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.
Steep volume and revenue drops drove record-poor margin performances.
With the COVID-19 pandemic shuttering elective procedures, the nation's hospitals saw operating margins freefall 174%, when compared with April 2019, according to a report from Kaufman Hall.
Operating EBITDA margins for April were down 118% from March, coinciding with the initial impact of the pandemic, as hospitals bore the brunt of a full month of COVID-19.
Operating margins fell 282% year-over-year and 120% compared to March. Median hospital operating margins fell to –29%, as measured by the Kaufman Hall's Hospital Operating Margin index.
Operating room minutes fell 61% in April, compared to April 2019—which Kaufman Hall said is more than triple the declines seen in March. In addition, discharges fell 30% year-over-year, and ER visits fell 43%. Outpatient Revenues fell 50% year-over-year and 51% below budget, while inpatient revenues fell 25% year-over-year and fell 30% below budget.
The losses mounted even as hospitals to drastic measures to cut costs, including widespread layoffs and furloughs of non-essential workers, and pay cuts for executives.
Kaufman Hall predicts that the aftershocks of the pandemic will lead to major changes in the healthcare industry, including reevaluations of cost structure, care models, and competitive dynamics.
"While healthcare leaders work to quantify the pandemic's near-term financial implications and develop sophisticated financial recovery plans, they must also develop a viewpoint about the post-COVID environment and plans for the roles their organizations should play," the report said.
Confusion about lethality comparisons may be owing to "a knowledge gap" in how the CDC reports on seasonal influenza and COVID-19.
New research shows that counted deaths from COVID-19 in mid-April were about 20 times greater than seasonal influenza counted deaths recorded during peak weeks of the past seven flu seasons.
"The demand on hospital resources during the COVID-19 crisis has not occurred before in the US, even during the worst of influenza seasons," co-authors Jeremy Samuel Faust, MD, of Harvard Medical School, and Carlos Del Rios, MD, of Emory University School of Medicine wrote in JAMA Internal Medicine.
"Yet public officials continue to draw comparisons between seasonal influenza and SARS-CoV-2 mortality, often in an attempt to minimize the effects of the unfolding pandemic," they wrote.
"This apparent equivalence of deaths from COVID-19 and seasonal influenza does not match frontline clinical conditions, especially in some hot zones of the pandemic where ventilators have been in short supply and many hospitals have been stretched beyond their limits."
The researchers said the confusion about lethality comparisons may be owing to "a knowledge gap" in how the Centers for Disease Control and Prevention reports on seasonal influenza and COVID-19.
The CDC, they note "like many similar disease control agencies around the world, presents seasonal influenza morbidity and mortality not as raw counts but as calculated estimates based on submitted International Classification of Diseases codes."
Thus, between 2013 and 2019, the yearly seasonal influenza deaths ranged from 23,000 to 61,000. However, the actual number of counted influenza deaths over that timespan ranged between 3,448 and 15,620 deaths each year. On average, the researchers said, CDC influenza death estimates are about six times greater than the number of counted deaths.
Conversely, COVID-19 deaths are not estimated, but counted and reported directly. The researchers suggested that a more valid measure would be to compare weekly counts of COVID-19 deaths to weekly counts of seasonal influenza deaths.
So, they did.
During two weeks in mid-April, 29,933 COVID-19 deaths were counted in the United States. In contrast, according to CDC, counted deaths during the peak week of the influenza seasons from 2013-2020 ranged from 351 (2016) to 1626 (2018).
The mean number of counted deaths during the peak week of influenza seasons from 2013-2020 was 752.4.
"These statistics on counted deaths suggest that the number of COVID-19 deaths for the week ending April 21 was 9.5-fold to 44.1-fold greater than the peak week of counted influenza deaths during the past 7 influenza seasons in the US, with a 20.5-fold mean increase," the researchers said.
"The ratios we present are more clinically consistent with frontline conditions than ratios that compare COVID-19 fatality counts and estimated seasonal influenza deaths," they wrote. "We infer that either the CDC's annual estimates substantially overstate the actual number of deaths caused by influenza or that the current number of COVID-19 counted deaths substantially understates the actual number of deaths caused by SARS-CoV-2, or both."
Faust Raps CDC Methodology
In an email exchange with HealthLeaders, Faust challenged the way CDC tracks seasonal influenza deaths.
"The CDC believes that flu counts are underestimated at several points in the healthcare system. But if that were true, we’d see increases in overall death counts in bad flu seasons. We simply don’t observe that. Their explanation in here. But the assumptions it make are simply not supported by reality. If they were, again we would see more “all cause” deaths in bad flu seasons. That does not occur," Faust wrote.
Faust said it's possible that CDC is reporting larger numbers of influenza deaths in the hopes of encouraging the public to use better hygiene and get flu shots.
"But I believe those aims can be achieved without that tactic. In fact, we tend to make the opposite argument for other vaccines. The proof that measle/mumps/rubella vaccines are so effective? That there are so few cases these days," he wrote.
Faust says he not quite clear why CDC sticks to these estimates for seasonal flu, rather than counting deaths, which they do with pediatric influenza.
"However, if they did that, they’d have to borrow those deaths from other causes, like heart failure," he wrote.
"Interestingly, if the CDC counted all of these and reported them directly it might very well be that the raw counts would come down even further than they are now," he wrote.
Why?
"If official documents are only 'allowed' to count one cause of death, that means the yearly total of deaths in the United States needs to add up to 2.5 million. In that regime, medical examiners would have to choose between causes of death," he wrote.
"For those dying of flu after a three-year battle with cancer? I’d give cancer the credit. The big question becomes: is this also happening with COVID-19? The answer is very little so far. How do we know? Because unlike a bad flu season, total numbers of deaths are up. That’s what makes this 'real.'"
Net operating income dropped 88% for the first three months of 2020, after a near-total shutdown of elective and outpatient services in the final two weeks of March.
Revenue growth at Mayo Clinic fell off a cliff in the final two weeks of the first quarter, owing to the shutdown of outpatient and elective services because of the coronavirus pandemic.
The famed, Rochester, Minnesota-based health system started the quarter in January "with strong performance" and net operating income of $153.1 million, a 6.7% margin for the first two months.
Volumes and revenues continued to be strong through the first half of March, until elective and outpatient services were shuttered on March 23.
"Mayo's 2020 first quarter results spanned two very different environments," Mayo said in a Q1 in-house analysis. "The practice experienced strong revenue growth of 8.2% in January and February over last year but was reduced by the contraction of the practice due to COVID-19 in March."
"With the onset of COVID-19, medical service revenue finished at $842 million, resulting in a net operating loss of $124 million for the month," Mayo reported.
Net operating revenues were $29 million for the quarter, down from $241 million in the first quarter of 2019, a drop of 88%.
Total revenue fell by 3.8% to $3.22 billion. Net Medical Service Revenue was $2.81 billion, up 0.7% from Q1 2019.
Mayo reported cash and investments of $10.55 billion on March 31, a drop of $647.7 million since December 31, 2019, "due largely to the volatility of the financial markets."
Key metrics Days Cash on Hand (252), Cash to Debt (252%) Debt to Capitalization (35%), and Days Revenue Outstanding (62.4) were down slightly from Q1 2019, suggesting that despite the dire quarter, the health system's finances were relative stable, Mayo said.
Dr. Qing Wang allegedly failed to disclose to NIH that he was also receiving grant money from the Chinese government.
A former researcher at the Cleveland Clinic Foundation has been arrested and charged with wire fraud and false claims for allegedly failing to disclose funding he received from the Chinese government while simultaneously accepting more than $3.6 million in funding from the National Institutes of Health, the Department of Justice said.
According to a criminal complaint filed by DOJ, Dr. Qing Wang "knowingly failed to disclose to NIH that he had an affiliation with and held the position of Dean of the College of Life Sciences and Technology at the Huazhong University of Science and Technology and received grant funds from the National Natural Science Foundation of China for some of the same scientific research funded by the NIH grant."
DOJ did not say what Wang was researching.
Federal prosecutors also allege that Wang participated in the Thousand Talents Program, which was established by the Chinese government to recruit people with access to foreign technology and intellectual property.
Through TTP, China gave Wang $3 million to enhance facilities and operations at HUST. Wang also allegedly received free travel and lodging for his trips to China, which included a three-bedroom apartment on campus for his personal use.
These perks came as Wang was also getting NIH funds, which he failed to disclose, DOJ said.
Cleveland Clinic Responds
Cleveland Clinic issued this statement regarding Wang's arrest:
"The National Institutes of Health raised concerns to Cleveland Clinic whether Dr. Qing Wang appropriately disclosed foreign research ties to China. Cleveland Clinic conducted an internal review into these matters. Based on the results of that review, Dr. Wang's employment at the Cleveland Clinic was terminated."
"Cleveland Clinic has cooperated fully with the NIH and with federal law enforcement as they conducted their own investigations into these same subjects and will continue to do so. Cleveland Clinic takes seriously its obligations to be a good steward of the federal research funds entrusted to us."
"Cleveland Clinic appreciates the commitment by the NIH and federal law enforcement to the integrity and security of research being conducted by the academic community across the country."
