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Monthly Archives: April 2020
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When will COVID-19 peak? A state-by-state analysis
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Peak demand for hospital resources due to COVID-19 is expected by mid-April in the U.S., according to an analysis from the University of Washington’s Institute for Health Metrics and Evaluation in Seattle.
The study presents estimates of predicted health service utilization and deaths due to COVID-19 for each state in the U.S. if social distancing measures are maintained. Researchers used state-level hospital capacity data, data on confirmed COVID-19 deaths from the World Health Organization, and observed COVID-19 utilization from select locations.
While peak demand for resources, namely hospital beds and ventilators, will occur at the national level in two weeks, this varies by state. About a third of states, including New York, are projected to hit peak capacity in the first half of April, but some states will see the most demand for hospital resources in May.
Below is the projected date of peak hospital resource demand in each state according to the model, which uses data last updated April 1.
April 8
New Jersey
April 9
Louisiana
Michigan
New York
Vermont
April 11
Delaware
Washington
April 15
Alaska
Connecticut
District of Columbia
April 16
Massachusetts
April 17
Alabama
Colorado
Maine
New Hampshire
April 18
Pennsylvania
April 19
Indiana
Ohio
Tennessee
April 20
Illinois
Nevada
Rhode Island
April 21
Mississippi
North Dakota
April 22
Minnesota
April 23
Nebraska
Oklahoma
Utah
April 24
Georgia
New Mexico
April 26
Arkansas
California
Idaho
Montana
North Carolina
April 27
Arizona
Wisconsin
April 28
Kansas
South Carolina
April 29
Maryland
May 1
Iowa
May 3
Florida
Hawaii
May 4
South Dakota
West Virginia
Wyoming
May 5
Oregon
May 6
Texas
May 16
Kentucky
May 20
Virginia
May 21
Missouri
Nonprofit hospitals vulnerable to coronavirus-related market fallout, Fitch says
Continued market losses prompted by the COVID-19 pandemic will likely weaken key liquidity metrics and pressure the ratings of some nonprofit hospitals, according to a new Fitch Ratings report.
About half of Fitch’s rated nonprofit hospitals have 10 percent to 40 percent of their portfolios invested in equities, but other nonprofit hospitals exceed this range by a wide margin, Fitch noted.
Throughout the last month, the stock market suffered historic losses, which caused hospitals with more aggressive asset allocation to underperform their more conservative counterparts by 10 percent to 25 percent, Fitch said.
Fitch said that hospitals in the last few weeks have seen a median loss of about 30 days of cash on hand. It noted this metric is not “an immediate concern yet, given the ample liquidity these hospitals have.”
But Fitch said most hospitals have cash on hand to fund about 200 days of operations.
The ratings agency said the market likely will remain volatile, and “time will tell if and how the stock market declines eat into a hospital’s reserves.”
How insurers are covering COVID-19
https://www.healthcaredive.com/news/how-insurers-are-covering-covid-19/575372/
Insurers are weighing how best to respond to the outbreak of the novel coronavirus as cases swell in the U.S. Here is a tracker to follow the latest policy and coverage decisions from the nation’s largest insurers.
The nation’s health insurers are responding to the coronavirus pandemic with changes to coverage associated with COVID-19 as the number of cases continues to swell across the U.S.
The biggest payers have said they will waive patient cost-sharing — copays, coinsurance and deductibles — for testing. Although some, such as Cigna and Humana, have gone farther by eliminating cost-sharing for all COVID-19 treatment.
In addition to coverage decisions, insurers are weighing the ways they can reduce administrative barriers to promote quicker access to care for those infected with the novel coronavirus. All are cutting back on prior authorization in various ways to ease access to care.
Hospitals say that’s not enough, and are calling on the biggest payers to follow actions taken by Congress and CMS to help resolve cash flow issues, by accelerating payments or opting into releasing interim periodic payments. The American Hospital Association also is urging payers to eliminate administrative burdens such as prior authorizations.
“This crisis is challenging for all of us, and everyone has a role to play,” AHA said in its letter to the nation’s largest insurers. “You could make a significant difference in whether a hospital or health system keeps their doors open during this critical time.”
Despite the policy changes by payers, employers with self-funded plans can opt out of these policies. A majority of workers are covered by self-insured plans, which essentially allow employers to decide coverage decisions given they’re paying for the claims and having insurers simply perform administrative services.
Below is a tracker with the latest coverage decisions for the nation’s largest insurers.
Blue Cross Blue Shield Association
The BCBSA is eliminating cost-sharing for COVID-19 diagnostic testing. It will also waive cost-sharing for treatment at in-network or Medciare rates through May 31, including inpatient stays.
BCBSA will remove prior authorization requirements for testing and for services that are medically necessary to treat an infected patient. BCBSA also is waiving limits on early refills to make it easier to access medications and expanding access to telehealth services.
Molina
Molina is halting cost-sharing for testing and treatment. That policy applies to Medicare, Medicaid and marketplace members nationwide.
Aetna (CVS)
Aetna will waive cost-sharing for certain members admitted to an in-network hospital with COVID-19 or complications from the disease. The policy applies to all of Aetna’s commercial plans, though self-insured members can opt out. The policy will apply to admissions through June 1. Aetna also is waiving cost-sharing for testing and associated visits, including telehealth.
Aetna also is attempting to make access to hospitalization faster for those with COVID-19 by easing prior authorization requirements, particularly in areas hard hit by the outbreak like New York and Washington.
Anthem
The nation’s second largest commercial insurer will waive cost-sharing for COVID-19 treatment and will reimburse providers at either in-network or Medicare rates through May 31. The policy applies to Anthem’s fully insured, individual, Medicaid and Medicare Advantage members. Self-insured plans can opt out. Anthem also is waiving cost-sharing for COVID-19 testing and in-network visits associated with testing whether it’s conducted at a physician’s office, urgent care or ER.
Anthem also is easing its limits on early refills for 30-day prescriptions. Anthem said it would waive cost sharing for telehealth visits, including those for mental health for a period of 90 days starting March 17. Self-insured plans have the option to opt in the new virtual care policy.
Centene
Centene will waive cost-sharing for COVID-19 related screening, testing and treatment for its Medicaid, Medicare and Marketplace members through June 30.
Centene also will eliminate prior authorization requirements for care for all its Medicare, Medicaid and Marketplace members. The company is also working to supply federally qualified health centers with personal protective equipment and assistance in providing small business loans to behavioral health providers and long-term service support organizations.
Cigna
Cigna will waive cost-sharing for all COVID-19 treatment, including testing and telehealth screenings through May 31. The policy applies to Cigna’s fully-insured group plans, individual coverage and Medicare Advantage plans. Self-insured plans can opt out.
Cigna will reimburse providers either at in-network or Medicare rates depending on the member. Cigna also is easing access to maintenance medication by offering free shipping for a 90-day supply. Cigna is easing prior authorization requirements for patients being discharged from the hospital to post-acure stays.
Humana
Humana is waiving cost-sharing for testing and treatment, including hospital admissions for COVID-19 cases. The policy applies to its Medicare Advantage plans, fully-insured commercial plans, Medicare supplement and its Medicaid plans. The policy is indefinite with no current end date. Cost-sharing will be waived for all telehealth visits and members can opt to refill prescriptions early.
Humana also is easing administrative barriers to allow infected patients to easily move from a hospital to post-acute care settings. It’s suspending prior authorization and referral requirements and requesting notification within 24 hours. It’s also implementing an expedited claims process to reimburse providers faster, Humana said.
UnitedHealthcare
The nation’s largest commercial insurer, will waive cost-sharing for COVID-19 treatment through May 31. The policy applies to its fully-insured commercial, Medicare Advantage and Medicaid plans. United also is waiving cost-sharing for COVID-19 testing at approved locations in accordance with Centers for Disease Control guidelines. There will be no cost-sharing for visits related to testing including at physician offices, urgent care, ERs and telehealth visits. The policy applies to United’s commercial, Medicare Advantage and Medicaid members.
UnitedHealthcare is opening a special enrollment period for some of its commercial members who opted out of coverage during the traditional enrollment period with their employers. This enrollment period will end April 6. The insurer also is easing prior authorization requirements through May 31, suspending prior approval for post-acute care and switching to a new provider.
Fauci says it would be ‘false statement’ to say we have coronavirus under control
National Institute of Allergy and Infectious Diseases Director Anthony Fauci said Sunday that it would be “a false statement” to say the government has the coronavirus pandemic under control.
“We are struggling to get it under control and that’s the issue that’s at hand right now,” Fauci said on CBS’ “Face the Nation” Sunday.
Trump has several times over the course of the pandemic claimed the outbreak was “under control,” including in mid-March as deaths rose in the U.S. He has, however, struck a more somber tone in the last week. He acknowledged Saturday “there will be a lot of death” in the coming week.
“This will be probably the toughest week,” Trump told reporters at a White House press briefing on COVID-19 Saturday afternoon.
Fauci noted that mitigation efforts are showing signs of success in hard-hit states such as New York.
“This next week is going to look bad because we’re still not at that apex,” he said of New York. “Within a week, eight, nine days or so we’re hopefully going to see that turning around.”
Host Margaret Brennan also asked Fauci if the eight states that have yet to impose stay-at-home orders — Arkansas, Iowa, Nebraska, North Dakota, South Dakota, South Carolina, Utah and Wyoming — are putting the nation at risk.
“It isn’t that they’re putting the rest of the country at risk as much as they’re putting themselves at risk,” Fauci responded. “Every time I get to that podium in the White House briefing room, I plead with people to take a look at those very simple guidelines of physical separation.”
The guidelines include maintaining six feet of distance between people and avoiding gatherings of 10 or more people.
Regardless of whether you live in a larger city or small town, “sooner or later, you’re going to see a surge of cases,” Fauci added.
The data in the week ahead, Fauci said, will be “shocking to some,” and he added that Americans should “continue to mitigate, continue to do the physical separation, because we’ve got to get through this week that’s coming up.”
Religious groups battle orders to close services
Several places of worship across the country are holding religious services for their congregations, and some are directly challenging state and local stay-at-home orders amid the coronavirus pandemic.
Most of the country is under a stay-at-home order, but a few of the 38 states that have issued such statewide restrictions have designated religious services as “essential,” which allows people to gather in larger groups to worship.
While many religious denominations have transferred their services online, some leaders say their in-person gatherings should be considered “essential.” Two pastors who held services this week have been arrested.
Pastor Rodney Howard-Browne was charged with misdemeanor counts of unlawful assembly and violation of public health rules in Florida’s Hillsborough County after running services for hundreds of worshipers at the River at Tampa Bay Church.
The Liberty Counsel, which has represented evangelical Christians on the issue of religious liberty, is representing the pastor. Mat Staver, the group’s founder and chairman, said Hillsborough County’s stay-at-home order was unconstitutional.
The county’s order says businesses not listed as exempt can remain open if they can keep a physical distance of six feet between people, he said. The River enforced social distancing rules for its service and purchased a $100,000 purification system.
“So there are ways in which you can balance the constitutional right to exist with protecting the health and welfare and safety of the people. And this church did that and yet it got punished,” Staver said.
Staver also pointed out that some congregants do not have internet access, saying they need religious services and a community to deal with the stress of the pandemic.
Hillsborough County Sheriff Chad Chronister said during a Monday press conference that Howard-Brown was acting out of a “reckless disregard for human life.”
But two days after Howard-Browne’s arrest, Florida Gov. Ron DeSantis (R) issued a statewide stay-at-home order that specifically exempted religious services.
Eleven states, out of the 38 that have issued statewide stay-at-home orders, have granted exemptions for religious gatherings: Arizona, Colorado, Delaware, Florida, Kentucky, Michigan, New Mexico, North Carolina, Pennsylvania, West Virginia and Wisconsin.
Almost a fifth of respondents to a poll last week said they were still attending religious gatherings in person, BuzzFeed News reported.
Another pastor, Tony Spell, was arrested after operating services in Central, La., for the Life Tabernacle Church. He was charged with six counts of violating the governor’s executive order. Louisiana has not exempted religious gatherings.
Pastor Juan Bustamante of City On A Hill Church in Houston filed a petition in the Texas Supreme Court, along with two pastors and a conservative activist, asking for Harris County Judge Lina Hidalgo’s stay-at-home order to be adjusted to classify religious services as essential.
Bustamante said places of worship should be designated as essential at a time when people are losing jobs and some are on the verge of suicide. The pastor said he has taken precautions for his congregation of 100 to 120 people, such as splitting services into three services, with some outside, to limit the virus’s spread.
“When people say that the church isn’t essential, I mean, I don’t really believe they know the extremity or the effect that it has on our communities,” he said. “I believe that our community suffers most when our churches are closed.”
Days after the lawsuit was filed, Texas Gov. Greg Abbott (R) declared religious services essential in his order recommending people stay at home.
Rachel Laser, the president and CEO of Americans United for Separation of Church and State, called the religious exemptions “unconstitutional” and ”immoral” because religious institutions in these states are being treated differently than secular groups.
“They’ve got it backwards because the Constitution requires that religious and secular institutions be treated the same,” she said.
Religious freedom experts agreed that the state laws regulating religious meetings during a pandemic do not violate the First Amendment because the government has a “compelling interest” to protect the public health of the country.
Benjamin Marcus, a religious literacy specialist at the Religious Freedom Center at the Freedom Forum Institute, said executive orders would violate the First Amendment if they forbade groups from gathering online or if law enforcement “disproportionately targeted” certain groups.
“If they allowed nonreligious communities to gather in large groups but not religious communities or vice versa, then that would be a different kind of scenario where they would be favoring religion over nonreligion or vice versa,” he said.
Luke Goodrich, the vice president and senior counsel at the Becket Fund for Religious Liberty, said every constitutional right has its limits and that most courts would support the government in these cases as the orders appear not to target specific groups.
He cautioned that people should avoid “crying wolf” on religious freedom violations because it could inhibit freedom in the long run.
“It’s really important to be able to distinguish between a real threat to religious freedom and a mere shadow of a threat,” he said.
Leana Wen, an emergency physician and public health professor at George Washington University, said the public health guidelines require more than solely staying six feet apart, with mandates of no gatherings of more than 10 people.
“Viruses do not — they do not distinguish between what kind of gatherings they are, so there should be no exceptions because there are no exceptions,” she said. “Nature does not offer exceptions either.”
More than 40 attendees of a March 15 service at one Pentecostal church in Illinois have developed coronavirus symptoms, with at least 10 testing positive for COVID-19 and at least one person dying, the Chicago Tribune and The Christian Post reported.
Vice President Pence, a devout Christian, has encouraged Americans to avoid church services with more than 10 people.
“We really believe this is a time when people should avoid gatherings of more than 10 people,” he said on ABC News’s “Nightline” on Wednesday. “We continue to urge churches around America to heed to that.”
General MacArthur on True Leadership
HENRY KOTULA 