest hit by the pandemic," Health and Human Services Secretary Alex Azar said.
"Close work with stakeholders informed how we targeted this new round of funds to hard-hit safety-net and rural providers," he said.
Bruce Siegel, MD, president and CEO of America's Essential Hospitals, said the latest round of funding "will help ease the severe financial pressure many face. But gaps remain, and more support is needed."
"We appreciate the administration's efforts to correct earlier funding gaps that left many essential hospitals without the support they need; but there is more work to do," Siegel said.
"This is an unprecedented public health emergency that has taken a disproportionately heavy toll on the communities that essential hospitals serve. It has put these hospitals in a precarious position that demands an ongoing commitment of federal support," he said.
The American Hospital Association estimates that the nation's hospitals could lose $323 billion or more through the end of 2020, owing to collapsing patient volumes.
"Hospitals with high Medicaid volume provide care to our most vulnerable patients and communities, many of which have suffered disproportionately from this virus," AHA President and CEO Rick Pollack said.
"Even before the pandemic these hospitals operated under serious financial pressure, and these funds will help them continue to stay open and provide care to all who need it," he said.
Donald Mueller, who begins his tenure later this month, now serves as CEO at Children's Hospital at Erlanger in Chattanooga.
Veteran pediatric healthcare executive Donald Mueller has been named CEO of the financially troubled St. Christopher's Hospital for Children, Drexel University and Tower Health announced jointly this week.
Mueller, 49, who for the past five years has served as CEO at Children's Hospital at Erlanger in Chattanooga, Tennessee, will take the reins at the Philadelphia-based, 188-bed, pediatric hospital on July 27.
He replaces Maria Scenna, who left St. Christopher's last September to become COO of Cancer Treatment Centers of America in Philadelphia.
Reading, Pennsylvania-based Tower Health and Drexel University bought the bankrupt St. Christopher's for $40 million last fall from Philadelphia Academic Health System, a subsidiary of California-based American Academic Health System.
"It is an honor to join the amazing team at St. Christopher's Hospital for Children and I am thrilled for the opportunity to strengthen and grow one of the most important healthcare facilities in the Philadelphia region," Mueller said in a media release.
While at Children's Hospital at Erlanger, Mueller led one of four Comprehensive Regional Pediatric Centers in Tennessee, providing the region's only full-service hospital with a dedicated 65-bed Level IV Neonatal Intensive Care Unit, a Pediatric Trauma Team, an Emergency Department, and Pediatric Intensive Care Unit.
He recruited more than 50 subspecialty physicians to the hospital, and oversaw the strategic planning, coordination and design of the new 100,000 square foot ambulatory center, and helped raise $46 million to update facilities. In 2019, Children's Hospital at Erlanger achieved Leapfrog Top Children's Hospital status.
Before Erlanger, Mueller served in various executive leadership roles for Children's Healthcare of Atlanta – Emory University for 15 years.
"Don is a highly skilled and experienced executive, with an extensive and successful background in developing high-quality pediatric clinical programs; recruitment of physicians and researchers; strengthening nursing; and building effective partnerships with the community," Clint Matthews, president and CEO of Tower Health, and John Fry, president of Drexel University, said in a memo to staff announcing Mueller's appointment.
A proposed rule would pay for innovative dialysis equipment and support in the home setting for patients with end-stage renal disease.
Home-based dialysis equipment and supplies for patients with end state kidney disease would be eligible for additional Medicare reimbursements under a proposed rule put forward this week by the Centers for Medicare & Medicaid Services.
CMS Administrator Seema Verma said the proposed rule – the latest in a series of initiatives put forward by Medicareto improve access to kidney dialysis – is particularly timely "in the midst of a deadly pandemic that poses a particular threat to those with serious underlying conditions."
In addition to often having multiple comorbidities, ESRD patients also have the highest hospitalization rates for COVID-19 among Medicare beneficiaries.
"CMS data shows that those with ESRD have the highest rate of hospitalization of any single group, a trend consistent with having to frequently leave home to receive dialysis," Verma said.
"(This) action represents a sorely needed course direction, making it easier for ESRD facilities to make new and innovative home dialysis machines available to patients who need them," she said.
Currently, more than 85% of Medicare fee-for-service beneficiaries with ESRD travel to a facility to receive their dialysis at least three times each week, spending an average of 12 hours each week attached to a dialysis machine away from home, CMS said.
Under the proposed rule, which would take effect on January 1, 2021, CMS would:
Expand the transitional add-on payment adjustment for new and innovative equipment and supplies (TPNIES) that was introduced last year to now cover qualifying new dialysis machines when used in the home.
Encourage under the ESRD Treatment Choices (ETC) Model the greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD to enhance care quality and reduce costs.
Determine whether new ESRD care delivery and payment options can improve the quality of care and reduce the total cost of care for patients with kidney disease.
Refine eligibility for the transitional drug add-on payment adjustment (TDAPA) under the ESRD PPS to target additional payments to innovative renal dialysis drugs and biological products.
New estimates underscore the importance of infection prevention, particularly among seniors.
Between 1% and 2% of New Yorkers infected with COVID-19 – including those with no or mild symptoms – died between March 1 and May 16, according to a new study.
The findings suggest that the fatality risk averaging 1.45% during that timespan is more than double the 0.7% fatality risk identified in previous studies from both China and France.
That's according to a new study from researcher at Columbia University's Mailman School of Public Health that was published online in medRxiv.
"These dire estimates highlight the severity of COVID-19 in elderly populations and the importance of infection prevention in congregate settings," the study authors wrote.
"Thus, early detection and adherence to infection control guidance in long-term care and adult care facilities should be a priority for COVID-19 response as the pandemic continues to unfold."
The researchers analyzed 191,392 laboratory-confirmed COVID-19 cases and 20,141 confirmed and probable COVID-19 deaths in New York City between March 1-May 16, 2020.
The analysis couples case and mortality data combined with cell phone data used to model changes in COVID-19 transmission rate due to social distancing.
Mortality risk was highest for older adults, with IFR of 4.67% for 65-74-year-olds and 13.83% for those 75 and older.
Younger people had far lower chances of dying from the disease: .011% among those younger than 25 and .12% among 25-44-year-olds.
The researchers said that their findings likely more accurately reflect the true mortality risk of the coronavirus because they rely on "robust data" collected by health officials in New York City, where specialists review all death certificates and record deaths into a unified electronic reporting system.
The study authors suggest that the death toll could be higher in areas outside of New York City, because of the city's relatively strong public health infrastructure.
"It is thus crucial that officials account for and closely monitor the infection rate and population health outcomes and enact prompt public health responses accordingly as the pandemic unfolds," the authors wrote.
"As the pandemic continues to unfold and populations in many places worldwide largely remain susceptible, understanding the severity, in particular, the IFR, is crucial for gauging the full impact of COVID-19 in the coming months or years," they wrote.
They also acknowledged the challenges of ascertaining the death risk elsewhere in the nation due to the large number of undocumented infections, fluctuating case detection rates, and inconsistent reporting of fatalities.
The total support available to eligible health care providers in 2020 will top $802M.
The Federal Communications Commission's Wireline Competition Bureau this week ordered that $197.9 million in unused funds from prior years be carried forward for the Rural Health Care Program.
The Rural Health Care Program funding cap for 2020 is $604.76 million. But the carry-forward pushes the total funds available to eligible providers to $802.74 million in 2020, the most in the program's history, the FCC said in a media release.
RHCP provides nonprofit rural providers with money to expand their telemedicine and high-speed broadband capacities. In recent years, demand for the funds has outstripped the funding cap, and the FCC moved two years ago to increase the funding cap, carryover funding, and adjust for inflation.
"In 2018, the FCC took swift action to ensure that the Rural Health Care Program better reflected the needs of and advances in connected care," FCC Chairman Ajit Pai said.
"Looking to the future, we gave providers more certainty by adjusting the cap annually for inflation and allowing unused funds from previous years to be carried forward," Pai said.
"And now, more than ever, our foresight is fortuitous, as telehealth is proving to be critical in our fight against COVID-19," Pai said, adding that the additional funding "speaks to the FCC's commitment to ensuring that rural healthcare providers can continue to serve their communities during this difficult time and well into the future."
