Dentist and physician practices bore the brunt of downturn, reporting a combined 30,000 job losses.
New data released Friday shows that the COVID-19 response has led to massive layoffs in the healthcare sector, as hospitals and other care venues pare back elective and non-emergency services and focus resources to cope with the pandemic.
The healthcare sector, for decades a job-creating machine in the U.S. economy, lost 42,000 jobs in March, according to unemployment figures released today by the Bureau of Labor Statistics.
Among the casualties, ambulatory services lost 33,300 jobs, including 17,000 jobs losses in dentist offices, 12,000 jobs losses physician offices, and 7,000 losses in other care venues.
The nation's hospitals, which created on average 8,500 jobs per month in 2019, created 200 jobs in March.
For decades, the nation's healthcare sector has been a job-creating powerhouse. In 2019, nearly one-in-five jobs created in was in healthcare, and 374,000 jobs for the year – about 33,000 jobs each month –which greatly outpaced nearly every other major sector of the economy, BLS data show.
The 2019 figures include 269,000 new jobs in ambulatory services, up from 219,000 jobs in 2018, and 102,000 new hospital jobs, down from 107,000 new jobs in 2018.
The March employment numbers are considered "preliminary" and could be revised.
More than half (54%) of primary care practices are conducting the majority of their visits by telephone.
Nearly 8 in 10 primary care clinicians say their practice is under "severe" or "close to severe" strain because of COVID-19, with only one-third of respondents to a new poll this week reporting that they have enough cash on hand to last one month.
The combined numbers are in line with a similar polls conducted by PCC and the Green Center last month.
"The quantitative and qualitative results of these surveys are a clarion cry for more health plans to step up and cover telehealth and telephonic visits as Medicare has done," said Ann Greiner, president and CEO of the Primary Care Collaborative.
"Next is to get financial relief to practices that are going under water and to move primary care much more rapidly to adequate prospective payment," she said. "Practices under such arrangements can weather these storms and provide higher-value care."
Among the survey findings:
Telehealth capacity is increasing, with 33% of respondents reporting that their practice had no video visits (down from 60% the week before), while half report no e-visits at their practice (down from 70% the week before).
More than half (54%) of primary care practices are conducting the majority of their visits by telephone.
Nearly a third of respondents work at practices that offer some visits in the parking lot.
Only 33% of clinicians say they have enough cash on hand to function for four weeks. Half answered either "no" (13%) or "unsure" (37%).
More than 20% of respondents said their practice may temporarily close, owing to either "clinician or staff illness," (20% maybe); "lack of PPE/supplies (21% maybe); and "lack of revenue" (16% maybe).
The survey respondents represent a wide range of primary care providers, including family medicine (59%), geriatrics (13%), internal medicine (12%), primary care-based pharmacists and behavioral health (11%), and pediatrics (5%).
About 20% of the respondents work in small practices with three or fewer clinicians, 29% work in community health centers, 33% work in practices owned by an academic medical center, and 20% are self-employed. Nearly one-quarter of the respondents practice in a rural setting, and about half of the clinicians said a majority of their patients are commercially insured.
"This week's survey shows that pressure on front-line clinicians is intense," said Rebecca Etz co-director of The Larry A. Green Center and associate professor of family medicine and population health at Virginia Commonwealth University.
"Practices are mostly holding on now, but in this week's survey, six in 10 clinicians said they were uncertain if their practice will be open a month from now due to the combined pressures of no PPE, clinician and staff illness, and lost income," Etz said.
Lefteris has served as UCI Health's COO since December 2018.
UCI Health's search for a new CEO ended Thursday with the announcement that current COO Chad T. Lefteris has been picked to lead the Orange County-based health system.
His appointment was approved this week by the University of California Board of Regents.
"With the vast spread of COVID-19, this is a pivotal time for healthcare in our state and nation," Lefteris said in a media release." I will prioritize the health of our community and the safety and well-being of our physicians, nurses and staff as we work together to get through this pandemic. It's a privilege to work with all of the outstanding physicians, nurses and staff at UCI Health – they are truly heroes."
Lefteris has served as UCI Health's COO since December 2018. His new post puts him in charge of the entire UCI Health system, which includes UCI Medical Center, an academic medical center, and more than a dozen outpatient research and specialty care venues in Orange and Riverside County.
"After a nationwide search, the search committee identified the ideal candidate within our own ranks," Steve Goldstein, MD, UCO Health's vice chancellor for health affairs, said in a media release.
"Chad brings years of experience and a natural ability to build relationships. I have all the faith and confidence that Chad will lead UCI Health through this COVID-19 crisis. He’s the right person to ensure that our frontline caregivers have the tools and resources they need to continue providing care for our community during these trying times," Goldstein said.
Before joining UCI Health, Lefteris was vice president of operations at UNC REX Healthcare in Chapel Hill, North Carolina.
Lefteris said the continued focus of UCI Health under his tenure will be meeting the needs of the region's patients.
"While we’re at the forefront of providing complex care and cutting-edge research, we also have a prominent role in providing primary and specialty care in all corners of the community," he said.
Editor's note: This story was updated on April 8, 2020.
With hospitals pushed to the breaking point, here are some suggestions to defuse the inevitable stressors that come with the pandemic.
As the nation's healthcare delivery system comes closer to capacity, tempers are bound to flare among patients, clinicians, administrators and other stakeholders.
1. Behavior is Communication. Most communication occurs beyond the words we use. Look for signs of anxiety in body language, tone and cadence. Understand that crisis behavior reflects a need and consider what it is the other person might want.
2. Avoid the Power Struggle. No one can meet every need at every moment. Challenging or exercising authority over a person can escalate negative behaviors. Considering options you can offer allows flexibility to address both parties’ needs and desired outcomes.
3. Use Limit Setting. Behavior can’t be forced but setting limits can help us influence behaviors. Framing acceptable behaviors or outcomes can encourage the other person to choose the most productive option.
4. Practice Rational Detachment. Don’t take behaviors personally. Stay calm. Find a positive way to release the negative energy you absorbed during the conflict. Keep in mind, you can only control your own attitude and actions.
5. Therapeutic Rapport. Learn from the conflict and help the other person learn from the experience. Focus on identifying and preventing the pattern of behavior in the future. Finally, put time and effort into repairing the relationship.
The sweeping "Hospitals Without Walls" initiative take effect immediately and allows hospitals to bill Medicare for services in unconventional settings.
The Trump Administration has suspended regulatory barriers and will now allow hospitals to clear precious bed capacity by triaging non-COVID-19 patients in thousands of ambulatory surgery centers, rehab hospitals, and even hotels and college dorms.
The sweeping "Hospitals Without Walls" initiative takes effect immediately, will last through the duration of the pandemic, and allows hospitals to bill Medicare and other government payers for providing these services in unconventional settings, the Centers for Medicare & Medicaid Services announced Monday.
"Front line healthcare providers need to be able to focus on patient care in the most flexible and innovative ways possible," CMS Administrator Seema Verma said.
"This unprecedented temporary relaxation in regulation will help the healthcare system deal with patient surges by giving it tools and support to create non-traditional care sites and staff them quickly," she said.
Martie Ross, managing principal of Knoxville, Tenn.-based PYA, says the guidance is meant to give providers wide latitude to manage through the COVID outbreak.
“They have really stripped out a lot of regulatory requirements applicable simply to relieve as much administrative burden as possible,” Ross says. “CMS goes a step further to expand the definition of a hospital. They're really trying to enable hospitals to use other facilities as are appropriate.”
Verma said the temporary waivers will give local health systems and hospitals the option of tapping into community-based healthcare venues and provide greater flexibility to respond to the COVID-19 pandemic as they see fit.
For example, the waiver allows health systems to bill government payers for home-based, or drive-through COVID-19 testing in order to limit exposure for both patients and providers, and to ease the strained supply of personal protective equipment.
The telehealth provisions allow for providers to get reimbursement for services that had been previously blocked, including those that involve simple phone calls between provider and patient, Ross says.
“It's not technically tele-health reimbursement,” Ross says. “They just turned on the telephonic evaluation of management codes. CMS had been staunchly refusing to do now for the last five years.”
Last week, America’s Health Insurance Plans said commercial plans would match CMS's waivers for Medicare beneficiaries in areas where in-patient capacity is under strain.
An Array Analytics study released Wednesday found that health systems across the country could boost ICU hospital bed capacity by 21% if ASCs were utilized, and that leveraging ASCs would boost medical-surgical bed capacity by 8% nationwide.
Under the waiver, ASCs could contract with local healthcare systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration as long as they follow their state’s emergency pandemic preparedness plan.
The waiver also allows ASCs and other care venues to administer services usually provided by hospitals such as cancer procedures, and trauma and other essential surgeries.
The Ambulatory Surgical Care Association, the lobbying arm for more than 5,800 ASCs across the nation, said Monday that it is still reviewing the waiver. However last week, ASCA CEO Bill Prentice said "our best suggestion would be to keep those patients out of the hospital that is dealing with a pandemic and shift that care to places like ambulatory surgery centers."
"We could be the outflow for necessary surgery that's still going to happen over the next few months," Prentice told HealthLeaders. "Hernias are still going to become strangulated. People are still going to tear their ACLs. People are going to be uncontrollable pain use. Let's use surgery centers as a an off-campus site for that work to do so the hospitals can focus on dealing with a pandemic."
Suspending the rules will allow hospitals to support physician practices by transferring medical equipment, including items used for telehealth, and providing meals and childcare for healthcare workers, CMS said.
HealthLeaders' Jim Molpus contributed to this report.
The task force wants hospitals to report COVID-19 testing data and provide daily reports on bed capacity and supplies.
Vice President Mike Pence has asked the nation's hospitals to provide federal monitors with a daily report on "in-house" coronavirus testing results, other pandemic surveillance data, and bed capacity.
"The data will help us better understand disease patterns and develop policies for prevention and control of health problems related to COVID-19," said Pence, who is leading the White House Coronavirus Task Force.
Specifically, the task force wants hospitals to report COVID-19 testing data to the Department of Health and Human Services, and provide daily reports on bed capacity and supplies to the Centers for Disease Control and Prevention National Healthcare Safety Network COVID-19 Patient Impact and Hospital Capacity Module.
The data request will not include information that could identify patients.
The task force is already collecting data from public and private health labs, but not from in-house hospital labs.
"The nation's nearly 4,700 hospitals have access to testing data that's updated daily," Centers for Medicare & Medicaid Services Administrator Seema Verma said. "This data will help us better support hospitals to address their supply and capacity needs, as well as strengthen our surveillance efforts across the country.
Ashley Thompson, the American Hospital Association's vice president for public policy, said the hospitals already are "being asked to submit data to many entities, including local and state authorities being."
"We have urged that the federal government streamline these efforts to ensure hospitals can remain focused on patient care," she said.
"During this unique period in which we are dealing with a national emergency, we will urge our members to report the data needed by the federal government to support epidemiological surveillance and public health decision making as this effort evolves," she said.
The temporary layoffs at the Lexington, Kentucky-based health system will affect 8% of its 6,000 employees, who were given the news on Friday.
Appalachian Regional Healthcare is temporarily furloughing 500 employees across its 13 hospitals in eastern Kentucky and southern West Virginia as part of a focus on essential services for an expected surge in COVID-19 patients.
"In this time of unprecedented uncertainty, this was not an easy decision to make," ARH Vice President of Human Resources Sonya Bergman said in a media release. "The temporary furloughs are in the best interest of the health of our employees and the community."
The furloughs will affect 8% of ARH’s 6,000 employees, who were given the news on Friday, Bergman said.
"As healthcare providers, we are on the front lines of the COVID-19 pandemic and need to do everything we can to ensure we have the right clinical resources in place, including staff, supplies and equipment, to prepare for a COVID-19 patient surge," she said.
Layoffs are being announced daily across the nation, as health systems grapple with the double-whammy of losing precious dollars from government-mandated postponed or cancelled elective surgeries, and by estimates that treating COVID-19 will be a money loser.
Bergman said ARH has seen a 30% decrease in its overall business operations from a decline in patient volumes and the closure of elective services because of the pandemic.
"When it is safe for our employees to resume work as normal and patient volumes return, we plan to restore services and bring these employees back," she said.
CMS says the waivers will give states more flexibility to respond to the coronavirus pandemic.
The federal government announced Friday that 34 states have been granted expedited 1135 Medicaid waiversso far in the ongoing fight against the coronavirus epidemic.
The emergency provision allows the Centers for Medicare & Medicaid Services to waive some requirements in Medicare, Medicaid, and CHIP that give state Medicaid agencies flexibility and remove red tape that can hamper access to needed services.
The expedited waiver process was part of a national emergency declaration issued earlier this month by President Donald Trump.
“These waivers allow states to make extraordinary adjustments to their Medicaid programs to meet the unprecedented demands of this emergency," CMS Administrator Seema Verma said in a media release.
The waiver: streamlines provider enrollment processes; allows care to be provided in alternative settings in unlicensed facilities if a licensed facility is evacuated; waives prior authorization requirements; suspends some nursing home screening requirements to provide necessary administrative relief; and extends deadlines for appeals and state fair hearing requests.
CMS said that the average review and negotiation period usually required for 1135 waivers has been reduced from months to an average of six days after a request is submitted, owing to a streamlined application process.
So far, the states granted the 1135 waiver are: York, Colorado, Hawaii, Idaho, Massachusetts, Maryland, Connecticut, Delaware, Minnesota, Pennsylvania, Wyoming, Iowa, Indiana, Rhode Island, Kansas, Kentucky, Missouri, Oregon, North Dakota, South Dakota, Oklahoma, Alabama, California, New Hampshire, New Mexico, New Jersey, Arizona, Virginia, North Carolina, Mississippi Louisiana, Illinois, Washington and Florida.
CMS has also approved eight state requests to invoke emergency flexibilities in their programs that care for the elderly and people with disabilities in their homes and communities.
The funding is part of a massive $2 trillion emergency stimulus package unanimously passed by the Senate late Wednesday.
The American Hospital Association is cheering the Senate's approval of a historic $117 billion stimulus package for the nation's besieged hospitals but warns that more resources will be needed to fight the coronavirus pandemic.
"While this legislation is an important first step forward, more will need to be done to deal with the unprecedented challenge of this virus," AHA President and CEO Rick Pollack said.
"We will continue to work with Congress to make sure providers on the front lines – hospitals, physicians and nurses – remain prioritized for future federal assistance as the COVID-19 pandemic spreads," he said.
The funding is part of a massive $2 trillion emergency stimulus package unanimously passed by the Senate late Wednesday. The House is expected to vote on the bill on Friday, and President Donald Trump has said he will sign the bill.
The 880-page bill includes: emergency funds for hospitals; a delay for the Medicaid Disproportionate Share Hospital cut; temporary elimination of the Medicare sequester; and a Medicare diagnosis-related group add-on payment.
AHA estimated the value of the stimulus package for hospitals at $117 billion, of which $100 billion is earmarked for healthcare-related expenses or lost revenues attributed to COVID-19.
Specifically, the stimulus would:
Eliminate the $4 billion in Medicaid DSH cuts this year, and reduce the cut for fiscal year 2021 to $4 billion from $8 billion. The FY 2021 cuts would be delayed until Dec. 1, 2020. No additional cuts would be added after FY 2025.
Eliminate the Medicare sequester from May 1 through Dec. 31;
Provide a 20% add-on to the DRG rate for patients with COVID-19, applied to patients treated at inpatient prospective payment system hospitals;
Allow hospitals to receive an advance on future Medicare payments.
Increase the amount most hospitals could receive based on prior payments to 100% (from 70%). Critical access hospitals would be eligible for up to 125%. Hospitals would have four months until recoupment, and one year or longer before repayment.
Provide flexibility for post-acute care providers to increase capacity without penalties during the emergency period.
Waive the "50% Rule," for long-term care hospitals, and the site-neutral payment policy.
Waive the three-hour rule for inpatient rehabilitation facilities.
In addition, for-profit and not-for-profit hospitals with fewer than 500 employees would be eligible for up to $10 million in emergency loans to pay for salaries, healthcare and other employee-related expenses benefits that could be eventually forgiven if no layoffs occur during the emergency period.
Bruce Siegel, MD, president and CEO of America's Essential Hospitals, said the emergency funding gives safety net hospitals "breathing room," but that more aid may soon be needed.
"Time will tell how far this funding will go and how much more our hospitals will need," he said. "We will continue to work with Congress and the administration to ensure we answer those questions and consider how to ease regulatory challenges, such as the pending Medicaid Fiscal Accountability Regulation, that would severely constrain safety-net funding just when it’s needed most."
NIH is testing the antiviral drug's safety and efficacy against COVID-19.
Gilead Sciences, Inc. has asked the federal government to rescind orphan drug designation for remdesivir, an antiviral drug that could be used to fight COVID-19.
"Gilead has submitted a request to the U.S. Food and Drug Administration to rescind the orphan drug designation it was granted for the investigational antiviral remdesivir for the treatment of COVID-19 and is waiving all benefits that accompany the designation."
Orphan drug designation is granted by the FDA for rare diseases that affect fewer than 200,000 people nationwide.
Remdesivir was originally designed by Gilead to treat Ebola and Marburg viruses.
The drug maker said Wednesday it "is confident that it can maintain an expedited timeline in seeking regulatory review of remdesivir, without the orphan drug designation."
Gilead's about-face on the orphan drug status comes as pressure was mounting on the drug maker to rescind the designation, which would have given Gilead a seven-year marketing monopoly.
A group of 50 public advocacy groups rapped Gilead for rushing to get the orphan designation earlier this month while there were fewer than 200,000 known COVID-19 cases in the United States.
"This is an unconscionable abuse of a program designed to incentivize research and development of treatments for rare diseases,” the advocates said in a letter sent Wednesday to Gilead CEO Daniel O'Day.
"COVID-19 is anything but a rare disease. Calling COVID-19 a rare disease mocks people's suffering and exploits a loophole in the law to profiteer off a deadly pandemic."
"Making the claim to special orphan status even more outrageous is the fact that the public already has largely paid for remdesivir's development through at least $60 million in grants and innumerable contributions from federal scientists. America, and the world, has the right to expect better from Gilead," the letter said.
The National Institutes of Health announced Wednesday that it would begin testing remdesivir to determine if it could be used safely and effectively to treat the coronavirus.
