Concerns have been raised that fear of coronavirus contagion has led patients to delay essential and even emergency care.
Even as coronavirus cases are trending up in many parts of the nation, the Trump Administration is encouraging healthcare facilities to reopen for non-emergency and elective care, and the Centers for Medicare & Medicaid Services is showing them how to do it.
"Americans need their healthcare and our healthcare heroes are working overtime to deliver it safely," CMS Administrator Seema Verma said. "Those needing operations, vaccinations, procedures, preventive care, or evaluation for chronic conditions should feel confident seeking in-person care when recommended by their provider."
Elective services came to a grinding halt in late March after health systems and other care venues attempted to slow the spread of the coronavirus.
The shutdown has left many providers in perilous financial shape, despite more than $175 billion in emergency stopgap funding provided by the federal government.
Concerns have also been raised that fear of contagion has led patients to delay critically needed and emergency care, along with routine maintenance visits at physicians' offices. CMS has released a guide for patients considering their in-person care options.
The Washington Post is reporting that, since the start of June, 14 states, including Texas, California, Florida, and Puerto Rico have recorded their highest-ever seven-day average of new coronavirus cases since the pandemic began. However, some have speculated that the increase in the numbers of reported coronavirus cases is owing more to improved testing.
On April 19, CMS issued Phase 1 recommendations to safely resume in-person care in areas with low incidence or relatively low and stable incidence of COVID-19 cases.
CMS has also offered recommendations for providers of in-person care that cover patient- and provider-safety issues, including facility considerations, testing and sanitation protocols, personal protective equipment and supplies, and workforce availability.
Ultimately, CMS says the decisions to reopen should be in line with federal, state, and local orders, Centers for Disease Control and Prevention guidance, and in collaboration with state and local public health authorities.
Another $10 billion is expected to be released soon to aid hospitals providing care in COVID-19 "hotspots."
The Department of Health and Human Services has released another $10 billion from the Provider Relief Fund, with this latest emergency package targeting safety net hospitals.
"Healthcare providers who focus on treating the most vulnerable Americans, including low-income and minority patients, are absolutely essential to our fight against COVID-19," HHS Secretary Alex Azar said in a media release.
Under the eligibility guidelines, the money is earmarked for hospitals with Medicare disproportionate payments of 20.2% or higher, with uncompensated care costs of $25,000 per bed over one year, and profit margins of 3% or less in their most recently filed Cost Report, HHS said.
Payments, which will range from $5 million to $50 million, are being sent directly to the safety net hospitals.
To date, HHS has provided more than $175 billion to aid appropriated under the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act, to hospitals and other providers disproportionately affected by the pandemic.
HHS on Monday reminded hospitals that another $10 billion in emergency funding for hospitals serving in COVID-19 "hotspots" would soon be made available, but that hospitals would have to update their COVID-19 positive-inpatient admissions data from January 1 through June 10 to determine eligibility. Hospitals have until 9 PM ET on June 15 to update their records.
The news of additional funding was greeting with hearty cheers from hospital stakeholders.
"Today’s announcement of $10 billion in additional funding for hospitals that provide safety-net care, as well as a future allocation of $10 billion for providers in COVID-19 hot spots, will help ease the financial pain this public health emergency has inflicted on these caregivers," said Bruce Siegel, MD, president and CEO of America's Essential Hospitals.
"We appreciate that the administration has recognized the severe pressures on front-line providers," he said.
Rick Pollack, president and CEO of the American Hospital Association, said his association was "pleased" with the new money, but suggested that more emergency funding may be needed.
"While we appreciate the emergency funds released by HHS to date, the AHA continues to urge the department to distribute substantial additional funds to hospitals and health systems in an expedited manner as the COVID-19 virus continues to spread, hospitalizations continue to occur, and many Americans continue to forgo care, including primary care and other specialty care visits," Pollack said.
$15B for Medicaid and CHIP
Elsewhere, the Health Resources and Services Administration is distributing $15 billion from the Provider Relief Fund to Medicaid and Children's Health Insurance Program providers.
HHS said this latest round of funding will focus on Medicaid and CHIP providers who have not received money from the Provider Relief Fund General Allocation.
Stuczynski has been with Memorial since 2005, most recently as CFO of Memorial Regional Hospital South in Hollywood.
Veteran healthcare executive Joe Stuczynski has been named CEO of Memorial Hospital Pembroke, a 301-bed community hospital in Pembroke Pines, Florida, Memorial Healthcare System announced Friday.
Stuczynski has been with Memorial since 2005, most recently as CFO of Memorial Regional Hospital South in Hollywood, Florida, and served as CFO of Memorial Hospital Pembroke from 2005 to 2015.
"It is an honor to return to Memorial Hospital Pembroke and be given the opportunity to collaborate with a team of skilled health professionals who are leading the way through innovation and high-quality service," Stuczynski said in a media release.
Stuczynski has more than 25 years of administrative experience in large integrated healthcare organizations with almost two decades at the executive level.
As CFO of Memorial Regional Hospital South, he was responsible for the Rehabilitation Institute, Memorial Manor Nursing Home and Home Health Services. Previously, he served as CFO for Memorial Hospital Pembroke, where he also had responsibility for a number of operational departments.
The six-hospital Memorial Healthcare System includes Memorial Regional Hospital, Memorial Regional Hospital South, Joe DiMaggio Children's Hospital, Joe DiMaggio Children's Health Specialty Center in Wellington, Memorial Hospital West, Memorial Hospital Pembroke, Memorial Hospital Miramar, and Memorial Manor nursing home.
However, hospitals posted 27,000 job losses for the month.
After suffering record job losses in April owing to the coronavirus pandemic, the healthcare sector saw 312,000 new jobs created in May as the nation attempts to reopen.
The bulk of the job gains were in dentists' offices (245,000), other healthcare practitioners (73,000) and physicians' offices (51,000), according to the May employment report issued Friday by the Bureau of Labor Statistics.
"These improvements in the labor market reflected a limited resumption of economic activity that had been curtailed in March and April due to the coronavirus (COVID-19) pandemic and efforts to contain it," BLS said.
However, the bleeding continues for the hospital sector, with 27,000 job losses reported in May, while nursing homes reported 37,000 job losses.
May was the second straight month of negative job growth in the hospital sector, which lost 127,000 jobs in April, BLS data show.
The healthcare sector shed a record 1.4 million jobs in April, as hospitals and outpatient care venues shuttered money-making elective services and slashed payrolls to stem the red ink.
Most of the jobs losses have been in ambulatory services, which lost about 950,000 jobs since February.
Overall, the healthcare sector accounted for 15.2 million jobs at the end of May, down from 16.5 million jobs in February.
In the larger economy, BLS reported that total nonfarm payroll employment rose by 2.5 million in May, and the unemployment rate declined to 13.3%, with sharp increases in leisure and hospitality, construction, education and health services, and retail trade.
BLS data for May and April is prelimiary and subject to revision.
The funding would be in addition to the $170 billion that the federal government has already provided to hospitals in stimulus spending.
The American Hospital Association on Tuesday pressed the federal government for an additional $52 billion in "expedited" emergency funding to help the nation's hospitals stem losses accrued during the coronavirus pandemic.
"Many hospitals are in dire circumstances as they face the biggest financial crisis in history," AHA President and CEO Richard J. Pollack said in a letter to Health and Human Services Secretary Alex Azar.
"While our members continue to do everything they can to address COVID-19 cases, quickly making substantial additional funds available would help them continue to put the health and safety of patients and personnel first, and in many cases, may actually ensure they are able to keep their doors open," Pollack said.
Hospitals across the nation have all but shuttered most elective and outpatient services for the past two months to contend with COVID-19. The AHA estimates a total four-month financial impact of $202.6 billion in losses for hospitals and health systems, an average of $50.7 billion per month.
So far, the federal government has doled out about $170 billion in direct aid to hospitals in a series of stimulus bills.
In this latest push for more emergency funding, AHA is asking for:
$10 billion for "hot spot" hospitals to offset costs incurred in testing, diagnosing and treating COVID-19 cases.
"If an admissions-based payment is again used, consideration should be given not only to the most recently available data on the raw number of admissions, but also to the portion of a hospital’s admissions accounted for by COVID-19," Pollack said, adding that HHS should also include $2 billion based on a hospital's low-income and uninsured patient mix, as HHS had done previously.
$10 billion for hospitals serving high numbers of Medicaid and uninsured patients, who often have underlying health conditions, and who have suffered disproportionately from the pandemic.
"They have been hospitalized at greater rates, and required more care and resources once hospitalized," Pollack said.
$30 billion to all hospitals, including rural and urban short-term acute-care, long-term care, critical access hospitals, as well as inpatient rehabilitation and inpatient psychiatric facilities.
"Funds should be distributed in an equitable manner, such as by the number of beds, as the Department recently did for skilled-nursing facility distributions," Pollack said.
To expedite the process, Pollack recommended that HHS use the same application process it created to distribute funds to hospitals and health systems based on their COVID-19-related costs and lost revenue.
"They include, for example, expenses related to surge capacity, expenses related to ensuring an adequate workforce, and additional expenses, such as for managing and treating persons under investigation who may or may not turn out to be COVID-19 positive," he said.
In 2009, EHRs correctly issued alerts about potential medication problems only 54% of the time. By 2018, EHRs detected about 66% of these errors.
One of the big promises made in the nation's decade-long, multibillion-dollar push to expand the use of electronic health records was that it would reduce medication errors.
Now, a new study published inJAMA Network Open suggests that EHRs are not delivering on that promise.
Researchers at the University of Utah Health, Harvard University, and Brigham and Women's Hospital in Boston found that the most commonly used EHRs in hospitals across the nation fail to detect up to 33% of potentially dangerous drug interactions and other medication errors that could harm or kill patients.
"EHRs are supposed to ensure safe use of medications in hospitals," said study corresponding author David C. Classen, MD, a professor of internal medicine at U of U Health. "They're not doing that."
"In any other industry, this degree of software failure wouldn't be tolerated," Classen said. "You would never get on an airplane, for instance, if an airline could only promise it could get you to your destination safely two-thirds of the time."
To determine the effectiveness of EHRs, the researchers looked at results from an EHR safety evaluation tool called Leapfrog CPOE EHR test. The test simulates drug orders that have the potential to injure patients, and almost all of the scenarios the researchers considered were based on actual adverse drug events that harmed or killed patients in the real world.
In one scenario, for example, a 52-year-old patient with a history of deep vein thrombosis was admitted to the hospital with pneumonia.
The patient was given warfarin three times a day, triple the dosage she took before admission, which went undetected by the hospital's EHR system for five days. The patient hemorrhaged and died of causes directly related to the wafarin overdose.
Scenarios such as this were fed into EHR systems at 2,314 hospitals nationwide from 2009 through 2018 to see if their systems would perform better.
The researchers found that, in 2009, these systems correctly issued warnings or alerts about potential medication problems only 54% of the time. By 2018, EHRs detected about 66% of these errors.
Classen said problem is compounded because hospitals often customize their EHR software to meet their own needs. That makes it difficult to keep up with changes in drug safety. Those limitations mean that a serious drug interaction that would trigger EHR warnings at one hospital might not at another one.
A critical first step in understanding the potential routes of transmission is knowing which tissues the virus is capable of infecting.
Researchers in Florida are hoping to learn if the SARS-CoV-2 virus that causes COVID-19 can be detected in semen and transmitted sexually.
"We hypothesize that SARS-CoV-2 may be present in the semen and be a source of transmission," said Ranjith Ramasamy, MD, associate professor of urology at the Miller School of Medicine and director of male reproductive medicine and surgery at the University of Miami Health System and the Miller School.
"Understanding the potential for COVID sexual transmission is critical because of the tremendous potential ramifications," he said.
The UM researchers are hoping to find at least 200 men who tested positive for COVID-19 to enroll in a study to determine the interaction of the virus with semen. So far, 30 men are enrolled in the study.
Ramasamy said that a critical first step in understanding the potential routes of transmission — and their ramifications — is knowing which tissues the virus is capable of infecting.
"Previous SARS strains have shown an ability to cross into the male reproductive tract, where it can be sexually transmitted," he said.
Ramasamy cited studies that estimate that 20% of men with asymptomatic COVID infection may have orchitis, an infection in one or both testes.
"We want to identify how long the presence lasts in semen and investigate whether COVID infection leads to orchitis and male infertility," he said.
The gateway into the body for this virus is the ACE2 receptor, present in the lungs, heart, intestines, kidneys, and testis.
"The COVID receptor is present in a lot of testes. The testis is responsible for sperm and testosterone production," Ramasamy said. "So, we not only want to check testosterone levels, but also research if young men have changes in their sperm counts."
More than 80% of healthcare executives express concerns about a post-pandemic reopening with the threat of a second wave looming.
Resuming deferred procedures as the nation's healthcare sector emerges from the two-month-and-counting coronavirus pandemic lockdown will not be as simple as flipping a switch, a new survey suggests.
Deloitte Consulting, LLP, queried 50 executives from health systems, hospitals, and ambulatory surgery centers and found that, although April 2020 procedure volumes were only 16% of those seen in April 2019, the vast majority (82%) expressed unease about reopening too soon.
With the threat of a second wave of the pandemic looming, the executives said their organizations are taking steps to mitigate patient and caregiver safety concerns. Notably, 88% of respondents have implemented some form of virtual health, and 10% are planning to implement use of virtual health for non-procedure visits.
Pre-pandemic surveys from Deloitte found that only 5% of surgical specialists used video visits in their practice.
"If the primary concern is a second wave, health systems are going to have to be extra diligent about testing, social distancing and infection control and this will create additional steps and inefficiencies to get back to full productivity," said Deloitte Principal David Betts. "This whole process of reopening may be more complicated and take longer than we think."
Even with the tremendous backlog created by the pandemic lockdown, executives don't expect to see elective procedures return to pre-pandemic levels for at least two to six months. In part, that is owing to patient unease about the risks of returning to healthcare venues.
More than half (54%) of respondents cited low patient demand as another big roadblock for reopening, and 50% cited an inadequate supply of materials, medications, equipment, or testing.
Clinical leaders also reported concerns about supply chains, including inadequate testing capabilities (74%), not enough personal protective equipment (PPE) (68%) and shortages of other medical and surgical supplies (58%).
Other fully or partially implemented steps include: additional cleaning and disinfecting measures (88%); training or retraining staff on infection control procedures (80%); acquisition of PPE (94%); and developing internal (92%) and external (70%) communications strategies. Only 36% have begun measuring consumer sentiment.
The North Carolina-based health system is the first in the nation to be granted a waiver by the FAA.
Novant Health, Inc. said Wednesday that it will use drones to shuttle personal protective equipment and other medical supplies to its hospitals battling the coronavirus pandemic in the Charlotte, North Carolina metro area.
The service, a partnership with drone flight company Zipline, is the first to be granted a Part 107 waiver by the Federal Aviation Administration. The operations will be under the auspices of the North Carolina Department of Transportation's Unmanned Aircraft System Integration Pilot Program, Novant said in a media release.
"Fast-tracking our medical drone transport capability is just one example of how we're pioneering in the health care industry, which is known for being resistant to change," she said.
Novant Health operates 15 hospitals and nearly 700 care venues in the southeastern United States.
The drone flights in the Charlotte area will range from 20 to 30 miles round trip. Zipline drones have a range of about 100 miles per round trip, which would put more than 30 additional Novant Health site within range upon FAA approval. The drones will fly in Class-D controlled airspace, where air traffic is managed by the FAA.
"Contactless" deliveries will be launched from an "emergency drone fulfillment center" and shuttled to designated drop zones. The drones can carry nearly four pounds of cargo and fly up to 80 miles an hour, even in high winds and rain.
The partnership hopes to expand beyond emergency services in the Charlotte area over the next two years to include regular commercial operations for healthcare sites, and ultimately fly directly to patients' homes across the state, which would have to be approved by the FAA.
"Hopefully, this project and ones like it can help ease the strain on our medical supply chains," North Carolina Secretary of Transportation Eric Boyette. "We're living through an unprecedented situation, and we're going to need innovative solutions like this to get us through it."
Beneficiaries who use insulin and join a plan participating in the voluntary model, beginning January 2021, could see average out-of-pocket savings of $446.
Insulin copays for beneficiaries in Medicare Part D drug plans could max out at $35 a month in 2021 under a voluntary model unveiled Tuesday by the Centers for Medicare & Medicaid Services.
Under existing regulations, Part D drug plans can offer lower cost-sharing in the coverage gap. When they do, however, the Part D plan accrues costs that drug makers pay. Those costs are passed on to beneficiaries in the form of higher premiums.
As a result, seniors are often left paying 25% of the insulin's cost in the coverage gap.
The new insulin model allows drug makers to continue paying their full coverage gap discount for insulin, even when a plan offers lower cost-sharing. However, Part D drug plans, relying on manufacturers' rebates, would agree to lower cost-sharing to no more than $35 for a month's supply for "a broad set of insulins," CMS said.
One-third of Medicare beneficiaries have diabetes, and more than 3.3 million Medicare beneficiaries use common forms of insulin.
CMS estimates that beneficiaries who use insulin and join a plan participating in the model could see average out-of-pocket savings of $446. The model is funded in part by manufacturers paying an estimated additional $250 million of discounts over the five years of the model.
"This market-based solution, in which insulin manufacturers and Part D sponsors compete to provide lower costs and higher quality for patients, will allow seniors to choose a Part D plan that covers their insulin at an average 66% lower out-of-pocket cost throughout the year," CMS Administrator Seema Verma said.
CMS said the voluntary model has received an enthusiastic response from Part D plans, and that beneficiaries will have access to the model in 50 states, the District of Columbia, and Puerto Rico through a stand-along prescription drug plan, or through Medicare Advantage.
The coverage begins on Jan. 1, 2020, and enrollment begins during Medicare open enrollment, which is from October 15 through December 7, 2020.
The model reduces copays for a range of insulins, including both pen and vial dosage forms for rapid-acting, short-acting, intermediate-acting, and long-acting insulins.
Participating drug makers will continue to pay their 70% discount in the coverage gap for their insulins that are included in the model. Those discounts will be calculated before the application of supplemental benefits under the model – which will reduce the out-of-pocket cost of insulin for Medicare beneficiaries.
Part D sponsors must submit their calendar year 2021 plan benefits to CMS by June 1 2020.
CMS will release premiums and costs for specific Medicare health and drug plans for the 2021 calendar year in September 2020, including final information on the model.
