COVID-19 Update June 5, 2020

Colleagues:

This week as our nation attempts to heal from a global pandemic that has disrupted the lives of all and taken the lives of many, recent events around the country and in our own state have forced us to confront other intolerable, insidious evils in our society–the longstanding pandemic of racism and a developing culture of indifference to human suffering.

Our Medical Society believes that all forms of racism and discrimination must be eradicated. We stand in support of the right of individuals to peacefully protest George Floyd’s death and against violence in all forms. George Floyd’s death has left this state and country reeling at a time when people are already feeling stressed, fearful, isolated and lonely due to COVID-19.   The all too familiar tragedy playing out on our streets has again highlighted the need for this country to address the prevalence of endemic racism.

Many members of the law enforcement community across the country and in our state have expressed their outrage for the hateful and unlawful behavior by some in their ranks. However, much more needs to happen to ensure that violence against people of color perpetrated in the name of law and order stops and that the right to peacefully protest is upheld and supported without violence and our citizens are treated universally with dignity and fairness. The responsibility for change falls upon us all. We as a Medical Society stand unified in the call to action that Mr. Floyd’s death has ignited and we will stand with those individuals who are calling for change – change that is an essential component of our very democracy.

Racism and injustice must be condemned.  As physicians, we believe this nation has the ability to finally halt the systematic racism and begin the healing process by listening to the voices of all that are grieving and crying out for justice.

As we move forward, let us do so in a compassionate and loving way for all.

“Now is the time to make real the promises of democracy. Now is the time to rise from the dark and desolate valley of segregation to the sunlit path of racial justice. Now is the time to lift our nation from the quick sands of racial injustice to the solid rock of brotherhood…”

Martin Luther King, Jr

From the “I Have A Dream” speech” delivered August 28, 1963, at the Lincoln Memorial, Washington D.C.

Bonnie Litvack MD
MSSNY President


This Week’s MSSNY Update Podcast


News & Highlights from the Governor’s Daily Briefing
GENERAL:
– Day 97 of COVID-19 pandemic, Day 12 of civil unrest.
– Gov played videos showing police shoving citizens in Buffalo and NYC, with no
threat to the officer shown. Said such actions were “offensive… frightening.”

REFORM:
– Gov proposed “Say Their Name” Reform Agenda in NY, inspired by the history
of black lives lost to police brutality. Four cornerstones:
– Transparency of prior disciplinary records (50-a).
– No chokeholds.
– False race-based 911 reports should be a hate crime.
– AG as independent prosecutor for police murders.
– Argued reforms worked to vindicate the overwhelming majority of good police.
Said the community-police relationship must heal for progress to occur.
– Gov claimed societal change is possible, as seen with the COVID-19 pandemic.

COVID-19:
– Deaths 6/4: 42 (new low, number was 800 just 8 weeks ago).
– Lowest number of hospitalizations to date.

Q&A:

BUFFALO:
– Gov said he was “sick to [his] stomach” after seeing the clip of a man being
shoved by police in Niagara Square and supported Mayor Brown’s decision to
suspend the officers responsible.
– Believes DA should review the incident for criminal charges.

POLICE:
– Argued police officers are aware of being filmed during protests so they are
not attempting to “get away” with anything.
– Gov believes use of body cameras would be helpful.


Congress Enacts Legislation to Provide Physicians Flexibility with PPP Awards
The President has signed into law legislation passed by the US Senate this week to provide greater flexibility over the spending of Paycheck Protection Program (PPP) funds after having been passed by the US House of Representatives last week.  The new law will enable up to 40% of PPP forgivable loan proceeds to be spent on non-payroll costs (instead of the current 25% limitation).

This is particularly important for small businesses including physician offices located in high rent areas such as downstate New York.  The legislation also extends from 8 to 24 weeks the period of time for the proceeds to cover, as well as extend to 5 years the re-payment time period.  MSSNY has been working with the AMA and other physician societies in support of reform and expansion of various stimulus programs, including the PPP.  More information here.


NY Businesses Can Refuse Entry to People Not Wearing a Mask
Gov. Cuomo tweeted May 29, “People don’t have a right to jeopardize other people’s health.” Another tweet from the day before reads, “No Mask – No Entry.”



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Study Shows 76% Of Coronavirus Patients Improve after Plasma Transfusion
Plasma from recovered COVID-19 cases is transfused to critically ill COVID-19 patients, with the hope that the antibodies will help the patient fight or neutralize the disease. Study authors say the treatment method has been used to treat microbial infections for more than 100 years. Other doctors began voicing optimism for the plasma transfusions in COVID-19 patients earlier in the pandemic when some cases improved. The Houston study was published May 26 in The American Journal of Pathology.

The study’s outcomes focused on safety and the potential benefit of transfusing convalescent plasma to patients with severe coronavirus. Noting several other studies that suggest plasma donations are an effective treatment strategy for COVID-19, the Houston reachers wanted to offer more data on initial clinical observations.

“The data indicate that administration of convalescent plasma is a safe treatment option for those with severe COVID-19 disease,” study authors wrote.

A week after transfusion, 36 percent of patients showed clinical improvement. Another seven days later, a total of 76 percent, or 19 patients, improved or were discharged from the hospital.

Study authors described the therapy, which was one transfusion of 300 mL of plasma, as “well-tolerated,” and said that “no transfusion-related adverse events were observed.”


New Reporting COVID-19 Guidelines Require Race and Age Data
New COVID-19 test reporting guidelines require labs to provide additional data such as patients’ race and age HHS said June 4. The newly required information will be used to monitor disease incidence and trends by initiating epidemiologic case investigations, assist with contact tracing, assess availability of testing resources, and anticipate potential supply chain issues, according to the HHS release. “The requirement to include demographic data like race, ethnicity, age, and sex will enable us to ensure that all groups have equitable access to testing, and allow us to accurately determine the burden of infection on vulnerable groups,” said Assistant Secretary for Health Adm. Brett Giroir, MD. (Becker’s Hospital Review, June 5)


N95 Mask Reuse and Failure Rates
A small, cross-sectional study in JAMA reports that duckbill N95 masks had a high rate of fit test failure (71%) among healthcare workers who were using their masks for extended periods. Dome-shaped N95 masks had a 28% failure rate. For the dome-shaped masks, failure was more likely with increasing duration of use. The authors of the research letter write: “Based on these preliminary data, health systems should closely evaluate N95 fit during extended use or reuse and limit duckbill


Sen. Passes Bill to Give Flexibility for Small Business Coronavirus Aid Program
The Senate passed legislation on Wednesday to provide more flexibility for the Paycheck Protection Program (PPP), which provides help for small businesses amid the steep economic impact of the coronavirus.

“Today we’re passing another piece of legislation that makes a few targeted changes to the program,” Senate Majority Leader Mitch McConnell (R-Ky.) announced from the floor. “I’m proud the Senate is sending it on to the president’s desk to become law.”

The bill, which would extend the window for businesses to be able to spend loans granted under the program, passed the Senate by unanimous consent. The bill already passed the House last month, meaning it now goes to President Trump‘s desk.

Under the March $2.2 trillion coronavirus package, businesses were given eight weeks to spend PPP funds. The bill passed by the Senate on Thursday would extend it to 24 weeks.

It would also change a 75-25 divide included in the March bill — which required businesses to spend 75 percent of the loan on payroll and 25 percent on other fixed costs such as rent and utilities — to a 60-40 ratio.

Negotiations on expanding the PPP’s flexibility have been ongoing for weeks after the Senate left town for the Memorial Day recess without being able to pass its own version of the House legislation.

“I’m glad our Republican friends have relented and passed the bill here as we are about to close session for this week. It passed the House. We Democrats have been pushing to get it done for the last three days,” said Senate Minority Leader Charles Schumer (D-N.Y.).

The passage of the bill comes only hours after Democrats tried to pass it earlier Wednesday, but Sen. Ron Johnson (R-Wis.) objected.

Johnson said at the time that he was objecting because language in the bill could be misinterpreted to let businesses apply for the PPP loans through the end of the year instead of through the end of June.

“I reached out to Democrat leaders saying we’re very close. I think we’ll probably be able to pass the House bill with assurances by unanimous consent, just not at this moment,” Johnson said.

Johnson was asking for committee leaders and Senate leadership to sign a “letter of intent” that the PPP not be automatically reauthorized through the end of the year.

“Put that letter in the Congressional Record so that we are certain that we’re not reauthorizing this or authorizing it through Dec. 31, that the authorization does end June 30,” Johnson said.

McConnell on Wednesday evening submitted a letter into the Congressional Record. Spokespeople for McConnell directed a question about the letter to spokesmen for Johnson, who didn’t immediately respond to a request for comment. But Schumer thanked Johnson shortly before the bill passed, saying they had talked on the phone “repeatedly.” This is an improvement that’s much needed and comes at the last minute,” he added, “Eight weeks will expire so soon, and now it’s extended to 24 weeks.” (The Hill, June 3)


Fauci Weighs Pros and Cons of Reopening Schools This Fall Amid COVID-19

The idea of keeping schools closed in the fall because of safety concerns for children might be “a bit of a reach,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. In a phone interview with CNN Wednesday, Fauci noted that children tend to have milder symptoms or even no symptoms when they are infected with COVID-19. (CNN.com International | June 3, 2020)


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Major Study on Hydroxychloroquine Retracted from Lancet
A major study on the effects of hydroxychloroquine on COVID-19 patients was retracted from a leading medical journal Thursday after doctors and scientists raised questions about the validity of the data. The study that was withdrawn had concluded patients taking the anti-malaria drug had a higher risk of death than those who were not taking the medication.

The three authors of the study, led by Mandeep R. Mehra of Harvard Medical School and published in late May, retracted their study from the Lancet because independent peer reviewers could not access the data used for the analysis. The source of the data was Surgisphere Corporation, which told peer reviewers it would not transfer the full dataset used for the study because it would violate client agreements and confidentiality requirements.

“We all entered this collaboration to contribute in good faith and at a time of great need during the COVID-19 pandemic,” the authors wrote in a statement Thursday. “We deeply apologize to you, the editors, and the journal readership for any embarrassment or inconvenience that this may have caused.” The study focused on more than 96,000 hospitalized COVID-19 patients at 671 hospitals on six continents, using hospital records obtained by Surgisphere Corporation, a little-known data company.

The Lancet wrote in a statement that it “takes issues of scientific integrity extremely seriously” and that there are “many outstanding questions about Surgisphere and the data that were allegedly included in this study.” (The Hill 6/4)


AstraZeneca Found Partners to Manufacture/Distribute COVID-19 Vaccine
The drug giant AstraZeneca said Thursday that it has found partners to manufacture and distribute 2 billion doses of the experimental Covid-19 vaccine created by Oxford University, inking a seriesof deals with non-government organizations and another manufacturer.


Support Health Equity Initiatives Through David & Donna Marie Meza Health Equity Fund
The David and Donna Marie Meza Health Equity Fundwas established by Thomas Madejski, MD, and Sandra Madejski to support health equity initiatives through the AMA Foundation. Support from this fund is focused on the AMA’s Center for Health Equity and the Foundation’s Community Health Program. 

Eligible initiatives must demonstrate a commitment to addressing health disparities and promoting health equity in diverse, economically disadvantaged environments. Preference shall be given to initiatives that support health literacy and self-management.

You can make a tax-deductible donation in direct support of this fund using the form here.


Invite to Join Global Physicians Network Foundation from Dr. Malhotra
I wanted to share with you about Global Physicians Network Foundation’s (GPNF) wellness initiative; programs for frontline healthcare workers and communities impacted by COVID-19. GPNF is a community based 501(c)(3) not-for-profit organization.

During the pandemic, GPNF volunteers created and distributed over 700 wellness bags to 20 hospitals in all the five boroughs of NYC.  We especially targeted the residents and fellows working tirelessly in the hardest hit areas.  We were also able to support nurses in several hospitals during ‘Nurses Week’.

The bags and its contents were very much appreciated by all. The feedback was extremely positive, and many commented on how it had boosted their morale and supported their needs.  This was made possible because of the generous contributions of donors, supporters, volunteers, and several companies all coming together.  We have posted some pictures on the instagram@gpnfoundation and the gofundme link.

We are honored that MSSNY shared the media coverage and have attached the link to the recent article on some of the work we have been doing.

Our wellness initiative continues with a targeted series of Wellness discussions and peer support for the frontline physicians, residents, fellows, medical students, and healthcare professionals. We are thrilled to invite MSSNY members and your team to the upcoming complimentary interdisciplinary Wellness Discussion Series.  The first session has been created to provide space for dialogue regarding the tragic and painful current events.  Attached is the flyer which can be forwarded to the members of your team. Please share with your residents, fellows, and students. Here is the link for Registration.

We look forward to your participation in the upcoming programs.  Please do not hesitate to contact me, if you have any questions.

Sandhya Malhotra MD
GPNF Team
718-938-560
www.gpnfoundation.org


Veterans Matters Podcasts
Check out MSSNY’s Veterans Matters podcast series on Veterans’ healthcare topics including PTSD in Returning Veterans, TBI in Returning Veterans, Substance Use in Veterans, Suicide in Veterans, The Special Mental Health Needs of Women Veterans and Military Culture: Everything Physicians Need to Know about Veterans as Patients.

Click here to listen to Part 1 of PTSD in Returning Veterans with Dr. Frank Dowling.

Click here to listen to Part 2 of PTSD in Returning Veterans with Dr. Frank Dowling.

Click here to listen to TBI in Returning Veterans with Dr. David Podwall.

Click here to listen to Substance Use Disorders with Dr. Thomas Madejski.

Click here to listen to Suicide in Veterans podcast with Dr. Jack McIntyre.

Click here to listen to The Special Mental Health Needs of Women Veterans with Dr. Malene Ingram, Colonel, U.S. Army Reserves and Retired Chief Master Sergeant, U.S. Air Force, Marcelle Leis.

Click here to listen to Military Culture: Everything Physicians Need to Know about Veterans as Patients with Retired Lieutenant Colonel, U.S. Army, Lance Allen Wang and Retired Chief Master Sergeant, U.S. Air Force, Marcelle Leis.


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COVID-19 Update June 4, 2020

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Some PPE Vendors Will Not Sell to Doctors with Smaller Practices; Or, Worse— Sell at Exorbitant Prices

Statement attributable to:
Bonnie Litvack, M.D.
President, Medical Society of the State of New York

“As the acute threat of COVID-19 begins to recede, physicians are anxious to return to providing in-person care to their patients. Telehealth has been essential in this crisis and remains an important and safe way for patients to receive treatment when an in-person visit is difficult or impossible. However, many conditions cannot be diagnosed or treated via telehealth and require a face-to-face visit.

“Masks, gowns, gloves, and other materials prevent the inadvertent transmission of viruses and germs between physicians, medical staff, and patients. As community physicians look forward to re-opening their offices, a major barrier to resuming regular patient care is the shocking shortage of this essential personal protective equipment (PPE).

“The contagious nature of the COVID-19 virus makes it necessary to change PPE frequently. Unfortunately, over the last several months some vendors refused to sell their products to smaller physician practices. Instead, they only contracted with larger institutions or government entities. In instances when suppliers would contract with physicians, there were outrageous price increases or supply limits that prevented physicians from receiving more than a few days’ supply.

“To ensure physicians can continue to serve their communities, these disgraceful business practices must be addressed. Otherwise, patient care will be compromised, as many patients may be unable to be seen and treated by their physicians.

“The State Legislature recently passed a measure to provide greater clarity under the law. Now, vendors who take advantage of a public health crisis to charge grossly inflated prices for needed medical equipment may be prosecuted. This is an important step to prevent price gouging but does not go nearly far enough. Currently, some vendors will not even attempt to sell to community physicians!

“The state and federal governments need to take immediate steps to require medical supply vendors are dealing fairly with physician practices. Should health care institutions receive all the medical supplies they need? Absolutely! However, community physicians play an essential role in treating patients on the front lines. However, without adequate PPE, some will be unable to open their offices and others will unable to stay open.

“We urge the Cuomo Administration and the Trump Administration to take the necessary steps to ensure that New York’s and America’s doctors have the basic tools to, once again, care for their patients and guarantee their safety during their office visits.”

(Dr. Litvack’s statement was featured in today’s Crains’ Health Pulse. See highlighted article below.)


Small Practices Struggle to Obtain PPE
As small physician practices look to bring back more in-person services, they’re having trouble securing the necessary personal protective equipment to do so. The Medical Society of the State of New York has heard from nearly 700 physicians in need of assistance procuring PPE. Though telehealth has been an important part of providing care during the Covid-19 crisis, some conditions can’t be diagnosed or treated virtually, Dr. Bonnie Litvack, president of the medical society, noted in a statement issued Wednesday.

Additionally, reopening offices will be particularly helpful for practices that have been financially strained by lower revenues and higher costs as a result of the pandemic.

“Unfortunately, over the last several months some vendors refused to sell their products to smaller physician practices,” Litvack said. “Instead, they only contracted with larger institutions or government entities. “Other practices saw substantial price increases or supply limits that prevented them from obtaining more than a few days’ supply, she added Litvack applauded the state Legislature for recently passing a measure that will help to prevent price gouging on medical equipment. However, she said, more efforts are needed from the state and the federal government to require vendors to deal fairly with community physicians.

A series of new surveys by researchers at NYU have found that the city’s primary care practices have been particularly hard hit by the pandemic. The most common sourcesof stress included shortages of equipment, which 53% of respondents reported.


News & Highlights from the Governor’s Daily Briefing

GENERAL:
– Day 96 of COVID-19; Day 11 of aftermath of death of George Floyd.
– Reiterated the division caused by racial and political division brought forth
by both COVID-19 and police brutality.
COVID-19:
– Total hospitalizations down.
– Lives lost 6/3: 52 – 38 in hospitals, 14 in nursing homes. Noted this was a
slight increase but did not think it was anything to worry about.
– NYS conducts an average of 50k tests per day. Testing data has found
positive tests average around 1-2% in LI, NYC, WNY, and the Cap Region.
REOPENING:
– Reiterated need for caution when reopening to avoid a second wave.
– Worried protesters would compound COVID-19, stating there were approx. 30k
protesters statewide, ~20k in NYC.
– Will be expanding testing criteria to all individuals who have joined
recent protests.
-Get a test at www.coronavirus.health.ny.gov
-Said to assume you’ve been exposed to COVID at protests and disclose attendance to relatives and surrounding individuals.
– NYC to enter Phase I on Monday, yet had the highest number of protesters.
– Outdoor dining included in Phase II opening (WESTCHESTER/ROCKLAND/OC reopen next Tuesday).
PROTESTS:
– Gov thanked protesters last night for remaining “mainly peaceful.” Also
voiced his support for their fight, noting his outrage towards Floyd’s murder.
– Gov noted violence against police officers (i.e. stabbing, shooting) and
requested protesters not take such actions.
– Recommended local DAs should charge looters for their crimes and set bail.
BUSINESSES:
– Directing insurers to expedite claims for looted businesses, provide free
mediation of disputes, and accept photos as reasonable proof of loss so
businesses don’t have to wait for police reports.
– Visit www.dfs.ny.gov if a business is having trouble with their insurance company.

Q&A:
PROTESTS:
– Gov claimed to be “stunned” by the disrespect shown to NYPD in NYC protests
but noted his support for protester’s fight. Argued against violence towards
police officers.
– Gov acknowledged tense political environment getting in the way of
responsible conversation and reform.
– When asked how he addresses racist divide in NYS, “I just tell people what
I think,” answered the Gov. He claimed to make decisions and recommendations
based on facts without political bias.
– Gov named police violence against peaceful protesters a criminal action.
– On a note that Burglary 2 only pertains to personal dwellings, Gov said to
“charge appropriately.” DeRosa clarified that statute allows for
Burglary 2 to be charged and bail set on looters

Study finds scarcity of behavioral health providers will become more pronounced.


COVID-19 Has Exposed Flaws in US Mental Health System
Modern Healthcare reports, “As COVID-19 and nationwide protests bring demand for behavioral health services even higher, the nation’s scarcity of providers likely will become more pronounced.” And although some providers “have been working to integrate behavioral and medical health for a few years, there are a host of organizational, cultural and financial burdens to overcome, many of which are highlighted in a RAND Corp. study published June 1 in the Annals of Internal Medicine.” Patrice A. Harris, M.D., M.A., president of the American Medical Association, said: “The COVID-19 pandemic has exposed and magnified the flaws in our mental health system and the true burden of mental illness in our country. Behavioral health care integration can help save lives and is a proven model that has many advantages over a more divided one.”


Scientists Question Data in Two Prominent Medical Journals
The New York Times (6/2) reports “a group of scientists has questioned the data used in studies in two prominent medical journals.” At issue are a study published in the New England Journal of Medicine on May 1 concerning the impact of blood pressure drugs on patients with coronavirus and a study published in The Lancet on May 22 concerning the use of hydroxychloroquine and chloroquine to treat patients with coronavirus. The studies share some of the same authors and both relied on the same database, which the group of scientists say may not be reliable.

The AP (6/2) reports that on Tuesday, the New England Journal of Medicine issued an “expression of concern” about the study it published that “suggested widely used blood pressure medicines were not raising the risk of death for people with COVID-19.” In its communication, the journal expressed concerns about the reliability of the database. Similarly, The Lancet issued an expression of concern about the study it published that “tied the malaria drugs hydroxychloroquine and chloroquine to a higher risk of death in hospitalized patients with the virus.” The Lancet said questions have been raised about the data used in the study.


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IM Resident Takes Time to Deliver Wellness Bags to Healthcare Workers
Internal Medicine intern Gayatri Malhotra-Gupta, daughter of MSSNY member Dr. Sandhya Malhotra (Queens), delivers wellness bags to health care workers across the city. Dr. Malhotra-Gupta is part of the Global Physicians Network Foundation, along with two others (GPNF members has delivered more than 500 bags to 12 hospitals). “I think that the sense of community in New York is what’s going to help us through this really tough time together,” she said.


Americans’ Top 5 COVID-19 Stressors
The most common stressor related to the pandemic for the U.S. public is reading or hearing about the severity and contagiousness of COVID-19, a new survey shows.

The survey was conducted April 7-9 and includes responses from 1,015 U.S. residents 18 years or older. Survey results were published in the Journal of General Internal Medicine.

Five top stressors related to the COVID-19 pandemic:
Note: Respondents could select multiple stressors.

  1. Reading or hearing about the severity and contagiousness of COVID-19: 96.6 percent
  2. Uncertainty about length of quarantine and social-distancing requirements: 88.3 percent
  3. Changes to social routines, such as spending time with friends and loved ones: 83.7 percent
  4. Changes to daily personal care routines, such as cooking, cleaning, exercise, and relaxation: 80.1 percent
  5. Cancellation of planned or scheduled celebrations, entertainment, vacations, or trips: 68.7 percent

Mental Wellness Has Crept Our Daily Discourse in Ways That It Never Has Before
While one in five adults has a clinically significant mental or substance use disorder, behavioral health integration into U.S. physician practices is still uncommon. Findings from a new joint study by the RAND Corp., the American Medical Association (AMA) shed light on what physicians say are the barriers to adoption.

The COVID-19 pandemic has exposed and magnified the flaws in our mental health system and the true burden of mental illness in our country.

One potential solution to the crisis is integrating behavioral health into medical care. As such, determining barriers to adoption is critical. Published today in the Annals of Internal Medicine, the new RAND-AMA study sheds important insight on motivations and barriers influencing physician practices’ implementation of behavioral health integration.


Obesity May Greatly Increase Odds of Children Getting Severe COVID-19
“If a child is infected with the new coronavirus,” having obesity “appears to greatly raise the odds for developing a severe form of COVID-19, a new study finds.” According to the research, “eleven (22%) of the 50 kids” had obesity, “and six of the nine children who required a ventilator” had obesity. The findings were published in JAMA Pediatrics.


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People of Color Have Been Disproportionately Affected By COVID-19

  1. About 26 percent of COVID-19 patients in the U.S. have been blackwhile white people account for 52.2 percent and Asian people account for 4.6 percent, according to CDC data updated June 1. The data is based on 718,254 COVID-19 cases in which race was specified. According to U.S. Census estimates from 2019, white people account for 76.5 percent of the nation’s population, while black individuals account for 13.4 percent and Asian people account for 5.9 percent.
  2. Nationwide, 26 percent of Latino adults said they know someone who has died from COVID-19, compared to just 10 percent of white adults, according to an ABC News-Ipsos survey published May 22. In Maryland, Virginia and Washington, D.C., Latinos represent about 10 percent of the population but account for one-third of cases, according to an analysis by The Washington Post.  (Becker’s Hospital Review, June 2)

Providers Want More Telehealth Flexibility and Higher CMS Payments
Rather than stopping telehealth’s momentum when the COVID-19 pandemic ends, provider groups want CMS to press forward by allowing more providers to take part in virtual care and boosting reimbursements for telehealth services. In their comments on CMS’ emergency changes to the Medicare program, provider groups praised the agency for its unprecedented extension of telehealth benefits during the COVID-19 pandemic. But they argued that the federal government should make permanent changes following the tectonic shift in telehealth during the past few months.

“It is imperative that the progress that has been made since March continue when the (public health emergency) ends,” the Association of American Medical Colleges said.

AAMC asked the agency to extend the telehealth flexibilities and waivers for one year beyond the end of the public health emergency to give Congress and federal regulators time to act. Public officials across the board support the long-term expansion of telehealth services, so it’s likely a matter of when, not if the changes will be made permanent.

Hospitals, medical groups and clinicians also want CMS to allow more providers to deliver higher levels of telehealth services to beneficiaries. For instance, there has been an increase in the number of inpatient interprofessional consultations during the COVID-19 pandemic, but CMS limits how often they can occur. Hospitals want the agency to lift the restrictions so that they can respond quickly to the healthcare needs COVID-19 patients without putting other patients, or their finances, at-risk.

Likewise, CMS has said that telehealth visits cannot replace in-person or home health visits under Medicare’s home health benefit, a restriction that’s made it more difficult for providers to deliver care to worried seniors.

“We have heard of instances where patients are refusing in-home care out of fear of contracting COVID-19. In these instances, telehealth may be the only possible avenue to access the patient and provide them with the healthcare they require,” the American Association of Nurse Practitioners said.

Provider groups are asking for increased reimbursement for telephone-only telehealth services too. CMS temporarily approved payment for telephone-only evaluation and management, or E/M, services in March. But providers say the reimbursements are too low because they don’t reflect the level of services that clinicians are delivering during the pandemic. Some patients are unwilling or unable to use video-based telehealth services, especially beneficiaries that are older and poorer.

The National Association of ACOs and eight other groups representing providers in accountable care organizations asked CMS to take several actions in response to the COVID-19 pandemic. They want the agency to give ACOs the option to give up some of their shared savings in exchange for protection against financial losses and extend the deadline for the Medicare Shared Saving Program. ACO providers also want CMS to overturn its decision to cancel the 2021 MSSP application cycle and to make ACO shared savings and Advanced APM bonus payments as soon as possible, according to a joint letter. (Modern Healthcare April 10)


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