Tentative steps toward recovering from a deadly pandemic


Baby Steps – Selah Someonetotalkto's Blog

The death toll from the novel coronavirus continued to mount this week, with more than 50,000 deaths reported in the US, and over 900,000 confirmed cases nationwide. Globally, the disease has infected more than 2.7M people and killed nearly 200,000. On Tuesday, public health officials in California announced that two people who died in Santa Clara County in early February were victims of COVID-19, making them the earliest known fatalities in the US, and altering experts’ understanding of how long the disease has been spreading in the country. New modeling from researchers at Northeastern University this week suggested that the virus may have been spreading widely in several cities by early February, but went undetected because of restrictions on testing.

National attention has remained focused on the subject of testing, as states and localities scramble to secure enough testing supplies and equipment to allow them to understand community spread and identify new cases. President Trump signed an emergency $484B relief bill on Friday that will provide $25B to ramp up testing, give additional aid to businesses forced to shutter, and send hospitals $75B in additional emergency funding.

The new money for hospitals is in addition to $100B already approved by Congress for a “provider relief fund” as part of the CARES Act. Having already distributed $30B of the initial grant money to hospitals, the Department of Health and Human Services (HHS) was expected to pay out an additional $20B today, this time according to a formula based on the net patient revenue of each hospital, rather than the earlier approach based on Medicare billings. The shift is expected to address concerns among children’s hospitals, safety-net providers, and others who were disadvantaged by the Medicare-based approach. It is unclear how the newly approved $75B of additional funding will be allocated.

Meanwhile, states began to plan for the reopening of their economies, with most governors taking a measured approach in coordination with neighboring states. A handful of states moved to loosen stay-at-home restrictions in advance of meeting the Trump administration’s “gating” criteria, including Florida, which reopened some beaches for recreational use, Oklahoma, and Georgia, which controversially allowed gyms, bowling alleys, hair and nail salons, and tattoo parlors to reopen on Friday.

Many states began to put in place plans to restart elective surgeries, which had been curtailed by a patchwork of differing state and local directives. The Centers for Medicare and Medicaid Services (CMS) released guidelines this week to help local officials decide when and how to restart surgeries. Whether for healthcare services or other types of economic activity, states will (and should) be guided by the ability to conduct widespread testing, robust contact tracing, and isolation of those infected with the virus. Ensuring that ability will likely make the next phase of the pandemic a protracted and frustrating “dance” of fits and starts, likely to last into the summer months and beyond.




Hospitals to get $75B in latest round of COVID-19 funding passed by Senate


Jobs: A Historic Topic When Presidents Address Congress ...

Dive Brief:

  • Hospitals are set to get $75 billion in the next round of emergency funding for the country’s COVID-19 response as the Senate approved legislation Tuesday and the White House expressed support. The House of Representatives could return for a vote as soon as this week.
  • The amount is three-quarters of what various hospital groups had requested as their facilities face a major financial hit from the pandemic. Most have stopped lucrative elective procedures at the same time expenses rise due to increased need for staff and specialty supplies to treat the virus. Still, hospitals commended the legislation, saying it would “help ensure that critical care can continue to be provided by frontline providers throughout the country.”
  • The Paycheck Protection Program and Health Care Enhancement Act allocates another $25 billion for expanding and administering COVID-19 testing for active infection and prior exposure as well as conducting surveillance and contact tracing.

Dive Insight:

Major hospital operators HCA Healthcare, Community Health Systems and Tenet Healthcare have all pulled their 2020 guidance as they adjust for the influx of COVID-19 patients across the country.

In its first quarter report Tuesday, HCA attributed a steep decrease in volumes and 45% drop in profit to the pandemic. “We do believe the impact to the company will be most pronounced during this current response phase, as volume continues to decline throughout April,” HCA CFO Bill Rutherford told investors Tuesday.

Hospitals received $100 billion in the $2.2 trillion Coronavirus Aid, Relief, and Economic Security Act passed last month and the first tranche of that funding has already been deposited in facilities’ bank accounts, based on historic Medicare payments.

The second round will be targeted to reach providers in hot spots and those not included previously, CMS has said. The agency has declined to give further details or an update on timing, however.

The American Hospital Association said in a statement the CARES funds “are already being used by hospitals and health systems to increase capacity and provide care, and in some cases to keep access to care available by keeping the doors open.”

And while the agency touted the funding as “no strings attached,” terms and conditions subsequently put out have given some providers pause.

CMS has made other attempts to help hospitals financially. The CARES Act includes a 20% bump to payments for treating COVID-19 and the agency has sent billions in expedited Medicare payments as hospitals request them.

Hospitals warned Tuesday that HHS should distribute funds quickly. “While we appreciate Congress taking swift action — more still needs to be done to defeat COVID,” the Federation of American Hospitals said in a statement. “It is important that HHS distributes the funding in a timely, well-targeted fashion. And it remains mission-critical to reform the Medicare Accelerated Payment Program so that it does not impede hospitals’ ability to meet patient needs.”





Beginning the long, winding journey back from coronavirus


45cat - The Beatles - The Long And Winding Road / For You Blue ...

It was another brutal week in the coronavirus pandemic, with more than 2.1M cases and nearly 150,000 deaths worldwide. The US continued to be the hardest-hit country, reaching a daily record 4,591 deaths from COVID-19 on Thursday. The national death toll is now more than 35,000, though there are signs that the number of new cases in the US has begun to plateau, raising hopes that the worst days may be drawing to a close. Meanwhile, with strict stay-at-home measures continuing in most places across the country, the economic toll of the virus mounted. New unemployment claims rose by another 5.2M, bringing the estimated number of American jobs claimed by the virus to 22M, eliminating a decade’s worth of job growth, and raising the unemployment rate to an estimated 17 percent.

As the growth in new cases flattened, attention turned this week to plans to “reopen” the American economy. Despite insisting early in the week that he alone would decide when and how to reopen the country, President Trump yesterday unveiled a set of non-binding, “Opening Up America Again” guidelines for state and local officials to use in judging when to loosen restrictions. The guidelines suggest a three-stage, gated approach, gradually allowing individuals and employers to return to normal activities based on criteria including disease trends, hospital capacity, and the availability of robust testing. Progressing from one stage to the next is predicated on maintaining a downward trajectory in new cases—with any signs of a resurgence indicating a need to reimpose restrictions.

Missing from the White House plan are specific details about how states, cities, and healthcare providers are to procure and pay for the many millions of tests and extensive contact tracing that will need to be available to allow businesses, public transport systems, and other essential services to resume activity. By week’s end, about 3.5M coronavirus tests had been conducted nationally, but the daily number of tests conducted has plateaued, and the test-positivity rate is still troublingly high. Public health experts continue to warn that testing must ramp up significantly before any steps toward reopening can be considered, a difficult challenge given widespread reports of shortages of testing supplies and trained lab technicians. To bolster testing capacity, the Centers for Medicare and Medicaid Services (CMS) this week nearly doubled the amount it will pay laboratories to analyze tests using high-throughput equipment.

Three coalitions of states—in the Northeast, Midwest, and West Coast—were formed this week to coordinate regional efforts to reopen the economy. Among the issues they’ll need to address: interstate travel restrictions, coordinated purchasing of critical supplies, investments in contact tracing capabilities, and ongoing surveillance of the virus’ spread. With federal agencies taking a back seat to states (“You are going to call your own shots,” the President told governors on a call this week), it became clear that the road back from the coronavirus pandemic will be circuitous, with a patchwork of different timelines and approaches in different locations based on local conditions and resources.

In the words of William Gibson, “The future is here—it’s just not very evenly distributed.”





How hospital capacity varies dramatically across the country


POPULATION                                    BED COUNT 

20M                      10M people                            0                          0                         25k beds                     50k

LUMEDX (@Lumedx) | Twitter

Healthcare Dive analyzed data to paint a picture of hospital capacity, pinpointing areas with a higher ratio of people to beds and signaling where there is a risk for capacity issues.

Fewer hospital beds in select regions make them especially vulnerable to the novel coronavirus as it’s expected to spread from big city hot spots to other areas of the country.

As the U.S. has become the next epicenter of the outbreak, hospitals are preparing for the worst. The pathogen threatens to overwhelm their facilities and resources, especially if mitigation efforts fail to blunt a surge of COVID-19 patients.

The latest figures from the Johns Hopkins Coronavirus Resource Center report more than 143,000 confirmed cases in the U.S. and more than 2,500 deaths as of Monday.

The New York City metro area has the most beds compared to the rest of the country. Still, that is not enough capacity to meet the crushing demand.

To illustrate hospital capacity across the country, Healthcare Dive sought to compare bed counts to population, and found population size isn’t always indicative of the number of beds available.

Population size is not always indicative of bed capacity in the top 20 metro areas

Below are the 20 most populated metro areas in the U.S., sorted by population. As you move down the chart, population size decreases, but bed counts do not always. Areas like D.C. and Seattle have fewer beds relative to population size, while Miami and Philadelphia have more beds relative to population.

Some areas like Washington, D.C., have relatively fewer beds compared to their population, while others like Miami, Philadelphia and St. Louis have more beds relative to the number of people in the region.

Some hospitals are turning to hotels and tents, and Vice President Mike Pence has said he’s working with the Department of Defense to get field hospitals and other options online.

Still, researchers cautioned there is a long way to go to meet projected demands. If America’s healthcare system was able to free up half of its beds by discharging patients, the country would still need three times as many beds, Ashish Jha, director of the Harvard Global Health Institute, told reporters during a call on Tuesday. That projection assumes 40% of Americans get infected over the next six months.

“What we know right now is that capacity to manage patients varies dramatically from community to community,” Jha said.

Areas with the highest ratio of people per bed

To paint a picture of hospital capacity across the country, Healthcare Dive used CMS cost reports and population data to calculate the ratio of people per bed in metropolitan areas and regions. In other words, how many residents are there for a single bed? It’s a way to pinpoint areas with a higher ratio of people to beds, signaling areas potentially at risk for capacity issues.


Hospitals certified by Medicare are required to submit annual cost reports to CMS, which include a vast array of information from bed counts to financials. Hospital beds analyzed in this report do not include all the beds a hospital may have reported to CMS.

Healthcare Dive excluded nursery, labor and delivery beds and psychiatric hospitals. In addition, due to the inconsistent reporting in ICU beds, Healthcare Dive did not highlight areas with higher ratios of people per ICU bed. It’s also important to note that some hospitals may have opened or closed since these latest CMS cost reports were published.

Healthcare Dive analyzed specific geographic areas, in this case metropolitan CBSAs, or core-based statistical areas, which are geographic areas that consist of an urban center of 50,000 people or more.

In the U.S., about 42% of the more than 143,000 cases are concentrated in New York, overwhelming available resources. Still, case counts are swelling in areas outside of New York including Chicago, Detroit and New Orleans. Indicating the outbreak is likely to be widespread in America.

Healthcare Dive found the Bloomsburg-Berwick, Pennsylvania, area has the lowest ratio in the nation with 86 people for each bed. Most areas have much higher ratios, the median being around 400 people per bed when comparing CBSAs. The metro area of New York City sits in the middle with 405 people per bed.

The Greeley, Colorado area has the nation’s highest ratio of people per bed, according to the data. About 60 miles northeast of Denver and with a population of more than 314,000, there are 1,397 people for every one hospital bed in the Greeley area.

The CMS data shows a total of 225 hospital beds in the Greeley area, operated by Banner Health’s North Colorado Medical Center.

However, a new 50-bed hospital opened recently and was not included in the most recent cost reports. It is operated by UCHealth.

Still, while those numbers may seem grim, Colorado’s hospital leaders cautioned that the state can and is working to tap into additional resources, citing freestanding emergency rooms and ambulatory surgical centers.

It’s imperative to look beyond just one locale or one hospital and consider the resources of the state as a whole, Colorado’s hospital leaders told Healthcare Dive.

Colorado has a total of 10,293 hospital beds (12,558 licensed beds) and at least 973 ICU beds, the Colorado Hospital Association said.

“It’s going to take the whole system for us to get through this,” Julie Lonborg, senior vice president at the Colorado Hospital Association, told Healthcare Dive.

There are only one or two hospitals in almost all of the 10 regions with the highest ratio of people per bed. Rounding out the top 10 areas with the highest ratio of people per bed following Greeley, include Albany, Oregon; Gettysburg, Pennsylvania; Merced, California; California-Lexington Park, Maryland; Bremerton-Silverdale, Washington; Lawrence, Kansas; Monroe, Michigan; Provo-Orem, Utah; and Ogden-Clearfield, Utah.

The data shows the total bed capacity in a region, but does not take into account the patients currently occupying those beds. However, in an effort to free up existing beds, many hospitals have halted elective surgeries, including in Greeley to free up resources and staff to be able to respond to a potential surge.

“UCHealth Greeley Hospital is caring for a large number of patients at this time, and by working together as a large system, UCHealth is able to redirect patients and admissions to other facilities to help even out our capacities at this and other hospitals,” Kelly Tracer, a spokesperson for the hospital, told Healthcare Dive.

In fact, many hospitals plan to lean on the larger systems they’re a part of to shuffle resources to respond to the pandemic.

In Gettysburg, Pennsylvania, there are 76 hospital beds and 1,353 people per hospital bed. WellSpan Health, which operates Gettysburg Hospital, said it plans to coordinate its response by using its eight other hospitals in different areas and some 200 locations.

“We are taking a comprehensive approach to this issue, developing a network of more than 10 outdoor testing locations across our five-county region and temporarily repurposing several of our outpatient medical practices to care locations dedicated solely for the treatment of patients who are suspected or confirmed to have COVID-19 and have non-emergency medical needs,” according to a statement WellSpan Health provided Healthcare Dive.

Other locations with the highest people per bed ratio are converting existing space into dedicated areas to treat COVID-19 patients to prepare for a crush of patients, including in Lawrence, Kansas, with 893 people for every bed.

Lawrence Memorial Hospital in Lawrence, Kansas, about 40 miles west of Kansas City, is prepared to up its capacity to 205, LMH said in a statement. The hospital reported 136 beds to CMS but said it is licensed for 174.

“At any given time we have upwards of 100 patients,” Traci Hoopingarner, vice president of clinical care and chief nursing officer for LMH Health, said in a statement.

As New York continues to grapple with mounting cases, leaders are issuing dire warnings to the rest of the country.

“New York is the canary in the coal mine. What happens to New York is going to wind up happening in California and Washington state and Illinois. It’s just a matter of time,” New York Gov. Andrew Cuomo said.

Below is an interactive table of hospital bed availability in different metros across the country. Search for your metro area to find the corresponding hospital capacity.


Trump rejects Obamacare special enrollment period amid pandemic


Trump rejects opening ObamaCare special enrollment period amid ...

Before the coronavirus outbreak, nearly 30 million Americans were uninsured and as many as 44 million were under-insured, paying for bare-bones plans with soaring deductibles and copays. Today, millions more Americans will begin losing their employer-based health insurance because they’ve lost their jobs during this pandemic.

Meanwhile, the Trump administration is still actively trying to repeal the entirety of the Affordable Care Act in court, which would cause an additional 20 million people to lose insurance *in the middle of a pandemic*.

And today, Trump refused to reopen ACA enrollment to those millions of uninsured Americans for a special enrollment window, leaving them without any affordable options to get covered. People are going to die because they can’t afford to seek treatment or end up saddled with thousands of dollars of medical debt if they do. Remember this the next time someone tries to tell you Medicare for All is too radical.

What do you think?

The Trump administration has decided against reopening Obamacare enrollment to uninsured Americans during the coronavirus pandemic, defying calls from health insurers and Democrats to create a special sign-up window amid the health crisis.

President Donald Trump and administration officials recently said they were considering relaunching HealthCare.gov, the federal enrollment site, and insurers said they privately received assurances from health officials overseeing the law’s marketplace. However, a White House official on Tuesday evening told POLITICO the administration will not reopen the site for a special enrollment period, and that the administration is “exploring other options.”

The annual enrollment period for HealthCare.gov closed months ago, and a special enrollment period for the coronavirus could have extended the opportunity for millions of uninsured Americans to newly seek out coverage. Still, the law already allows a special enrollment for people who have lost their workplace health plans, so the health care law may still serve as a safety net after a record surge in unemployment stemming from the pandemic.

Numerous Democratic-leaning states that run their own insurance markets have already reopened enrollment in recent weeks as the coronavirus threat grew. The Trump administration oversees enrollment for about two-thirds of states.

Insurers said they had expected Trump to announce a special enrollment period last Friday based on conversations they had with officials at the Centers for Medicare and Medicaid Services, which runs HealthCare.gov enrollment. It wasn’t immediately clear why the Trump administration decided against the special enrollment period. CMS deferred comment to the White House.

Trump confirmed last week he was seriously considering a special enrollment period, but he also doubled down on his support of a lawsuit by Republican states that could destroy the entire Affordable Care Act, along with coverage for the 20 million people insured through the law.

People losing their workplace coverage have some insurance options outside of the law’s marketplaces. They can extend their employer plan for up to 18 months through COBRA, but that’s an especially pricey option. Medicaid is also an option for low-income adults in about two-thirds of states that have adopted Obamacare’s expansion of the program.

Short-term health insurance alternatives promoted by Trump, which allow enrollment year-round, is also an option for many who entered the crisis without coverage. Those plans offer skimpier coverage and typically exclude insurance protections for preexisting conditions, and some blue states like California and have banned them or severely restricted them. The quality of the plans vary significantly and, depending on the contract, insurers can change coverage terms on the fly and leave patients with exorbitant medical bills.

Major insurers selling Obamacare plans were initially reluctant to reopen the law’s marketplaces, fearing they would be crushed by a wave of costs from Covid-19, the disease caused by the novel coronavirus. But the main insurance lobby, America’s Health Insurance Plans, endorsed the special enrollment period roughly two weeks ago while also urging lawmakers to expand premium subsidies to make coverage more affordable for middle-income people.

Congress in last week’s $2 trillion stimulus passed on that request, as well as insurers’ petition for an open-ended government fund to help stem financial losses from an unexpected wave in coronavirus hospitalizations.

Democrats pushing for the special enrollment period are also grappling with the high costs facing many people with insurance despite new pledges from plans to waive cost-sharing. Obamacare plans and a growing number of those offered by employers impose hefty cost-sharing and high deductibles that could still burden infected Americans with thousands of dollar in medical bills.

House Energy and Commerce Chairman Frank Pallone (D-N.J.) on a press call Monday contended that “we also need to have free treatment” after Congress eliminated out-of-pocket costs for coronavirus tests.

“We did the testing, which is now free, and everybody, regardless of their insurance, gets it,” Pallone said. “But that has to be for the treatment as well.”





Justice Department sues Anthem, alleging Medicare fraud


Justice Department sues Anthem alleging Medicare Advantage fraud ...

The Department of Justice has sued Anthem, alleging that the health insurance company knowingly submitted inaccurate medical codes to the federal government from 2014 to 2018 as a way to get higher payments for its Medicare Advantage plans and turned “a blind eye” to coding problems.

Why it matters: This is one of the largest Medicare Advantage fraud lawsuits to date, and federal prosecutors believe they have more than enough to evidence to claim that Anthem bilked millions of dollars from taxpayers.

Background: DOJ has been probing the “risk adjustment” practices of all the major Medicare Advantage insurers for years, but hadn’t pulled the trigger on a lawsuit against a major player.

  • Risk adjustment is the process by which Medicare Advantage companies assign scores to their members based on the health conditions they have. Patients who have higher risk scores lead to higher payments from the federal government to the companies that insure them.
  • Insurers are required to review patients’ medical charts to verify the health conditions, and if insurers find any inaccurate diagnoses, they have to be deleted — which also would require the companies to pay back money to the federal government.

The Department of Justice is alleging that Anthem reviewed medical records, but only focused on finding “all possible new revenue-generating codes” while purposefully ignoring all erroneous diagnoses.

  • For example, according to the DOJ’s lawsuit, Anthem coded one member in 2015 as having active lung cancer.
  • “Anthem’s chart review program did not substantiate the active lung cancer diagnosis,” the DOJ alleges. Instead of deleting that diagnosis, Anthem allegedly added another three codes — leading to a $7,000 overpayment just for that member that year.

The other side: Anthem said in a statement that it intends “to vigorously defend our Medicare risk adjustment practices” and that “the government is trying to hold Anthem and other Medicare Advantage plans to payment standards that CMS does not apply to original Medicare.”

The big picture: Medicare Advantage continues to enroll seniors and people with disabilities at high rates, even as more allegations of fraud come out against the insurers that run the program.

Read the lawsuit.





Another week on the exponential curve


Image result for coronavirus response plan

As efforts to increase testing for COVID-19 ramped up this week, the number of cases in the US rose exponentially, and the number of deaths increased sharply as well. Early but incomplete data from the Centers for Disease Control and Prevention (CDC) indicated that the virus was impacting younger people in greater numbers than had been seen in China and Italy, and concerns grew that asymptomatic but infected people could be spreading the virus to those with compromised health status. In response, many cities and states moved aggressively to put in place stricter measures to keep people in their homes to mitigate spread.

Several flashpoints have emerged across the healthcare system. Supplies of personal protective equipment (PPE) are in short supply, raising concerns about putting healthcare workers at risk. Testing supplies—particularly collection swabs—are also running low in many places, forcing some newly-launched testing locations to close after just a few days. Hospitals across the country began to gear up for a wave of patients, with the number of potential cases likely to far exceed existing capacity of hospital beds, intensive care beds, and, in particular, ventilators.

In response, the President invoked the Defense Production Act, which will allow the government to direct private sector production of critically needed equipment. Hospital leaders have been advised by the government to cancel elective surgeries and minimize non-emergency utilization of healthcare resources, to preserve supplies and capacity for the coming wave of cases.

The Centers for Medicare and Medicaid Services (CMS) loosened several key regulations to allow more care to be delivered virtually, in an attempt to relieve pressure on the system (more on that below). By week’s end, hospitals in several areas—including Seattle, San Francisco, New York, and New Orleans—were reporting that they were perilously close to being overwhelmed.

As many have pointed out, we are faced with a decision of which curve we want to be on: one that looks like Italy, which responded late with mitigation and suppression efforts and has found their healthcare system collapsing under the volume of hospitalizations; or one that looks like South Korea, where aggressive measures to suppress spread, including extensive testing, strict social distancing, and isolation of infected people, seem to have “flattened the curve”.

The next two weeks will be critical in determining what the next year looks like in America.