Less than 40% of physicians said they were treating COVID-19 patients. However, 60% of physicians who were not treating those patients said they'd be willing to.
More than 20% of physicians report that they've either taken a pay cut or been furloughed by the coronavirus pandemic, including 30% of physicians who are not treated COVID-19 patients, according to a new survey commissioned by The Physicians Foundation.
Of those physicians who've taken a financial hit or a furlough, 18% said they were treating COVID-19 patients, and 30% said they were not, according to the findings in an online survey of 842 physicians, conducted last week by Irving, Texas-based physician recruiters Merritt Hawkins.
"Prior to the pandemic, physicians were already facing a number of stress factors eroding their morale and potentially limiting patient access to their services," Merritt Hawkins said. "The coronavirus is likely to add to these stresses, and more attention therefore needs to be paid to physician well-being, both during the current crisis and after it has been contained to help ensure an adequate and engaged physician workforce."
Less than 40% of physicians said they were treating COVID-19 patients. However, 60% of the physicians who were not treating those patients said they would be willing to, which Merritt Hawkins said suggests "that the physician workforce has extra capacity to bring to bear on the pandemic, with (that) many doctors willing to assume the risk, responsibilities and (presumably) the rewards of treating those infected with the virus."
While two-thirds (66%) or respondents said they would continue to practice medicine as they are now, 34% said they would make changes, including 14% who said they'd seek a different practice, 7% who said they'd close their practice temporarily, 5% who said they'd retire, and 4% who said they'd leave private practice and work for a hospital.
The survey also found that 48% of physicians are using telehealth to access patients, up from 18% in a 2018 Merritt Hawkins survey.
"The emergence of the virus has clearly accelerated the use of technological platforms used to treat patients remotely," Merritt Hawkins said.
Thirty-six percent of the respondents were primary care physicians, and 66% were surgeons, diagnosticians, and other specialists, which corresponds with the percentages in the nation's physician workforce.
The merger, under which Akron, Ohio-based Summa would become a wholly owned subsidiary of Beaumont, was announced in January.
Beaumont Health and Summa Health have postponed their merger plans while the coronavirus pandemic rages, the two health systems announced.
"Both Summa and Valmont are all hands on deck with the COVID-19 crisis," Beaumont CEO John Fox told reporters Tuesday. "We didn't plan this, but we are deferring until we have a little more clarity about the impact of this crisis.
"They are doing the same things we're doing. We talk multiple times during the week as they try to navigate through their own version of the surge that they'll experience in northern Ohio," Fox said.
The merger, under which Akron, Ohio-based Summa would become a wholly owned subsidiary of Beaumont, was announced in January, about six months after the two health systems entered negotiations. Beaumont and Summa have combined revenues of $6.1 billion, operate 12 hospitals in Ohio and Michigan, and employ about 45,000 people.
Summa Health spokesman Mike Bernstein said the merger has cleared all federal and state regulatory hurdles and that Summa's board of directors "is working closely with Beaumont to finalize the path forward and the appropriate timing to combine our organizations."
"That said, the immediate priority is for both Summa and Beaumont to focus first and foremost on caring for our patients, employees, physicians and communities as we are impacted by the COVID-19 pandemic," Bernstein said.
"We must prioritize efforts to ensure the health and safety of all those we serve during this difficult time and we remain committed to finalizing all necessary details to close this transaction when appropriate."
Fox said he doesn't know how long the merger will be delayed.
"We can't turn a blind eye to the pandemic," he said. "Going through the merger process and all those activities we thought was an unnecessary distraction, given that we were working seven days a week, 16 hours a day to deal with the pandemic. And so was Summa. It's kind of like you had a plan to do something, but the house is now on fire. So, we're going to deal with the fire."
Fox's announcement Tuesday that the merger would be delayed followed his announcement that the health system would temporarily lay off 2,475 employees, eliminated another 450 jobs, and slashed executive pay to staunch the financial "hemorrhaging" created by the coronavirus pandemic.
In the first quarter ending March 31, Beaumont's net income was -$278.4 million, a plummet of $407.5 million over the first quarter of 2019. Operating revenue fell to $1.07 billion, a $78.2 million decrease over the $1.15 billion reported in the first quarter of 2019.
Net operating income for the first quarter of 2020 was –$54.1 million, a $91.7 million decrease compared to the same time last year.
The first-quarter losses mounted even though the virus impacted the health system for the last two weeks of March, and Beaumont officials warned the losses could be much worse in the second quarter.
In the first quarter of 2020, Beaumont's net income was -$278.4 million, a free-fall of $407.5 million over Q1 2019.
Beaumont Health has temporarily laid off 2,475 employees, eliminated another 450 jobs, and slashed executive pay to staunch the financial "hemorrhaging" created by the coronavirus pandemic.
Beaumont began caring for COVID-19 patients five weeks ago, and nearly all inpatient and outpatient surgeries and other non-COVID-19 medical services were shut down, while the number of patients seeking care unrelated to COVID-19 fell off after March 16.
In the first quarter ending March 31, Beaumont's net income was -$278.4 million, a plummet of $407.5 million over the first quarter of 2019. Operating revenue fell to $1.07 billion, a $78.2 million decrease over the $1.15 billion reported in the first quarter of 2019.
Net operating income for the first quarter of 2020 was –$54.1 million, a $91.7 million decrease compared to the same time last year.
The first-quarter losses mounted even though the virus impacted the health system for the last two weeks of March, and Beaumont officials warned the losses could be much worse in the second quarter.
In a media availability on Tuesday announcing the cuts, Beaumont CEO John Fox, who will take a 70% temporary pay cut to his base salary, likened the health system's dilemma to "a tale of two cities."
"An absolutely outstanding performance by clinical teams who I cannot be more proud of in terms of how they responded without hesitation and handled more COVID-19 positive patients than any other system in Michigan by far," he said. "The other piece of that is by doing the most, we are also hemorrhaging the most in terms of cash, and we have to deal with that piece of the puzzle."
Fox declined to say how much he earns, saying "I'm not going down that rabbit hole" to multiple media requests on Tuesday. The Detroit Free Press reported that Fox's compensation was $5.6 million a year in 2017. Other top executives at the Royal Oak, Michigan-based health systems will take temporary cuts of up to 45%.
In addition to the layoffs and the salary cuts, Fox said the health system was forced to permanently eliminate 450 positions, most in corporate and administrative services, owing to uncertainty in the healthcare sector "well after the COVID-19 initial surge subsides."
"We must adjust the way we operate our organization moving forward," he said. "This pandemic has changed the delivery of healthcare, and we will be treating patients with this virus until we get a vaccine."
Beaumont, the state's largest health system, has 38,000 employees and operates eight hospitals across southeast Michigan.
The collaborative is distributing hydroxychloroquine from the government's Strategic National Stockpile to healthcare providers in hard-hit areas.
The Department of Justice said this week it will not mount an antitrust challenge against AmerisourceBergen Corp. collaborations to obtain coronavirus-related medical supplies.
"We commend AmerisourceBergen's efforts to assist the United States in responding to the COVID-19 pandemic through improved supply of medicines to those most in need," Assistant U.S. Attorney General Makan Delrahim of DOJ's Antitrust Division, said in a media release.
The collaborative is facilitating distribution of hydroxychloroquine from the government's Strategic National Stockpile to healthcare providers in hard-hit areas. Under the arrangement, AmerisourceBergen is instructed on volumes and ship-to destinations, using its distribution network.
"We also appreciate AmerisourceBergen's intention to comply with the antitrust laws, regardless of circumstances. Division staff worked expeditiously to resolve its request for a Business Review Letter within our ambitious seven-day target," Delrahim said.
Verma calls for "a more tailored and flexible approach" with input from local leaders.
The Centers for Medicare & Medicaid Services is offering recommendations for how hospitals in areas with low incidences of COVID-19 can re-open for non-emergency procedures.
"Today, some areas of the country are experiencing fewer cases and lower incidence of the virus, necessitating a more tailored and flexible approach," CMS Administrator Seema Verma said.
"Every state and local official will need to assess the situation on the ground to determine the best course forward, but these guidelines provide a gradual process for restarting non-COVID-19 essential care while keeping patients safe," she said.
The recommendations, released Sunday, target communities that are in Phase 1 of the Guidelines for Opening Up America Again with low incidence or relatively low and stable incidence of COVID-19 cases.
CMS is calling for a "gradual transition," with providers coordinating with state and local public health officials, and accounting for the availability of personal protective equipment and other supplies, workforce availability, facility readiness, and testing capacity.
To get to Phase 1, states or regions need to pass gating criteria regarding symptoms, cases, and hospitals. However, CMS said recommendations are just that, and are not meant to be implemented by every state, county, or city right now. Ultimately, governors and local leaders will make decisions on whether re-openings are appropriate.
Emergency designations on care venues means that the now-empty, 185-bed hospital will treat only COVID-19 patients until the pandemic declaration has lifted.
Beaumont Hospital, Wayne "temporarily paused" this week in anticipation of a "second surge" of COVID-19 patients that the health system said could occur if social distancing restrictions are eased.
"Beaumont Hospital, Wayne is important to Beaumont Health and is not permanently closing. Rumors to that effect are false," the Royal Oak, Michigan-based health system said.
Wayne's "few remaining patients" were either discharged or transferred from the 185-bed, acute-care hospital this week, and staff were redeployed to other Beaumont hospitals or temporarily laid off.
Beaumont said the region was expecting a surge in COVID-19 patients two weeks ago and gained state approval to designate Wayne as a COVID-19-only hospital.
"Fortunately, the surge was more moderated, likely due to aggressive social distancing, the stay at home order and other factors mitigating the spread of the disease," Beaumont said.
However, Beaumont said, strict state designations on care venues means that the now-empty Wayne hospital will remain under the COVID-19-only status until the pandemic declaration has been lifted.
"This is in preparation for a second surge that could occur after the stay at home restrictions end," Beaumont said. "The pandemic remains very unpredictable. Beaumont Health is committed to responding to potential ongoing COVID-19 surges by relying upon our Wayne hospital and other resources."
"Beaumont is committed to reopening Beaumont, Wayne and making sure the services provided there both meet the community's needs and fit within our system’s overall strategic plan. However, we will only do that when it is safe to do so and when we have more clarity about the pandemic."
As of Friday afternoon, Michigan had reported 29,263 COVID-19 cases and 2,093 deaths.
Medicare's reimbursement for automated tests will increase from $51 to $100.
In an attempt to reduce lag times for COVID-19 diagnoses and get a better sense of the scope of the pandemic, Medicare said it will nearly double its payments for high-throughput commercial lab tests.
"CMS has made a critical move to ensure adequate reimbursement for advanced technology that can process a large volume of COVID-19 tests rapidly and accurately," CMS Administrator Seema Verma said. "This is an absolute game-changer for nursing homes, where risk of Coronavirus infection is high among our most vulnerable."
The higher $100 payment – an increase from $51 – will be paid to private sector labs, such as Roche, Hologic, Abbott and Cepheid, that have developed highly automated processes to increase testing capacity and achieve faster and more accurate results.
The high-throughput labs can process more than 200 tests each day.
A lack of testing kits and long delays in getting the results of COVID-19 tests were citied as a major reason for backups in hospital patient throughput in March, according to a study released this month by the Office of the Inspector General for the Department of Health and Human Services.
The scarcity of the tests, and the subsequent wait for results for patients and staff, which often took a week or longer, had a snowball effect on patient throughput, OIG said in its report.
MedPAC asks CMS not to use 2020 data to calculate baseline year spending for future benchmarks.
The Medicare Payment Advisory Commission is recommending that the Centers for Medicare & Medicaid Services scrap pandemic-skewed 2020 performance benchmarks for at-risk accountable care organizations.
"The COVID-19 public health emergency has likely affected—and will continue to affect, at least through 2020—Medicare spending in ways that are yet to be fully understood," MedPAC Chairman Francis J. Crosson, MD,said in a letter this week to CMS Administrator Seema Verma.
"This is particularly problematic for providers participating in ACOs, whose 2020 performance will be assessed using benchmarks established before the current emergency," Crosson said. "Given the dramatic shifts in care delivery that have occurred in 2020, attempting to adjust 2020 spending and benchmarks for COVID-19 will be impractical. It also may be inequitable."
Specifically, Crosson asked CMS to:
Not use 2020 data to determine ACO quality, bonuses and penalties; not use 2020 data to calculate baseline year spending for future benchmarks; and consider extending existing ACO agreement periods by one year.
Not use 2020 claims data to assign beneficiaries, because the use of telehealth could distort ACO assignment. Instead, MedPAC is recommending that CMS consider using 2019 and/or 2021 claims data to assign beneficiaries in 2021.
Provide an extension of the NextGen ACO model through 2023, which will give ACOs already in the model time to continue in the program without having to adapt to a new model during the pandemic.
Delay the start of the Center for Medicare & Medicaid Innovation Direct Contracting model, by at least one year, to give providers a change to understand the new model before committing to it.
NAACOS Objects
The MedPAC recommendations brought down the ire of the National Association of ACOs, which said "ignoring shared savings in 2020 would devastate Medicare ACO programs."
"In 2018, Medicare paid ACOs back roughly $900 million of the $1.7 billion they saved. ACOs used that money to pay for quality improvement programs, care coordinators, health IT, analytics and other infrastructure," NAACOS said.
"Without those funds, ACOs will no longer have resources to focus on improving quality and addressing chronic disease, which help improve patient care. The impact of the pandemic will play out differently from region to region and market to market. To gut the savings opportunity before the data are in is presumptuous at best."
Instead, NAACOS said, MedPAC should consider other options, such as holding at-risk ACOs harmless, allowing ACOs to forego less shared savings in exchange for less risk, or extending the dropout deadline to give ACOs the chance "to understand how COVID-19 will playout in the coming months.
"MedPAC has consistently underplayed the value ACOs bring to Medicare payment reform.," NAACOS said. "Let's hope CMS doesn't accept this advice that would have detrimental effects on Medicare's overall shift to value."
A poll released this week shows that 54% of ACOs in Medicare's Shared Savings Program would likely leave the program amid fears of getting stuck with massive financial losses to cover the cost of the COVID-19 pandemic.
The National Association of ACOs estimates that the COVID-19 pandemic could cost Medicare between $38.5 billion and $115.4 billionover the next year.
A separate study released last week by America's Health Insurance Plans estimated the cost of the pandemic for the nation's healthcare system at between $56 billion and $556 billion
Almost 80% of Medicare risk-bearing ACOs said they were "very concerned" about their financial performance this year.
More than half of accountable care organizations in Medicare's Shared Savings Program say they'll likely leave the program amid fears of getting stuck with massive financial losses to cover the cost of the COVID-19 pandemic.
That's according to a new online survey conducted this month by the National Association of Accountable Care Organizations, which asked 2020 Medicare Shared Savings Program and Next Generation ACO Model participants across the nation to gauge their experience in handling the ongoing pandemic.
Almost 80% of the 225 ACOs that responded to the five-question survey, conducted between April 3-8, said they were "very concerned" about their financial performance this year.
Further, 56% of respondents they would leave the payment model, including 21% who said they were "very likely," 14% who were "likely" and 21% who said they were "somewhat likely."
"When ACOs made a commitment to assume risk, they didn't expect they'd be handling the risk of a global pandemic," said NAACOS President and CEO Clif Gaus.
"Rather than be forced to pay enormous losses resulting from the pandemic, these groups of providers may sadly quit the program, which they can do without penalty by May 31," he said. "Medicare's decade-long effort to change how we pay for health care to better reward quality and outcomes may be lost unless Washington acts quickly to throw these providers a lifeline."
In mid-March, NAACOS cosigned a letter with the American Hospital Association, the American College of Physicians, and seven other stakeholder organizations, askingthe Centers for Medicare & Medicaid Services to hold harmless Shared Savings participants from performance-related penalties for 2020. CMS has yet to respond.
"CMS has yet to adequately mitigate the costs and disruptions of the pandemic," Gaus said. "ACOs are telling us that they will leave the program unless there is protection from the losses of the pandemic, and it would be a tragedy for millions of Medicare beneficiaries to lose the access to care coordination and quality improvement that ACOs offer."
NAACOS estimates that the COVID-19 pandemic could cost Medicare between $38.5 billion and $115.4 billionover the next year. A separate study released last week by America's Health Insurance Plans estimated the cost of the pandemic for the nation's healthcare system at between $56 billion and $556 billion
Because of the pandemic, about 25% of ACOs said they expect spending to increase by more than 10%, another 25% say they expected spending to increase between 5% and 10%, while 10% said they expect spending to remain the same or fall, and 37% said they "don’t know."
The wide variance in cost estimates depends upon how many people are infected by the virus, the availability of testing, and compliance with preventative measures such as social distancing.
The federal government is making available more than $100 billion to cover costs for the nation's hospitals under the $2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act.
That $100 billion averages about $108,000 per hospital bed. Is it enough?
Moody's Investors Service doesn’t think so, particularly if the pandemic extends for months. The rating agency called the federal aid "extraordinary" but also "unlikely to fully cover the material revenue decline facing hospitals as a result of the pandemic."
Moody's Vice President Dan Steingart said the $100 billion "provides some relief to hospitals by supporting their operations and providing access to critical supplies."
"However, it is unlikely to fully compensate the sector for the two main financial challenges facing providers as a result of the coronavirus outbreak," he said.
"The first is a material decline in revenue and cash flow as profitable elective surgeries, procedures and other services are postponed to preserve resources and avoid spreading the virus," he said. "The second is difficulty curbing expenses as surge preparation costs offset any expense reductions from postponed or canceled services."
Citing anecdotal evidence, Moody's estimates that postponed elective services will reduce hospital revenues by as much as 40% per month and strain cash flow. These reductions are occurring, Moody's said, even at hospitals and areas of the country that have not seen that many COVID-19 patients.
That's because many states have suspended nonessential hospital services indefinitely, creating uncertainty for hospitals about when they can resume providing these money-making elective services, Moody's said.
Up to $556B Over 2 Years
A study released Wednesday by America's Health Insurance Plans offers a canyon-wide estimate of the pandemic's cost for commercial health plans, ranging from $56 billion to $556 billion over the next two years.
The wide cost variance in the study, conducted by Wakely Consulting Group, depends upon how many people are infected by the virus, the availability of testing, and compliance with preventative measures such as social distancing.
Assuming a 20% infection rate among the study population, for example, Wakely estimates that more than 50 million people will become infected, with at least 5.5 million requiring hospitalization – of which 1.3 million will require intensive care, with average ICU costs per patient exceeding $30,000.
"This new data provides us with better insight to help policymakers, private sector leaders, and other stakeholders understand the investments required to successfully care for every American subjected to this life-threatening virus," AHIP President and CEO Matt Eyles said.
Wakely estimates enrollee cost sharing would average approximately 14%-18% of annual allowed costs and would range from $10 billion to $78 billion. That estimate does not take into account decisions by some payers to waive out-of-pocket costs for COVID-19 testing and treatment.
Treating the Uninsured
A study this week by Kaiser Family Foundation estimates that providing care for up to two million uninsured Americans infected with the virus could cost between $13 billion and $42 billion, consuming more than 40% of the CARES Act funding for hospitals.
The variance of the estimate is owing to uncertainty about how may people will become infected.
"Covering COVID-19 hospital costs for patients who are uninsured would give them peace of mind that their inpatient costs will be covered," KFF President and CEO Drew Altman said. "While the details are spotty, uninsured patients could still be on the hook if they test negative for coronavirus and if they receive care outside hospitals."
Altman said the KFF analysis raises questions about how the federal government will help offset the bills of uninsured patients, and whether it reimburses physicians who treat uninsured COVID-19 patients.
